BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping (...) review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

Public officials rely on performance data that are self-reported by organizations to evaluate progress on a wide range of prosocial outcomes. Policies that require public disclosure of performance in health care are thought to enable patients to select high-quality providers, which in turn may spur quality improvements as providers seek to protect their reputation or increase economic returns. Drawing on institutional theory that examines how conflicting institutional pressures influence organizational decisions, we theorize how profit orientation may mediate the response (...) of health care providers to disclosure mandates in a public health crisis. We focus on measures of data quality—completeness and accuracy—in self-reported data on COVID-19 status and outcomes generated by thousands of long-term care facilities. Using pooled regressions and a difference-in-differences style design, we find that overall, for-profit and not-for-profit facilities report similarly complete data but that for-profit facilities report less accurate data than their not-for-profit counterparts. Our results suggest that it may be important to incentivize each dimension of data quality separately to address differential institutional pressures that affect reporting practices. (shrink)

Dans son nouveau livre, Marie-Paule Ha bouleverse les idées reçues sur le rôle des Françaises dans les colonies. Se concentrant sur l’Indochine, Ha affirme que les femmes françaises n’ont pas tracé une ligne de démarcation stricte entre les colonisateurs et les colonisés. Elles ont bien plutôt inventé des façons diverses de vivre aux colonies, en fonction de leur position sociale, de leur privilèges de « race » et de leur accès à l’administration coloniale. Dans l’introduction, M.-P. Ha situe...

This commentary paper examines the issue of contract cheating in higher education, drawing on research and current debate in the field of academic integrity. Media coverage of this issue has reflected significant concerns in the field about students’ use of custom academic writing services, along with sector and national calls for action that would lead to making such essay mills illegal. However, recent studies have revealed the complex nature of contract cheating, with a relatively low proportion of students engaging in (...) outsourcing behaviours involving a third party. This paper focuses on how universities and colleges can respond to this emergent concern, and proposes that institutions extend and establish strategies to embed the values, principles and practices aligned to academic integrity. As part of this endeavour, five areas of consideration are offered for higher education institutions that relate to: determining academic integrity strategy; reviewing institutional policy; understanding students; re-visiting assessment practices; and implications for staff professional development. (shrink)

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the (...) principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career. (shrink)

Therapists and their patients must deal with the negative sequelae of short term mating strategies. Implications for therapy of Gangestad & Simpson's strategic pluralism theory are compared with those of Buss's sexual strategies theory and Eagly's social role theory. Naive theories held by therapists and patients, as well as prevailing societal views, are posited as influential in determining the course and outcome of therapy.

Neurocognitive and genetic approaches have made progress in understanding language-music interaction in the adult brain. Although there is broad agreement that learning processes affect how we represent, comprehend, and produce language and music, there is little understanding of the content and dynamics of the early language-music environment in the first years of life. A developmental-ecological approach sees learning and development as fundamentally embedded in a child’s environment, and thus requires researchers to move outside of the lab to understand what children (...) are seeing, hearing, and doing in their daily lives. In this paper, after first reviewing the limitations of traditional developmental approaches to understanding language-music interaction, we describe how a developmental-ecological approach can not only inform developmental theories of language-music learning, but also address challenges inherent to neurocognitive and genetic approaches. We then make suggestions for how researchers can best use the developmental-ecological approach to understand the similarities, differences, and co-occurrences in early music and language input. (shrink)

This paper intends to sum up the main findings of the European project RoboLaw. In this paper, the authors claim that the European Union should play a pro-active policy role in the regulation of technologies so as to inform the development of technologies with its values and principles. The paper provides an explication of the rationale for analysing of a limited and heterogeneous number of robotics applications. For these applications, the following issues are addressed: whether robotics deserve a special case (...) of regulation; the direct and indirect role ethics can play in regulating technology; the transformations of both vulnerabilities and capabilities, and the effects of liability law in favouring the socially relevant applications. In conclusion, a reflection on the possibility to generalize some of the RoboLaw findings to other technologies is proposed, with respect to liability and ethics. (shrink)

