Across the health sector there is increased recognition of the ethical significance of interventions that constrain or coerce. Much of the recent interest stems from debates in public health over the use of quarantines and active monitoring in response to epidemics, as well as the manipulation of information in the service of health promotion (or ‘nudges’). But perhaps the area in which these issues remain most pressing is mental health, where the spectre of involuntary treatment has always loomed large. Indeed, (...) there are good reasons to think of psychiatry as ethically exceptional given its broader role as social and legal arbiter. This is compounded by the fact that mental health treatment has other special features that can serve as potential entry points for more subtle forms of pressure and influence. These include the relative cognitive and emotional vulnerability of patients, the highly confidential information involved, and the importance of the therapeutic relationship. Thus the field of mental health needs to grapple with a range of closely related issues concerning the ethics of influence. In this chapter I explore several, with a primary focus on clinical concerns, although implications for research ethics are also touched on. Discussion of treatment pressure has traditionally focused on ‘coercion,’ or, very roughly, the use of threats or force to get someone to do something they otherwise would not. Here I follow suit, beginning with discussion of its conceptual standing alongside other categories of influence, including manipulation and persuasion. As it stands, there is nothing close to a consensus on these matters. But a relatively broad understanding of coercion is available and can be useful for ethical deliberation. Or so I suggest here. Interestingly enough, there is also a growing body of empirical literature on coercion in psychiatry, including research on the use of coercive measures such as hospitalization, physical restraint, and forced medication, as well as the construct of ‘perceived coercion,’ which tracks patients’ experiences of treatment pressure. I briefly describe several key findings and their relation to recent recommendations to reduce coercion. Building on all of this, I then take up the normative questions directly, by way of evaluating a recently proposed framework for the ethical analysis of influence. (shrink)

The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast between categorical and dimensional models, with (...) renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis. (shrink)

Julie Houts has cultivated a devoted following as "Instagram's favourite illustrator" (Vogue) by lampooning the conflicting messages and images women consume and share with the world every day. A collection of darkly comic illustrated essays, Literally Me chronicles the daily exploits of "slightly antisocial heroines" (Refinery29) in vivid, excruciatingly funny detail, including: -The beauty routine of a deranged bride who aspires to be "truly without flaws" on her wedding day -What happens when Kylie Jenner has an existential crisis and (...) can no longer "step out" -A journey to Coachella by the Four Horsewomen of the Apocalypse -The true dating confessions of a fembot -The terrifying description for Alice Staunch's book How to be the Perfect Feminist -The diary of Fiddle Ficus, a tree that lives inside a CÉLINE store, and much more. Literally Me marks the launch of a brilliant new social satirist. Julie's singular voice and beautiful illustrations reveal the truth about the absurdity of life in the social media age: the line between becoming a total `Girlboss' and a 21st-century American Psycho is razor-thin."--Dust jacket. (shrink)

In this close analysis of Immanuel Kant’s aesthetics in his Critique of Judgment, Dr. Julie N. Books, explains why Kant fails to provide a convincing basis for his desired necessity and universality of our aesthetic judgments about beauty. Drawing upon her extensive background in the visual arts, art history, and philosophy, Dr. Books provides a unique discussion of Kant’s supersensible, illuminating how it cannot justify his a priori nature of our aesthetic judgments about beauty. She uses examples from the (...) history of art, including paintings by Michelangelo, Caravaggio, Rubens, and Constable, to support her views. This book will make a significant addition to courses on the philosophy of Kant, aesthetics, philosophy of art, metaphysics, the history of Western philosophy, ethics, psychology, and art history. (shrink)

"J’étais morte, mais pas enterrée, et c’est la philosophie qui m’a ramenée à la vie. Comme une mère, elle m’a non seulement donné la vie en me donnant accès à ma vie intérieure par l’élargissement de ma conscience, mais elle m’a également appris à vivre, c’est-à-dire comment agir au mieux dans la vie quotidienne. Tout au long de ses réflexions et de son témoignage, l’auteure affirme haut et fort que la philosophie peut sauver des vies, car elle rend possibles la (...) conversion du regard et la prise en charge de sa propre liberté."--Résumé de l'éditeur. (shrink)

