Human infants begin very early in life to take advantage of multisensory information by extracting the invariant amodal information that is conveyed redundantly by multiple senses. Here we addressed the question as to whether infants can bind multisensory moving stimuli, and whether this occurs even if the motion produced by the stimuli is only illusory. Three- to four-month-old infants were presented with two bimodal pairings: visuo-tactile and audio-visual. Visuo-tactile pairings consisted of apparently vertically moving bars (the Barber Pole illusion) moving (...) in either the same or opposite direction with a concurrent tactile stimulus consisting of strokes given on the infant’s back. Audio-visual pairings consisted of the Barber Pole illusion in its visual and auditory version, the latter giving the impression of a continuous rising or ascending pitch. We found that infants were able to discriminate congruently (same direction) vs. incongruently moving (opposite direction) pairs irrespective of modality (Experiment 1). Importantly, we also found that congruently moving visuo-tactile and audio-visual stimuli were preferred over incongruently moving bimodal stimuli (Experiment 2). Our findings suggest that very young infants are able to extract motion as amodal component and use it to match stimuli that only apparently move in the same direction. (shrink)

The current situation around COVID-19 portrays a threat to us in several ways: It imposes uncertainty, a lack of control and reminds us of our own mortality. People around the world have reacted to these threats in seemingly unrelated ways: From stockpiling yeast and toilet paper to favoring nationalist ideas or endorsing conspiratorial beliefs. According to the General Process Model of Threat and Defense the confrontation with a threat - a discrepant experience - makes humans react with both proximal and (...) distal threat responses. While the proximal response manifests in behavioral inhibition that leads to heightened anxious arousal and vigilance, distal responses seek to lower behavioral inhibition and the associated state of anxiety and vigilance through engaging in distal defenses. In the present research, we propose that the reactions to COVID-19 may represent distal defense strategies to the pandemic (in the form of environmental or group related worldview defenses) and therefore can be explained and forecasted by the model. Thus we hypothesized increased perceived COVID-19 threat perception to lead to a proximal threat response in the form of heightened behavioral inhibition. This, in return, should enhance the use of distal defenses (i.e.: several ingroup biases, system justification and conspiratorial beliefs) overlapping with the reactions observed as a response to COVID-19. This hypothesized mediated effect of increased perceived COVID-19 threat on distal defenses was tested in two pre-registered studies: In Study 1 (N = 358) results showed perceived COVID-19 threat to be related to behavioral inhibition and in turn to be associated with increased distal defenses (i.e., higher entitativity, control restoration motivation, passive party support). In Study 2 (N = 348) we manipulated COVID-19 threat salience and found results suggesting the distal defenses of system justification and conspiratorial beliefs to be mediated by the proximal threat response. The results of the present research hint towards a common mechanism through which the seemingly unrelated reactions to COVID-19 can be explained. The results might help to predict future behavior during the COVID-19 pandemic and design measures to counteract detrimental effects of the pandemic. (shrink)

Drawing on philosophy, law and political science, and on a wealth of practical experience delivering emergency medical services in conflict-ridden settings, Lepora and Goodin untangle the complexities surrounding compromise and complicity.

After initially emerging in China, the coronavirus outbreak has advanced rapidly. The World Health Organization has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and (...) this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians. (shrink)

Boredom, in cinema as well as in our everyday experience, is usually associated with a generalised loss of meaning or interest. Accordingly, boredom is often perceived as that which ought to be avo...

This paper focuses on a specific aspect of political imaginaries: political myth. What are political myths? What role do they play within today commoditised political imaginaries? What are the conditions for setting up a critique of them? We will address these questions, by putting forward a theory of political myth which situates itself between psychoanalysis and political philosophy, in line with the tradition of critical theory that many still associate with the name of the Frankfurt School. We will first discuss (...) the notion of political myth by illustrating the contribution of both disciplines to its understanding and then, through a discussion of the notion of social unconscious, we will apply this analysis to a contemporary example of political myth, that of a clash of civilisations. (shrink)