Indirect speech acts—responding “I forgot to wear my watch today” to someone who asked for the time—are ubiquitous in daily conversation, but are understudied in current neurobiological models of language. To comprehend an indirect speech act like this one, listeners must not only decode the lexical-semantic content of the utterance, but also make a pragmatic, bridging inference. This inference allows listeners to derive the speaker’s true, intended meaning—in the above dialog, for example, that the speaker cannot provide the time. In (...) the present work, we address this major gap by asking non-aphasic patients with behavioral variant frontotemporal dementia and brain-damaged controls with amnestic mild cognitive impairment to judge simple question-answer dialogs of the form: “Do you want some cake for dessert?” “I’m on a very strict diet right now,” and relate the results to structural and diffusion MRI. Accuracy and reaction time results demonstrate that subjects with bvFTD, but not MCI, are selectively impaired in indirect relative to direct speech act comprehension, due in part to their social and executive limitations, and performance is related to caregivers’ judgment of communication efficacy. MRI imaging associates the observed impairment in bvFTD to cortical thinning not only in traditional language-associated regions, but also in fronto-parietal regions implicated in social and executive cerebral networks. Finally, diffusion tensor imaging analyses implicate white matter tracts in both dorsal and ventral projection streams, including superior longitudinal fasciculus, frontal aslant, and uncinate fasciculus. These results have strong implications for updated neurobiological models of language, and emphasize a core, language-mediated social disorder in patients with bvFTD. (shrink)

According to I3 Theory, individuals enact aggressive behaviors when (a) instigating triggers are severe, (b) impelling forces are strong, and/or (c) inhibiting forces are weak. Archer's analysis of human sex differences in aggression could be bolstered by a careful analysis of male-female discrepancies in reactivity (or exposure) to instigating triggers, proneness toward impelling forces, and/or proneness toward inhibiting forces.

'When I play with my cat, who knows if I am not a pastime to her more than she is to me?' - Michel de Montaigne. Why do we live with pets? Is there something more to our relationship with them than simply companionship? What is it we look for in our pets and what does this say about us as human beings? In this fascinating book, Erica Fudge explores the nature of this most complex of relationships and the (...) difficulties of knowing what it is that one is living with when one chooses to share a home with an animal. Fudge argues that our capacity for compassion and ability to live alongside others is evident in our relationships with our pets, those paradoxical creatures who give us a sense of comfort and security while simultaneously troubling the categories human and animal. For what is a pet if it isn't a fully-fledged member of the human family? This book proposes that by crossing over these boundaries pets help construct who it is we think we are. Drawing on the works of modern writers, such as J. M. Coetzee, Elizabeth Marshall Thomas and Jacques Derrida, Fudge shows how pets have been used to think with and to undermine our easy conceptions of human, animal and home. Indeed, "Pets" shows our obsession with domestic animals that reveals many of the paradoxes, contra - dictions and ambiguities of life. Living with pets provides thought-provoking perspectives on our notions of possession and mastery, mutuality and cohabitation, love and dominance. We might think of pets as simply happy, loved additions to human homes but as this captivating book reveals perhaps it is the pets that make the home and without pets perhaps we might not be the humans we think we are. For anyone who has ever wondered, like Montaigne, what their cat is thinking, it will be illuminating reading. (shrink)