In recent years there has been increased recognition of the global burden of mental disorders, which in turn has led to the expansion of preventive initiatives at the community and population levels. The application of such public health approaches to mental health raises a number of important ethical questions. The aim of this collection is to address these newly emerging issues, with special attention to the principle of prevention and the distinctive ethical challenges in mental health. The collection brings together (...) an interdisciplinary group of experts in bioethics, mental health, public health, and global health. (shrink)

Self-deception may be a natural consequence of active goal operation instead of an adaptation for negotiating the social world. We argue that because autonomous goal programs likely drove human judgment and behavior prior to evolution of a central executive or “self,” these goal programs can operate independently to attain their desired end states and thereby produce outcomes that “deceive” the individual.

The importance of voice and myth of the 'voiceless' -- Community pespective, experience and voice -- Glebelands Hostel, Durban -- Xolobeni, Eastern Cape -- Thembelihle community, Johannesburg -- Dominant media telling and elite communication -- The polical economy of dominant power and storytelling -- media diversity and voices(s) -- Rethinking media freedom, revamping media ethics -- Planting the seeds of change.

This book offers a radical alternative to the positive orientation of popular psychology. This positive orientation has been criticized numerous times. However, there has yet to be a coherent alternative proposed. We all know today that life hurts and that there is no ultimate remedy to this pain. The positive approach feels to us as dishonest and irrelevant. We require a new, more negative, perspective and practice, one that is honest and does not pretend to offer an escape from the (...) agonies of the world. This book offers in three main chapters a ‘depressive realist’ perspective that explores the structural role of negativity and tragedy in relation to the individual psyche, society, and nature. It explores the possibility of ‘negative psychoanalysis’ which takes into account the tragedy of human existence instead of adopting escapist positions. (shrink)

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013–2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN’s 2030 Agenda for Sustainable Development (...) (United Nations, 2015). The WHO’s Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN’s SDGs include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (shrink)

This article discusses what is involved in having full moral status, as opposed to a lesser degree of moral status and surveys different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

Despite widespread recognition that psychiatry would be better served by a classificatory system based on etiology rather than mere description, it goes without saying that much of the necessary work is yet to be done. In this chapter I take up the increasingly important question of how mechanistic explanation fits into the larger effort to build a scientifically sound etiological and nosological framework. I sketch a rough picture of what mechanistic explanation should look like in the context of psychiatric research, (...) with a focus on several potential challenges posed by the special features of many psychiatric conditions. These include the role of social and environmental factors, the relatively transient nature of symptoms, the presumably complex organization of underlying systems, and the likelihood that many disorders are the product of nonstandard development. I suggest that these explanatory challenges can be met with a sufficiently broad notion of mechanism, one that allows for something less than the flawless execution of internal operations, appeals to the influence of contextual factors, and attends to organizational relations both within the mechanism itself and across the wider cognitive system. (shrink)

Nunez's description of the brain as a medium capable of wave propagation has provided some fundamental insights into its dynamics. This approach soon reaches the descriptive limits of the brain as a physical system, however. We point out some biological constraints which differentiate the brain from physical systems and we elaborate on its consequences for future research.

Given that the concept of coercion remains a central concern for bioethics, Quigley's (Monash Bioethics Rev 32:141–158, 2014) recent article provides a helpful analysis of its frequent misapplication in debates over the use of ‘nudges’. In this commentary I present a generally sympathetic response to Quigley’s argument while also raising several issues that are important for the larger debates about nudges and coercion. I focus on several closely related topics, including the definition of coercion, the role of empirical research, and (...) the normative concerns at the core of these disputes. I suggest that while a degree of precision is certainly required when deploying the relevant concepts, perhaps informed by empirical data, we need to continue to push these debates towards more pressing normative considerations. (shrink)

