The problem of addiction to psychoactive substances, such as alcohol and other drugs, has been addressed in psychiatry traditionally from the perspective of a mechanistic-reductionist epistemological model, whose main focus in clinical care is to avoid or suppress the use of these substances, rather than understanding the meaning of a treatment and the meaning of the alterations of consciousness produced by these addictive substances. This paper attempts to contribute towards overcoming this epistemological perspective from the perspective of phenomenological psychopathology. In (...) the first part of the article, the main characteristics of phenomenology and its incorporation into the field of mental health will be presented. Then the issue of addiction will be analysed from two ways of understanding it: the mechanistic-reductionist model and the phenomenological dialectical model. Finally, the pragmatic consequences of the dialectical perspective of phenomenology, called Dialectical Phenomenology (DPh), which seeks to enrich the diagnostic process in the mental health clinic, allowing scientific diagnoses to approach the complexities of clinical reality, will be presented. (shrink)

The paper starts by identifying dynamic stabilization as a defining feature of modern societies. This term refers to the fact that such a society requires growth, augmentation and high rates of innovation in order to reproduce its structure and to preserve the socioeconomic and political status quo. The subsequent sections explore the mechanisms and consequences of this mode of social reproduction, proceeding in three steps. First, three key aspects or ‘motors’ of dynamization are identified, namely the mechanisms of appropriation, acceleration (...) and activation. In the second step, we argue that this ‘Triple-A-Mode’ of dynamic stabilization necessarily entails a logic of incessant escalation which eventually threatens to undermine itself, leading to a multifaceted process of destabilization. Unmistakable signs of this can be seen in the current financial, democratic, ecological and psychosocial crises. The third and last part briefly and very preliminarily sketches out the possible contours of a ‘post-growth’ society which could move beyond the current mode of dynamic stabilization. (shrink)

Health care and public health programs increasingly rely on, and often even require, organizational action, which is facilitated, if not dependent on, trust. Case examples in this essay highlight trust, trustworthiness, and distrust in public and private organizations, providing insights into how trust in health‐related organizations can be betrayed, earned, and justified and into the consequences of organizational trust and trustworthiness for the health of individuals and communities. These examples demonstrate the need for holistic assessments of trust in clinicians and (...) trust in organizations and for organizations, public health, and the medical profession to address questions concerning their own trustworthiness. Normative and empirical assessments of trust and trustworthiness that capture the experiences of those treated within the walls of a health care organization, as well as the care of those outside, will contribute to more trustworthy systems of care. (shrink)

usually brings to mind images of picket signs held by laborers striking for better wages and benefits. Collective action, however, need not be limited to the withholding of labor. Nor need it involve only the working or middle classes, as airline pilots have recently demonstrated. Finally, collective action need not have as its only purpose the self-interest of the group. Collective action does, however, always involve a joining together of individuals united by common goals or interests in order to consolidate (...) power for the purpose of negotiating with another group or entity. Examples of collective action obviously include striking, other withholding labor actions, and slowdowns, but can also include many other activities. for example, have been threatened or used by house officer organizations in the past. In a paper strike, patient care continues but without documentation, and thus, the institution suffers from absent or delayed financial remuneration. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 13-16, December 2011.

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including (...) residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

Se plantea la pregunta de si efectivamente el delirio es idéntico a la irracionalidad,como se ha postulado desde la Ilustración. Se hace una breve síntesis de la forma como ha sido concebida la locura desde la Antigüedad Clásica hasta nuestros días. De esta revisión es importante destacar cómo el carácter absoluto del "ego cogito" de Descartes hace impensable la locura como posibilidad humana y abre el camino a su conceptualización como enemiga de la razón, vale decir, como irracionalidad. Como argumento (...) en favor a la tesis contraria al racionalismo, se menciona el sentido biográfico de la locura, ejemplificado en figuras literarias, como Edipo, Ofelia y Don Quijote. Lo común a todas estas vidas que terminan en la locura es un afán desmedido por permanecer en lo ilusorio, en el autoocultamiento, de tal modo que cuando una circunstancia los obliga a ver su propia verdad transforman "una realidad imposible en una posible irrealidad", vale decir, enloquecen. Ahora bien, tanto en las figuras literarias como en los esquizofrénicos de la práctica diaria, encontramos que el desborde se produce no hacia lo irracional y dionisíaco, sino exactamente en la dirección opuesta: hacia lo apolíneo y racional. La tesis de que en la base de la locura habría un exceso y no una falta de racionalidad, tratamos de demostrarla a través del análisis de dos casos paradigmáticos, en los que aparece tematizada la entrega al dominio absoluto de la razón como capacidad analítica y sintética y a la razón como luz que saca a los objetos cognoscibles desde las sombras. El delirio sería, entonces, el producto de un imperio sin contrapeso de la razón,entendida ésta ya sea como "ratio" o como "logos". (shrink)