'When I play with my cat, who knows if I am not a pastime to her more than she is to me?' - Michel de Montaigne. Why do we live with pets? Is there something more to our relationship with them than simply companionship? What is it we look for in our pets and what does this say about us as human beings? In this fascinating book, Erica Fudge explores the nature of this most complex of relationships and the (...) difficulties of knowing what it is that one is living with when one chooses to share a home with an animal. Fudge argues that our capacity for compassion and ability to live alongside others is evident in our relationships with our pets, those paradoxical creatures who give us a sense of comfort and security while simultaneously troubling the categories human and animal. For what is a pet if it isn't a fully-fledged member of the human family? This book proposes that by crossing over these boundaries pets help construct who it is we think we are. Drawing on the works of modern writers, such as J. M. Coetzee, Elizabeth Marshall Thomas and Jacques Derrida, Fudge shows how pets have been used to think with and to undermine our easy conceptions of human, animal and home. Indeed, "Pets" shows our obsession with domestic animals that reveals many of the paradoxes, contra - dictions and ambiguities of life. Living with pets provides thought-provoking perspectives on our notions of possession and mastery, mutuality and cohabitation, love and dominance. We might think of pets as simply happy, loved additions to human homes but as this captivating book reveals perhaps it is the pets that make the home and without pets perhaps we might not be the humans we think we are. For anyone who has ever wondered, like Montaigne, what their cat is thinking, it will be illuminating reading. (shrink)

We have achieved a residue‐level resolution of genetic interaction mapping – a technique that measures how the function of one gene is affected by the alteration of a second gene – by analyzing point mutations. Here, we describe how to interpret point mutant genetic interactions, and outline key applications for the approach, including interrogation of protein interaction interfaces and active sites, and examination of post‐translational modifications. Genetic interaction analysis has proven effective for characterizing cellular processes; however, to date, systematic high‐throughput (...) genetic interaction screens have relied on gene deletions or knockdowns, which limits the resolution of gene function analysis and poses problems for multifunctional genes. Our point mutant approach addresses these issues, and further provides a tool for in vivo structure‐function analysis that complements traditional biophysical methods. We also discuss the potential for genetic interaction mapping of point mutations in human cells and its application to personalized medicine. (shrink)

BackgroundInnovations in technology have contributed to rapid changes in the way that modern biomedical research is carried out. Researchers are increasingly required to endorse adaptive and flexible approaches to accommodate these innovations and comply with ethical, legal and regulatory requirements. This paper explores how Dynamic Consent may provide solutions to address challenges encountered when researchers invite individuals to participate in research and follow them up over time in a continuously changing environment.MethodsAn interdisciplinary workshop jointly organised by the University of Oxford (...) and the COST Action CHIP ME gathered clinicians, researchers, ethicists, lawyers, research participants and patient representatives to discuss experiences of using Dynamic Consent, and how such use may facilitate the conduct of specific research tasks. The data collected during the workshop were analysed using a content analysis approach.ResultsDynamic Consent can provide practical, sustainable and future-proof solutions to challenges related to participant recruitment, the attainment of informed consent, participant retention and consent management, and may bring economic efficiencies.ConclusionsDynamic Consent offers opportunities for ongoing communication between researchers and research participants that can positively impact research. Dynamic Consent supports inter-sector, cross-border approaches and large scale data-sharing. Whilst it is relatively easy to set up and maintain, its implementation will require that researchers re-consider their relationship with research participants and adopt new procedures. (shrink)

We argue against Christopher Meyers’s call for clinical ethicists to participate in deceiving patients, surrogate decision-makers, or family members. While we acknowledge that some forms of deception may be ethically appropriate in highly circumscribed situations, the type of case Meyers describes as involving justifiable deception differs in at least two important ways. First, Meyers fails to distinguish acts of deception based on the critical feature of who is being deceived—patient, surrogate, or family member—and the overarching duty to respect the autonomy (...) of relevant decision-makers to make rationally-informed decisions. Second, Meyers’s analysis relies on an assessment of harm, a value-laden concept which health care professionals and ethicists should not presumptively assess without considering how the patient, surrogate, or family might assess specific harms. (shrink)

A series of structural constitutional arguments lodged in multiple cases against Centers for Medicare and Medicaid Services’ (CMS) authorities to negotiate prescription drug prices via the 2022 Inflation Reduction Act threaten the legitimacy of CMS program and federal agency powers.