La defense d'un profond humanisme dont les racines puisent dans la Renaissance ainsi que le souci permanent d'une pedagogie exemplaire ont guide Genevieve Giudicelli-Delage durant toute sa carriere. Professeur emerite de l'Universite Paris 1 Pantheon-Sorbonne, ou elle a notamment dirige pendant de nombreuses annees le DEA devenu Master II de droit penal et politique criminelle en Europe, redactrice en chef de la Revue de science criminelle et de droit penal compare pour les editions Dalloz, presidente de l'Association de recherches penales (...) europeennes (ARPE), directrice de l'Ecole du Centre Ouest des avocats a Poitiers, Genevieve Giudicelli-Delage n'a cesse d'oeuvrer pour un depassement des frontieres disciplinaires et geographiques dans l'approche du phenomene criminel, ce dont temoignent en particulier son engagement en faveur du developpement du droit compare et son attachement a repousser les lignes d'horizons juridiques. Son regard sur le droit penal a profondement marque des generations d'etudiants et de doctorants. Par ses recherches individuelles, comme par les recherches collectives qu'elle mene admirablement, elle a egalement contribue au rayonnement doctrinal du droit penal en general, et de certaines de ses disciplines telles que le droit penal des affaires, le droit international penal, le droit penal europeen ou la procedure penale. C'est donc au chercheur comme au pedagogue que nous avons souhaite rendre hommage par ces Melanges regroupant une soixantaine d'auteurs, anciens eleves/collegues/amis, universitaires et/ou praticiens reunis autour du theme Humanisme et justice, que le Professeur Giudicelli-Delage a, par un soin constant, nourri et questionne durant toutes ses annees d'exercice. (shrink)

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific (...) to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy. (shrink)

In this chapter we outline ethical issues raised by the application of public health approaches to the field of mental health. We first set out some of the basics of public health ethics that are particularly relevant to mental health, with special attention to the ongoing debate over the traditional presumption of non-infringement, increased recognition of the social determinants of health, and the concept of prevention. Then we turn to the moral particularities of mental health, focusing on questions concerning coercion (...) and treatment pressure, personal identity and sociocultural factors (including stigma), and unresolved conceptual and methodological issues in psychiatry that complicate its extension into the domain of public health. (shrink)

This chapter examines the core explanatory strategies of cognitive science and their application to the study of psychopathology. In addition to providing a taxonomy of different strategies, we illustrate their application, with special attention to Autism Spectrum Disorder and Major Depressive Disorder. We conclude by considering two challenges to the prospects of a developed cognitive science of psychopathology.

Où en sont aujourd'hui les études au sujet de Maître Eckhart (1260-1327), frère prêcheur et maître en théologie de l'université de Paris, dont plusieurs propositions ont été condamnées par le pape Jean XXII dans la bulle In agro dominico? De la variété et de la richesse des directions de recherche actuelles, ce volume en propose, conformément à l'esprit de la collection, une sélection. Quatre perspectives principales se dégagent. La première concerne les questions métaphysiques et théologiques majeures - Dieu, l'Un, la (...) Trinité, les transcendantaux - ainsi que la théorie de l'intellect. La deuxième regroupe les questions spirituelles, morales et anthropologiques soulevées par la réflexion eckhartienne. Une troisième s'intéresse aux auteurs aux-quels les textes d'Eckhart ouvrent, que ces auteurs précèdent ou suivent chronologiquement le maître thuringien : Plotin, Maïmonide, le Liber de causis et l'idéalisme allemand, Heidegger, Derrida ou encore les études comparatistes de Shizuteru Ueda avec le bouddhisme zen. Une quatrième manière de lire ce recueil consiste à suivre la distinction et la complémentarité de oeuvre latine et de oeuvre allemande de Maître Eckhart avec les différents problèmes herméneutiques et doctrinaux qu'elles posent. Que chaque lecteur puisse trouver à son gré, à travers les différences d'approches et de voix, ses propres chemins pour entrer dans oeuvre de Maître Eckhart. (shrink)