The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes in the information accumulation models. These are (...) discussed by comparing the traditional and new models of data accumulation. Big data analytics is fast becoming a crucial component for the modelling of transmission—aiding infection control measures and policies—emergency response analyses required during local or international outbreaks. However, the application of big data analytics in infectious diseases is coupled with a number of ethical impacts. Four key areas are discussed in this paper: automation and algorithmic reliance impacting freedom of choice, big data analytics complexity impacting informed consent, reliance on profiling impacting individual and group identities and justice/fair access and increased surveillance and population intervention capabilities impacting behavioural norms and practices. Furthermore, the extension of big data analytics to include information derived from personal devices, such as mobile phones and wearables as part of infectious disease frameworks in the near future and their potential ethical impacts are discussed. Considered together, the need for a constructive and transparent inclusion of ethical questioning in this rapidly evolving field becomes an increasing necessity in order to provide a moral foundation for the societal acceptance and responsible development of the technological advancement. (shrink)

Medical complicity in torture is prohibited by international law and codes of professional ethics. But in the many countries in which torture is common, doctors frequently are expected to assist unethical acts that they are unable to prevent. Sometimes these doctors face a dilemma: they are asked to provide diagnoses or treatments that respond to genuine health needs but that also make further torture more likely or more effective. The duty to avoid complicity in torture then comes into conflict with (...) the doctor’s duty to care for patients. Sometimes the right thing for a doctor to do requires complicity in torture. Whether this is the case depends on: the expected consequences of the doctor’s actions; the wishes of the patient; and the extent of the doctor’s complicity with wrongdoing. Medical associations can support physicians who face this dilemma while maintaining a commitment to clear principles denouncing torture. (shrink)

The Sārasaṅgaha is a Pāli text of XIIth–XIIIth century by the Sinhalese monk Siddhattha Thera. Its themes include the aspiration to become a Buddha, shrines, meditation, theories on rain, wind, gender and more. The main body consists of citations from the Nikāyas, the Jātakas, the Visuddhimagga and above all, from commentarial literature. By analysing the way the Sārasaṅgaha refers to and establishes a dialogue with the quoted works, this paper promotes a new assessment of the cultural and textual tendencies that (...) influenced the development of Buddhist literature especially in the Middle Ages. In particular, the analysis of this text and the quotations of which it is composed reveals the importance of commentarial literature, a literary genre that only recently has attracted the attention of Pāli scholars. (shrink)

We develop an account of how mutually inconsistent models of the same target system can provide coherent information about the system. Our account makes use of ideas from the debate surrounding rob...

This paper is an attempt to think through paranoia’s epistemic and affective features, which pervade both the worldview presented in Senecan tragedy and the inner life of many of its protagonists. Drawing upon recent literary-critical work, I argue that paranoia is temporally and epistemically ambivalent: subjects simultaneously attempt to “get ahead” of a looming cataclysm—looking to the future in an attempt to avert disaster—while inevitably “falling behind,” failing to predict or preempt the future in time to protect themselves. Much of (...) Senecan tragedy plays out paranoia’s future-oriented vigilance on the formal level. Foreshadowing, allusions, and meta-literary flourishes serve to render both readers and characters hyperaware of the earth-shattering horrors to come; however, in doing so, they also reveal that this forward-oriented bracing only serves to dredge up negative affect in advance. By contrast, I argue that Seneca’s Phoenissae thematizes in the character of Oedipus not only paranoia’s future-looking vigilance but also its inherent lagging, the failure to know and act in advance. These elements of slowness, stuckness, and delay open a space for stillness, relief, and intimacy, even within a narrative which hurtles toward cataclysm. (shrink)

In the philosophy of science and epistemology literature, robustness analysis has become an umbrella term that refers to a variety of strategies. One of the main purposes of this paper is to argue that different strategies rely on different criteria for justifications. More specifically, I will claim that: i) robustness analysis differs from de-idealization even though the two concepts have often been conflated in the literature; ii) the comparison of different model frameworks requires different justifications than the comparison of models (...) that differ only for the assumption under test; iii) the replacement of specific assumptions with different ones can encounter specific difficulties in scientific practice. These claims will be supported by a case study in population ecology and a case study in geographical economics. (shrink)