Angesichts der gegenwärtigen ökonomischen, ökologischen und sozialen Krisen zeichnet sich ab, dass die Wachstumsdynamik moderner Gesellschaften nicht mehr stabilisierend wirkt, sondern selbst zum Krisentreiber geworden ist. In diesem Band diskutieren die Philosophin Nancy Fraser und die Soziologen Klaus Dörre, Stephan Lessenich und Hartmut Rosa, was dies für die Gegenwart und die Zukunft der Demokratie bedeutet und welche Konzeptionen und Wege hin zu einer demokratischen Transformation vorstellbar sind. Aus ihrer demokratietheoretischen Perspektive intervenieren Viviana Asara, Banu Bargu, Ingolfur Blühdorn, Robin Celikates, Lisa (...) Herzog, Brian Milstein, Michelle Williams und Christos Zografos. (shrink)

Though trust is essential to relationships between people, including that between patient and clinician, its role in organizational ethics is largely unexplored. Nonetheless, trust is also ideally a part of the relationship between patient and health care institution, both because it is desirable in and of itself, and because it makes for better medical care.

Volume 20, Issue 7, July 2020, Page 6-8.

This paper gives a simple method for providing categorial brands of feature-based unification grammars with a model-theoretic semantics. The key idea is to apply the paradigm of fibred semantics (or layered logics, see Gabbay (1990)) in order to combine the two components of a feature-based grammar logic. We demonstrate the method for the augmentation of Lambek categorial grammar with Kasper/Rounds-style feature logic. These are combined by replacing (or annotating) atomic formulas of the first logic, i.e. the basic syntactic types, by (...) formulas of the second. Modelling such a combined logic is less trivial than one might expect. The direct application of the fibred semantics method where a combined atomic formula like np (num: sg & pers: 3rd) denotes those strings which have the indicated property and the categorial operators denote the usual left- and right-residuals of these string sets, does not match the intuitive, unification-based proof theory. Unification implements a global bookkeeping with respect to a proof whereas the direct fibring method restricts its view to the atoms of the grammar logic. The solution is to interpret the (embedded) feature terms as global feature constraints while maintaining the same kind of fibred structures. For this adjusted semantics, the anticipated proof system is sound and complete. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 62-63, August 2011.

ZusammenfassungAnhand von Alexander Mitscherlichs Plädoyers für eine Psychosomatische Medizin werden dessen epistemologische Neupositionierungen in den 1940er, 1950er und 1960er Jahren untersucht. Sie eröffnen den Blick auf die Auseinandersetzung von Psychiatern, Internisten und Psychotherapeuten um valides und handlungsrelevantes Wissen in der Nachkriegszeit. Zentral war für Mitscherlich ein Krankheitsverständnis, das der Subjektivität der Patienten einen festen Platz zuwies. Damit verbunden war eine kontinuierliche Kritik an statistischen Verfahren zur Validierung von Einzelbefunden und Hypothesen. Gezeigt wird, wie anpassungsfähig Mitscherlich mit seiner Kritik an einer (...) naturwissenschaftlich orientierten Methodik in der Medizin war, wenngleich er die ursprüngliche Stoßrichtung trotz aller Wandlungen aufrechterhielt. (shrink)