The authors interrogate genital examinations as events in which both client and practitioner are `produced' as relational subjects in quite specific ways. This article explores the way one female sex health worker talks about her work as a form of cultural exchange, noting what she requires of her clients and seeks to give of herself. Of particular importance is the way the practitioner produces the client as a social subject amenable to intimate examination, while resisting some traditional means for (...) doing so. The authors use a Foucauldian conceptual framework to signal their departure from feminist analyses which explain such practices in terms of a patriarchal medical system. (shrink)

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as “mental illness,” take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional (...) ecologies in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that “uncivilizes” mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health. (shrink)

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several (...) important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to “re-contextualize” patients, in order that they might be better equipped to make decisions that harmonize with their real lives. (shrink)

An at-home mindful movement practice-identify where you physically hold emotions, interpret your body's unique language, cultivate resilience, dispel emotional blockages, and improve your life with the power of movement.

The decline of empathy among health professional students, highlighted in the literature on health education, is a concern for medical educators. The evidence suggests that empathy decline is likely to stem more from structural problems in the healthcare system rather than from individual deficits of empathy. In this paper, we argue that a focus on direct empathy development is not effective and possibly detrimental to justice-oriented aims. Drawing on critical and narrative theory, we propose an interpersonal approach to (...) enhance empathic capacities that is centered on constructive and transformative interactions which integrates the participatory arts and involves both patients and health professional students. We describe and evaluate a program where patients and students create collaborative, original songs. Interviews and a focus group revealed interactional processes summarized in four themes: reciprocal relationships, interactions in the community, joint goal, and varied collaboration. There was a significant enhancement of positive attitudes about care post-program amongst health professional students. The interpersonal approach may be a preliminary framework for the medical humanities to shift away from a focus on direct empathy development and further towards participatory, co-creative, and justice-oriented approaches to enhance health and thereby empathic capabilities. (shrink)

This book brings together scholars from a variety of epistemological perspectives to explore the multiple ways in which sexuality does indeed matter in the arena of public education.

Using a dataset of corporate philanthropic gifts of $1 million or more, we examine the influence of corporate donors on the performance of recipient non-profit organizations. We find that corporate donors positively influence NPO performance, specifically in the form of higher revenues per employee, program ratios, and fundraising returns. We find little evidence that large foundation or individual donors similarly enhance organizational performance. In additional analysis, we find that large corporate donations matter when the corporation is more likely to have (...) influence over the recipient NPO. These findings suggest that corporate donors provide the monitoring and expertise needed to enhance organizational performance beyond simply providing funding to NPOs. Our results are robust to a two-stage model and propensity score matching to address endogeneity concerns. While prior research has examined the effect of corporate philanthropy on donor organization performance, we contribute to the literature by examining whether corporate philanthropy also improves recipient organization performance. (shrink)

With improved diagnostic capability and accuracy, the fields of medicine, neuroscience, psychiatry, and psychology have benefitted remarkably from the dramatic advancements in neuroimaging technology. Not only can surface and subsurface structures of the brain be mapped with incredible anatomical detail, now neural activity can be imaged across time as the brain responds to different stimuli. These sophisticated techniques have been a vital element in the recent increase in neuroimaging-based research. This increase, while producing new diagnostic techniques and improved treatment mechanisms (...) for neurological disease, has also led to a new dilemma for human subjects researchers: how should incidental findings be managed? An incidental finding is a finding concerning an individual research participant that has potential health or reproductive importance and is discovered in the course of conducting research but is beyond the aims of this study. (shrink)

Objectives To characterize the prevalence and content of pediatric triage policies.Methods We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.Results Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children’s hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared (...) their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.Conclusions While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities. (shrink)