Compromise arises in contexts where irreconcilable claims must nonetheless somehow be resolved. Ordinary people in everyday life, politicians and artists, doctors engaging in research, humanitarian workers providing aid in the midst of war – all of them will have faced situations where compromise appeared to be the only reasonable option, and yet will have felt that there was nevertheless something deeply wrong with it. The aim of this paper is to help make sense of that sentiment. The focus of this (...) paper will be on some aspects of the morality of compromise. Its lynchpin will be to construe compromise as a joint action, in particular, a joint wrongdoing – taking part in, and sharing responsibility for, the doing of things that are wrong from the point of view of those who are the parties to the compromise. The question of ‘what is wrong with compromise?’ is thus recast as a question of ‘what is my part in the wrongs being done as part of the compromise?’ It is tempting to suppose that a compromise serves to dilute personal responsibility, parsing it out among parties to the compromise. Viewing a compromise as a joint action, in contrast, will help us to see how a compromise actually increases responsibility among parties to it. They are now jointly collaborating in some action that each of them sees as wrong, at least in part (albeit in differing parts). Discussions of compromise traditionally prioritize the inter-personal aspect – compromise, in the transitive form of ‘compromising with’ someone. But I argue that the intransitive form – ‘compromise of’ – deserves pride of place. The reason for prioritizing the intransitive ‘compromise of’ is simple: that is what is involved in the intra-personal calculation that must, of necessity, go on inside one's own head in the process of deciding whether or not to agree to a 'compromise with' someone else. In this paper I shall concentrate specifically on compromises of principles, or (more precisely) on ‘matters of principled concern to the compromising parties’. Not only is that the most troubling and morally problematic sort of compromise, it is also logically the most central case. I demonstrate that that is so by shifting the focus from inter-personal compromise to the more fundamental intra-personal process underlying it – the compromise we are involved in when adjudicating among our own conflicting values, to decide whether or not to agree to a compromise of the inter-personal sort. This is the subject of the first section of the paper below. Compromise involves resolving conflicts of principles through mutual concessions that are accepted and undertaken by all parties. Doing so may be on-balance desirable, not only from some larger perspective (of social peace, or whatever) but also from each party's own perspective. Nevertheless, from each party's perspective, compromise necessarily involves interacting with, and sometimes contributing to, wrongdoing. Morally, something is lost, even if more is gained on balance. (shrink)

In this chapter, I will present an empirical conjecture to the effect that some bodily actions are categorically perceived. These are bodily actions such as grasping or reaching for something, which I am going to call motor actions. My conjecture builds on one recently put forward about how the categorical perception of facial expressions of some emotions works. I shall motivate my own conjecture on the basis of both theoretical and empirical considerations, describe how it could be operationalised and what (...) explanatory gain could be obtained from it. (shrink)

This article probes the visual spatial représentations underlying the creative conceptual design of complex objects.

What are the most detailed descriptions under which subjects intend to perform bodily actions? According to Pacherie (2006), these descriptions may be found by looking into motor representations—action representations in the brain that determine the movements to be performed. Specifically, for any motor representation guiding an action, its subject has an M‐intention representing that action in as much detail. I show that some M‐intentions breach the constraints that intentions should meet. I then identify a set of intentions—motor intentions—that represent actions (...) in as much detail as some motor representations while meeting the constraints that intentions should meet. (shrink)

Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need of treatment, doctors can find (...) themselves torn. To accede to the requests of the torturers may entail assisting or condoning terrible acts. But to refuse care to someone in medical need may seem like abandoning a patient and thereby fail to exhibit the beneficence expected of physicians. -/- In this paper, we argue that this dilemma is real and that sometimes the right thing for a doctor to do, overall, is to be complicit in torture. Though complicity in a wrongful act is itself prima facie wrongful, this judgment may be outweighed by other factors. We propose three criteria for analyzing how those factors apply to particular cases of medical complicity in torture. (shrink)