El artículo esboza una economía política de la pandemia del coronavirus. En línea con Fernand Braudel, la peste es interpretada como un “golpe externo” que remite a estructuras de larga data. Detrás de la pandemia y de la recesión que la sigue se esconde una crisis profunda. Ella es consecuencia de la tenaza económico-ecológica que tiene atrapadas a las sociedades del Norte Global. Esta nueva cesura no puede entenderse sin tener en cuenta el crash financiero de 2007-2009 y el interregno (...) político de los años de poscrisis. Según mi tesis, la pandemia y la recesión que la sigue son efectos repulsivos de una hiperglobalización que ha socavado progresivamente sus propios presupuestos. Sin embargo, no puede hablarse de un determinismo del coronavirus. La pandemia no conducirá espontáneamente a un “Build Back Better”. Un cambio de rumbo de este tipo exige alternativas creíbles y claramente delineadas, y, sobre todo, fuerzas sociales y actores políticos que lleven adelante los cambios. Por tanto, con llamamientos generales a las élites no se logra mucho. En lugar de ello, aquí se sugiere un análisis preciso de la tendencia hacia democracias bonapartistas que bloquean la revolución de sustentabilidad. El artículo explora las dificultades de una sociología pública y se expresa a favor de un nuevo orden institucional caracterizado por la democracia económica y la creación de consejos de transformación. (shrink)

Those who advocate higher out-of-pocket spending, especially high deductibles, to keep health care costs better controlled without losing quality use market language to talk about how people should think about health care. Consumers—that is, patients—should hunt for bargains. Clip coupons. Shop around. Patients need to have more “skin in the game.” Consumer-patients will then choose more carefully and prudently and use less unnecessary health care. Unfailingly, “skin” refers to having money at stake. Usually, those arguing for high deductibles express dismay (...) or frustration that patients do not face the full cost of the health services they receive. Unfortunately, a lack of price transparency, the need to unbundle bundled groups of services to discover total price, and the challenge of validly and reliably measuring and disclosing quality make shopping for health care a challenge for even the savviest patient. Urgency, fear, and sickness that impairs peak cognitive function and other aspects of emotionally laden decision-making, even when “shared” with a physician, add obstacles to coupon clipping and tire kicking. Who has more at stake in health decisions than patients? Whose flesh is literally, not just figuratively, at risk? (shrink)

Volume 19, Issue 12, December 2019, Page 57-60.

The American Journal of Bioethics, Volume 11, Issue 7, Page 1-2, July 2011.

In the ‘ordinary business of life’, everyone makes claims about what there is. For instance, we say things like: ‘There are some beautiful chairs in my favourite furniture shop’. Within the context of philosophical debate, some philosophers also make claims about what there is. For instance, some ontologists claim that there are chairs; other ontologists claim that there are no chairs. What is the relation between ontologists’ philosophical claims about what there is and ordinary claims about what there is? According (...) to Cian Dorr, ontologists’ claims and denials of existence belong to ‘a sort of professional jargon’. Dorr claims, for example, that ‘There are prime numbers between 20 and 30’ can be used superficially or used fundamentally. Ordinary uses of are superficial: we use the sentence to assert a boring, well-known truth. But in the ontology room, is used fundamentally, to assert that numbers are ‘part of the ultimate furniture of reality’: and this is a substantial metaphysical doctrine, not a boring truth. In this paper, we will show that none of Dorr’s arguments for these claims succeeds. (shrink)

This is a symposium on my book, Writing the Book of the World, containing a precis from me, criticisms from Dorr, Fine, and Hirsch, and replies by me.

Cian Dorr (2002) gives an argument for the 1/3 position in Sleeping Beauty. I argue this is based on a mistake about Sleeping Beauty's epistemic position.

According to Cian Dorr, non-cognitivism has the implausible implication that arguments like the following are cases of wishful thinking: If lying is wrong, then the souls of liars will be punished in the afterlife; lying is wrong; therefore, the souls of liars will be punished in the afterlife. Dorr further claims that if non-cognitivism implies that the above argument and similar arguments are cases of wishful thinking, then non-cognitivism remains implausible even if one solves the so-called Frege-Geach problem. (...) Dorr’s claims have faced a number of objections, but I believe that Dorr is on to something. So, after summarizing Dorr’s argument and briefly describing three flaws in what Dorr claims, I shall present a distinct objection to non-cognitivism and use the preceding to show what Dorr’s argument gets right and what it gets wrong. (shrink)