Since its origins in the mid-1980s, DNA profiling has become the most powerful tool for identification in contemporary society. Practitioners have deployed it to determine parentage, verify claims to identity in various civil contexts, identify bodies in wars and mass disasters, and infer the identity of individuals who have left biological traces at crime scenes. Thus DNA profiling can be used to implicate or exonerate individuals from participation in particular social relations and activities; this affords it a growing importance in (...) major social institutions such as the family, the criminal justice system, immigration services, and health services. There are key state, security, civil liberty, personal, and commercial considerations surrounding the reliability and social implications of DNA profiling in establishing the identities of “family members,” “claimants,” “customers,” “suspects,” and “citizens.”Given that DNA profiling is increasingly influential in forensic inquiries, the recently-developed practice in the UK of “familial searching” of DNA databases has the potential to become a significant aspect of investigations. (shrink)

This article contextualizes some of the more specifically focused articles in this Special Issue of ‘Women and Mental Health’ by reviewing general historical and political currents structuring contemporary discussions around questions of models, treatment and provision for women within British mental health services. We highlight some particularities of the current British context (in relation to other national scenes) in terms of the forms and expressions of feminist activity around mental or emotional distress. While not absolute mirrors of each (...) other, resonances between general trends in feminist debates and organizational forms within feminist mental health work give rise to a wide spectrum of sites of intervention. We discuss some of the conditions that gave rise to these forms of (visible) feminist intervention within mental health service provision, focusing particularly on women's counselling and therapy services, and we offer an analysis of the range and conceptual tensions within which such interventions may be situated, including contested perspectives on power and empowerment. We also consider ways in which women's political activity around mental health issues is likely not to be noticed as such, given women's prototypical positions as patients and practitioners. We end by identifying what we see as current challenges for feminist activism around distress and its links with the conditions of women's lives and oppression more generally, not only as instances of more general tensions and challenges within contemporary feminisms, but also as offering an arena of opportunity for broader alliance and coalition-building. (shrink)

In October 2015 the UK enacted legislation to permit the clinical use of two cutting edge germline-altering, IVF-based embryonic techniques: pronuclear transfer and maternal spindle transfer. The aim is to use these techniques to prevent the maternal transmission of serious mitochondrial diseases. Major claims have been made about the quality of the debates that preceded this legislation and the significance of those debates for UK decision-making on other biotechnologies, as well as for other countries considering similar legislation. In this article (...) we conduct a systematic analysis of those UK debates and suggest that claims about their quality are over-stated. We identify, and analyse in detail, ten areas where greater clarity, depth and nuance would have produced sharper understandings of the contributions, limitations and wider social impacts of these mitochondrial interventions. We explore the implications of these additional considerations for the protection of all parties involved, should the techniques transfer to clinical applications; the legitimacy of focussing on short-term gains for individuals over public health considerations, and the maintenance and improvement of public trust in medical biotechnologies. We conclude that a more measured evaluation of the content and quality of the UK debates is important and timely: such a critique provides a clearer understanding of the possible, but specific, contributions of these interventions, both in the UK and elsewhere; also, these additional insights can now inform the emerging processes of implementation, regulation and practice of mitochondrial interventions. (shrink)