Abstract:In many of his works, Seneca puts a philosophical premium on the ability to see through the deceptive appearances of words and things, identifying the hidden truths that underlie these appearances. In this paper, I turn to a passage that casts doubt upon the efficacy of this interpretive method: Seneca's excursus on flattery in the preface to Book 4a of the Natural Questions. Seneca locates in flattery a pleasure that listeners cannot eradicate by exposing its insincerity. By undermining a hermeneutic (...) practice at the heart of many of his therapeutic methods, Seneca draws out, and invites us to dwell within, a contradiction in his system of thought. Furthermore, in his transition from his discussion of flattery to the scientific content of Nat. 4a, Seneca suggests an alternative approach to treacherous pleasures, which locates therapeutic potential not in the ability to look beyond appearances, but in the "surface-level" experiences of distraction and amazement. (shrink)

Virgilio desarrolló en sus obras el mito de la edad de oro y lo concibió como posible en el tiempo presente. El objetivo de nuestro trabajo es analizar en Eneida las menciones de los gobernantes itálicos de la edad de oro, Saturno y Augusto, como un continuum mítico-histórico. Nos proponemos demostrar que el regreso áureo en Eneida, en consonancia con sus anteriores obras (Ecl. y G.), solo es factible si existe un buen gobernante que cumpla determinadas condiciones, como promover la (...) paz entre guerras (Zetzel, 1997) y dar leyes al pueblo para fomentar la agricultura (Johnston, 1980). (shrink)

Life sciences research is increasingly international and data-intensive. Researchers work in multi-jurisdictional teams or formally established research consortia to exchange data and conduct research using computation of multiple sources and volumes of data at multiple sites and through multiple pathways. Despite the internationalization and data intensification of research, the same ethics review process as applies to single-site studies in one country tends to apply to multi-site studies in multiple countries. Because of the standard requirement for multi-jurisdictional or multi-site ethics review, (...) international research projects are subjected to multiple ethics reviews of the same research protocol. Consequently, the reviews may be redundant and resource-consuming, whilst the opinions delivered by ethics committees may be inconsistent both within and across jurisdictions. In this article, we present findings based on interviews conducted with international experts in research ethics on the topic of et... (shrink)

This study analyses for the first time whether and when moral distress may be related to work-family conflict and burnout. Additionally, this study examines whether resilience and positive refocusing might protect healthcare professionals from the negative effects of moral distress. A total of 153 Italian healthcare professionals completed self-report questionnaires. Simple and moderated mediation models revealed that moral distress was positively related to burnout, directly and indirectly, as mediated by work-family conflict. Highly resilient professionals experienced low work-family conflict, regardless of (...) moral distress levels. Moreover, professionals who frequently used positive refocusing were less vulnerable to burnout following moral distress. (shrink)

: Autonomous driving systems promise important changes for future of transport, primarily through the reduction of road accidents. However, ethical concerns, in particular, two central issues, will be key to their successful development. First, situations of risk that involve inevitable harm to passengers and/or bystanders, in which some individuals must be sacrificed for the benefit of others. Secondly, and identification responsible parties and liabilities in the event of an accident. Our work addresses the first of these ethical problems. We are (...) interested in investigating how humans respond to critical situations and what reactions they consider to be morally right or at least preferable to others. Our experimental approach relies on the trolley dilemma and knowledge gained from previous research on this. More specifically, our main purpose was to test the difference between what human drivers actually decide to do in an emergency situations whilst driving a realistic simulator and the moral choices they make when they pause to consider what they would do in the same situation and to better understand why these choices may differs. Keywords: Self-driving Cars; Trolley Problem; Moral Choices; Moral Responsibility; Virtual Reality Dilemmi morali nelle automobili a guida autonoma Riassunto: I sistemi di guida autonomi promettono importanti cambiamenti per il futuro dei trasporti, principalmente attraverso la riduzione degli incidenti stradali. Tuttavia, vi sono preoccupazioni etiche, in particolare due questioni centrali, fondamentali per il loro sviluppo. In primo luogo, le situazioni di rischio che comportano inevitabili danni ai passeggeri e/o ai pedoni, ovvero situazioni in cui alcune persone devono essere sacrificate a beneficio di altri. In secondo luogo, l’identificazione delle parti responsabili in caso di incidente. Il nostro lavoro affronta il primo di questi problemi etici. Siamo interessati a studiare come gli umani rispondono a situazioni critiche e quali reazioni considerano moralmente giuste o almeno preferibili. Il nostro approccio sperimentale si basa sul trolley problem e sulle conoscenze acquisite da precedenti ricerche su questo ambito. Più specificamente, il nostro scopo principale è quello di testare la differenza tra ciò che i conducenti umani decidono effettivamente di fare in una situazione di emergenza, mentre guidano un simulatore realistico, e le scelte morali che compiono se posti nella stessa situazione e hanno la possibilità di decidere senza limiti di tempo. Lo scopo è inoltre comprendere come e perché queste scelte possono differire. Parole chiave: Automobili a guida autonoma; Trolley problem; Scelte morali; Responsabilità morale, Realtà virtuale. (shrink)