While philosophical questions about health and disease have attracted much attention in recent decades, and while opinions are divided on most issues, influential accounts seem to embrace negativism about health, according to which health is the absence of disease. Some subscribe to unrestricted negativism, which claims that negativism applies not only to the concepts of health and disease as used by healthcare professionals but also to the lay concept that underpins everyday thinking. Whether people conceptualize (...) class='Hi'>health in this manner has implications for medical care and public health, and so we set out to examine this claim in two studies. Participants were asked to assess and compare the health states of two people presented in two vignettes. We found that both lay people and medical students conceptualize health as something more than the absence of disease. We argue that our findings highlight a need to rethink unrestricted negativism and indicate a need to rethink the way the debate has traditionally focused on disease. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.2 (2002) 189-191 [Access article in PDF] Listening, Acting, and the Quest for AlternativesA Response to Charland and Bracken Erica Lilleleht The challenge is not to replace one certitude... with another but to cultivate an attention to the conditions under which things become 'evident,'... ceasing to be objects of our attention and therefore seeming fixed, necessary, and unchangeable. (Rabinow on Foucault 1997, p. XIX) (...) I do not know whether it must be said today that the critical task still entails faith in Enlightenment; I continue to think that this task requires work on our limits, that is, a patient labor giving form to our impatience for liberty. (Foucault 1997, p. 319) IN RESPONDING TO MY PAPER, Bracken and Charland raise a number of interesting points. Through discussing Tuke's York Retreat (Charland) and Foucault's "regimes of truth" (Bracken), the character of moral treatment, the value of a Foucauldian analysis, the importance of listening (as well as its limits), and the necessity of taking action are all raised as important issues when considering the history and current status of psychiatry. In my response, I shall focus on the latter two issues, namely, the possibility of listening and the necessity of action. I will make the argument that although action can, and often should, follow listening, having action as its necessary (and immediate) goal brings with it a set of pressures and practices that can render both experiences difficult, if not impossible.First, let me share my understanding of Bracken and Charland's main theses and arguments. For Patrick Bracken, the main purpose of any critique, but particularly a critique of current psychiatric practice, is to present readers with a new way of listening and understanding. It should, to paraphrase Bracken, open things up for deeper analysis. The Foucault he is listening to, then, is a man in whose "hands history becomes philosophy". This transformation is important because as it occurs new "discursive spaces" open up, thereby presenting readers of his work with new voices (e.g., patients, less-than-famous psychiatrists, priests). This incursion of the new does not necessarily, however, invalidate the old. Bracken substantiates this by making the important point that Foucault did not simply reject Enlightenment reason (an old and highly persistent voice), but rather "challenged the idea that we have to choose to be for or against" it. Bracken further points out that listening to these voices, [End Page 189] old or new, is never a completely "clean" practice. In Bracken's words, "there is no neutral, asocial or apolitical vantage point from [which] we can judge the validity of one position over the other." This means that in listening to the "other" (as patient, friend, argument, or psychiatric practice) we must maintain a kind of double consciousness, one in which we attend to this other voice while at the same time being aware that neither of us are speaking from within a neutral, clean space (devoid of political, social, and/or cultural pressures or implications). Maintaining this kind of awareness is difficult for obvious reasons. In mental health practice and for Bracken, however, this difficulty can be worthwhile if it results in formerly silent participants having "their voice heard in debates about service development and the nature of progress."Although I doubt Louis Charland would disagree with the idea that listening is important, he does take the function of critique one step further. Specifically for Charland, critiques of psychiatric practice, past and particularly present, should result in the identification of alternative solutions. Failing to do so can indicate that the critique "borders on a lack of depth." If one extends this assertion about my analysis to Foucault's own work, we find that Charland is not alone. For example, Hoy, in his introduction to his edited Foucault: A Critical Reader (1992), states that "Foucault's continued refusal to specify either a prescription or a prognosis for social illnesses he diagnoses suggests to some readers that genealogy is as unserious and irresponsible as archeology" (p. 7). This point emerges... (shrink)

Epidemiology for and by Indigenous peoples uses quantitative and statistical methods to better document Indigenous health concerns, and is oriented around providing data for use in advocacy to promote Indigenous health equity. This advocacy-oriented, technoscientific work bridges the often distinct social worlds of Indigenous communities, professional public health research, and public policy-making. Using examples from a multisited ethnographic study in three settings, this paper examines the forms of expertise that researcher/practitioners enact as they conduct research that simultaneously (...) harnesses epidemiology’s persuasive power in social worlds like public health and public policy, while also critically challenging legacies of colonialist erasures and misrepresentations of Indigenous health in population statistics. By demonstrating how these continual translations across multiple social worlds enact expertise, this analysis offers a new integration of discussions about both coloniality and expertise within science and technology studies. By focusing on the experiences of technoscientific professionals themselves, this study’s findings also pose new questions for broader STS conversations about how activism is shaping the production of knowledge about health in the twenty-first century. (shrink)