Whereas “professional vision” has been mostly analyzed in apprenticeship and other settings where knowledge is made explicit or reflected upon, I focus on how expertise tacitly plays out in task-oriented interaction among practitioners. The paper considers orientation both to the coworker’s and one’s own expertise in the collaborative accomplishment of airport security work. I show how screeners recruit action from colleagues in largely underspecified ways, based on shared access to the visibility field and expected professional vision. Requesting is tacitly accomplished (...) via “highlighting,” which also accounts for one’s request. Accepting is silently achieved via locomotion, which also serves as a display of understanding. Embodied action is systematically preferred to verbal one. Talk is employed in larger proportions when the domain of scrutiny is not equally accessible to interactants, and when “face-work” is required. (shrink)

Il trascendentalismo della prassi per andare oltre lo scetticismo e oltre ogni pretesa da parte della filosofia di cogliere l'essere nella sua definizione universale e razionale. Una proposta anche storiografica.

I concentrate on difficulties met by Putnam's "internal" or "scientific" realism. They concern his attempt to reconcile pragmatism and realism. My line of argument is the following. A) By exploiting Putnam's argument against the "God's-eye view" and the Brains-in-a-Vat argument , it can be shown that the realism he is defending is either a too strong metaphysical realism or a too weak "residual" position. B) If it is a metaphysical position, then it contradicts Putnam's own views on GEV. C) If (...) it is a "residual" position, then in the context of a Theory of meaning for formal and natural languages, it is not more explicative than some forms of functionalism. The paper ends with an attempt to reconcile Putnam's pragmatism with a functionalist approach to epistemic features of "meaning," for the sake of a reconciliation between pragmatism and realism. (shrink)

The development of artificial agents for social interaction pushes to enrich robots with social skills and knowledge about (local) social norms. One possibility is to distinguish the expressive and the functional orders during a human-robot interaction. The overarching aim of this work is to set a framework to make the artificial agent socially-competent beyond dyadic interaction – interaction in varying multi-party social situations – and beyond individual-based user personalization, thereby enlarging the current conception of “culturally-adaptive”. The core idea is to (...) provide the artificial agent with the capability to handle different kinds of interactional disruptions, and associated recovery strategies, in microsociology. The result is obtained by classifying functional and social disruptions, and by investigating the requirements a robot’s architecture should satisfy to exploit such knowledge. The paper also highlights how this level of competence is achieved by focusing on just three dimensions: (i) social capability, (ii) relational role, and (iii) proximity, leaving aside the further complexity of full-fledged human-human interactions. Without going into technical aspects, End-to-end Data-driven Architectures and Modular Architectures are discussed to evaluate the degree to which they can exploit this new set of social and cultural knowledge. Finally, a list of general requirements for such agents is proposed. (shrink)

Complicity consists in one person contributing to someone else's wrongdoing. But there is a diverse cluster ways of being involved in another’s wrongdoing. For a ‘diagnosis by exclusion’, we first fix the meaning of complicity in contrast to that with which it is often wrongly conflated. Literally cooperating in wrongdoing with others, for instance, is more than complicity. Each and every cooperator is actually a co-principal in the wrong jointly committed; and each bears the full responsibility, shared with all co-principals, (...) for the outcomes of that wrongdoing. Other sorts of involvement with wrongs committed by others amount to less than complicity because the involvement there is causally inert and hence does not actually contribute to the other’s wrongdoing at all. Pardoning wrongs wholly in the past may be like that. So too may be some cases of wilfully overlooking wrongs that others commit under one's very nose. Complicity is a very precise way of being involved in wrongdoing. Complicity consists in a secondary contribution of a causal (or potentially causal) sort to a wrong committed by someone else. That ‘contribution factor’ can be graded on many axes, in terms of how proximate, reversible or frequent the contribution was. Other things being equal, one is more complicit the …. (shrink)

This study conducted on a sample of 295 Dutch and Italian undergraduate and graduate students aims to investigate how psychopathic personality traits (meanness, boldness and disinhibition) may lead to cheating behavior, and to study whether there are correlations between psychopathic traits, motivation, moral disengagement, the perception of seriousness of academic dishonesty and frequency of academic dishonesty to try to better understand what causes students to cheat and engage in dishonest conduct. Results confirmed the key role of psychopathic traits, particularly the (...) disinhibition aspect in predicting academic dishonesty. In addition, it was shown that students’ perceptions of what constitutes academic dishonesty and what does not are also important in predicting the frequency of dishonest behavior. Furthermore, the role of motivation and moral disengagement in predicting and mediating the relationship between traits of psychopathy and academic dishonesty were analyzed through mediation and regression analysis. (shrink)

This essay explores how hormone treatments were used to optimize and normalize individuals under Italian Fascism. It does so by taking the activities of the Biotypological Orthogenetic Institute − an Italian eugenics and endocrinological centre founded by Nicola Pende in 1926 − as the prime example of a version of eugenics, biotypology, which was based on hormone therapies. This essay first demonstrates that Italian Fascist biopolitics was not only concerned with increasing the size of the Italian population, but also with (...) improving its quality. It suggests that under the Italian Fascist regime hormone therapies became eugenic tools of intervention to improve the Italian race. Second, while Pende's institute purportedly enhanced men and women, its activities show the extent to which the ‘techniques of normalization’ pursued by the Fascist regime were both systematic and invasive. (shrink)

RNA modifications have recently emerged as an important regulatory layer of gene expression. The most prevalent and reversible modification on messenger RNA (mRNA), N6‐methyladenosine, regulates most steps of RNA metabolism and its dysregulation has been associated with numerous diseases. Other modifications such as 5‐methylcytosine and N1‐methyladenosine have also been detected on mRNA but their abundance is lower and still debated. Adenosine to inosine RNA editing is widespread on coding and non‐coding RNA and can alter mRNA decoding as well as protect (...) against autoimmune diseases. 2′‐O‐methylation of the ribose and pseudouridine are widespread on ribosomal and transfer RNA and contribute to proper RNA folding and stability. While the understanding of the individual role of RNA modifications has now reached an unprecedented stage, still little is known about their interplay in the control of gene expression. In this review we discuss the examples where such interplay has been observed and speculate that with the progress of mapping technologies more of those will rapidly accumulate. (shrink)

Chris Letheby’s defence of psychedelic therapy hinges on the premise that psychedelic-facilitated insights about the self are in a better epistemic position than those about the external world. In this commentary, I argue that such a claim is not sufficiently defended. More precisely, I argue that one element is underexplored in Letheby’s otherwise compelling picture: namely, that unlike new beliefs about the external world, beliefs about oneself have the capacity to turn into self-fulfilling prophecies. Recognising the psychedelic experience and the (...) subsequent integration process as opportunities not only to apprehend certain facts about the self but also to actively shape and redetermine those facts is key to understanding the epistemic differences between insights patients have about themselves and about the external world. (shrink)