At a colloquium in Bonneval, Lacan criticized Merleau-Ponty for his inability to account for the unconscious. For this reason he concluded the latter’s philosophy was fundamentally incompatible with psychoanalysis. This argument set the tone for scholars who studied the relationship between phenomenology and psychoanalysis. J. B. Pontalis, for example, famously argues that Merleau-Ponty misuses the term unconscious. According to Pontalis, Merleau-Ponty equates the unconscious with a “horizon” of possible experience: a moment of experience that is currently in shadow but can (...) be brought to light.1 Psychoanalytic therapy does, in part, treat the unconscious as a territory that can be colonized by language... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.1 (2001) 39-40 [Access article in PDF] Remembering Feminisms:A Response to the Commentary Erica Burman I am grateful to Gwen Adshead for outlining the broader arguments surrounding feminist critiques of science and their relevance for mental health, particularly in forensic contexts. As she highlights, the debates about the status of accounts of memory hinge upon contested concepts of objectivity and the problem of (...) discursive and provisional (but also necessary) claims to external reality, these being debates to which feminists have actively contributed. There are four additional points I would like to make in response to her comments.Firstly, while I am in general agreement with her presentation of feminist positions in relation to scientific theory and method--and this does largely reflect a current consensus within feminist approaches--it is important not to overstate this consensus. Feminist debates about science, method, and claims to truth are precisely debates. There is no unitary feminist approach. Key arguments between feminists concern, for example, whether to lay claim to (forms of "strong") subjectivity rather than objectivity (see Harding 1986, Hollway 1989, Griffin et al. 1998) or whether to re-work criteria for objectivity to takeaccount of well-known gender biases (Eichler 1988).In my analysis of feminist approaches to "false memory syndrome" (FMS), I wanted to highlight the diversity of feminist positions in order to indicate something of the interconnections between feminist and other political, theoretical, and cultural analyses--ranging from the modernist and empiricist to the postmodernist and constructionist. Hence, while I agree with Adshead that much feminist analysis seems unremarkable since its impact on cultural practice has been so great, I would argue that her account glosses over the many different feminist positions mobilized within the debate around "false/recovered memories." There are widely different views, for example, about the status of evidence/science. Another key area of debate is the role of psychiatric diagnosis between those who subscribe to and those who reject the "terms of art" of psychiatric diagnostic categories.This may sound like a mere effort to attest to the rigor and rationality of feminist scholarship, including feminist re-workings of these terms. However, to come to my second point, there is a material consequence of this closer attention to the conditions for, and reception of, specific feminist analyses. For the debate about "false" or "recovered" memories goes beyond questions about the circulation of the roles of victim versus perpetrator that surround claims of credibility, legitimacy, manipulation, or gullibility. [End Page 39]Thus, Laura Brown and I (1997) and Jan Haaken (1998) have suggested that in order to understand how the current debates surrounding (women's) reported memories could have come about, we need to analyze what has happened through, and what the stakes have been in, the (limited) institutionalization of feminism within models and practices of therapy. This involves attending to the particular forms of feminism that have been included and excluded: For example, how far do therapeutic models accept, and how far do they problematize, the forms and functioning of families? We also need to consider the broader societal response (or backlash?) to a feminized/therapeutic culture, including consequences of the confounding of the therapeutic with the feminized. In particular, Haaken draws attention to the gender essentialism that pervaded second wave (1960s and 1970s) U.S. feminist therapies. This essentialism, she argues, has fueled a failure to interrogate power dynamics (including therapeutic dynamics) between women that make possible displacements of transferential dynamics to an outside party, whether past or present.My third point concerns the ever closer relationship between the therapeutic and legal arenas reflected within the career of FMS. Adshead's reference to a film narrative to highlight competing versions of legal knowledge puts me in mind of how FMS--as a potent cocktail of psychiatric labeling, familial conflict and abuse, and litigation--is the U.S. television courtroom drama writ large. It may be the case that, as Adshead argues, I fail adequately to address the complexity of legal process, with its assumptions about what makes certain accounts more credible or legitimate than others... (shrink)