The topic of coercion has a long and contentious history in both political philosophy and medical ethics. This substantial literature centers on two fundamental questions: What is coercion? And when is it justified? In the context of psychiatry there has been a recent upsurge of interest in coercion, with particular focus on the latter question. For example, a number of research groups have been investigating the relationship between coercion and clinical outcomes. But of course such research relies heavily on assumptions (...) about the former question, that of the concept of coercion. Coercion is often tracked in these studies by various measures of “perceived coercion,” in response to the recognition that involuntary legal status is a poor gauge of the presence of coercion. A result of this approach is that empirical research has started to provide an interesting picture of a variety of coercive pressures and experiences. And these newly emerging findings, in turn, underscore the need for further conceptual analysis. The aim of this paper, then, is to draw out provisional implications for philosophical debates about coercion from recent research in psychiatry. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP across the (...) entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

Recent cognitive models of delusions have attempted to explain why delusions are commonly circumscribed, in that they tend to center on isolated beliefs, and incorrigible, as they often persist in the face of countervailing evidence. In this effort, the suggestion has been made that ‘modularity’ – a concept originating in seminal accounts of the architecture of perceptual and cognitive processes – may help explain delusions. The aim of this paper is to take up this suggestion, critically evaluating the applicability of (...) modularity and its attendant features to the explanation of delusions. The conclusion presented here is that although a modular explanation of delusions may be relatively consistent with models that implicate dysfunctional cognitive components such as motor control and ‘theory of mind’ (ToM) systems, ultimately the application of modularity to delusions conflicts with traditional understandings of cognitive architecture and does not help provide satisfactory or sufficient explanations of delusional symptomatology. (shrink)

Narcissism continues to be an important topic of research, with a great deal of ongoing empirical work in social and personality psychology. But there are theoretical issues that have received less attention recently, including those that relate to the foundational theories of the psychoanalytic tradition. As the first step in a larger project of reevaluation, this article offers a critical review of Freud and Heinz Kohut’s theories of narcissism. Centered on a theoretical reconstruction, it clarifies several significant – and often (...) underspecified – features of each account. I also explore the continuities and discontinuities between these two closely related systems. Most notably, both Freud and Kohut lacked fully developed accounts of primary narcissism and the relevant instinctual drives. At the same time, Kohut’s theory expanded upon Freud’s in innovative ways, particularly with its emphasis on a secondary line of narcissistic development that has positive, transformative features. In the final section, however, I introduce a speculative reading that describes theoretical prefigurations of these features in elements of Freud’s structural theory. (shrink)

Broadly speaking, an entity has moral status if and only if it or its interest matters morally for its own sake. Some philosophers, who think of moral status in terms of duties and rights owed to an entity, allow that moral status can come in degrees, with only some beings having status of the highest degree – that is, full moral status (FMS). We critically review the competing accounts of what qualifies one for FMS. Some accounts demand cognitive sophistication, which (...) excludes many children, while others are inclusive of children but fail by (a) putting children morally on a par with most animals (experiencing subject of a life), (b) invoking criteria of dubious moral relevance (potentiality, membership in a biological species), or (c) not securing impartial moral status (special relationships). We end with our own account, which attempts to rectify such problems, addressing specifically the moral status of children. (shrink)

This book examines the contributions of seventeenth- and eighteenth-century French women philosophers and intellectuals to moralist writing. Moralist writing, a distinctively French genre, draws on philosophical and literary traditions extending back to classical antiquity. Closely connected to salon culture and influenced by Augustinianism, it engages social and political questions, epistemology, moral psychology, and virtue ethics. The first half of the book analyzes women’s use of moralist forms such as the essay, maxim, and “character” or portrait to explore classical topics: self-knowledge (...) and knowledge of the self, the ethics and obligations of friendship, the relation of the passions to happiness. The second half focuses on topics that relate directly to women’s lifeworld: the critique of the institution of marriage, the status of older women, and the question of women’s nature and capabilities. Each chapter traces the evolution of women’s moralist thought from the late seventeenth century to the Enlightenment and the decades immediately following the French Revolution, a period of tremendous change in the horizon of possibilities for women as public figures and intellectuals. (shrink)

Reveals how our survival depends on embracing complexity consciousness and relating to nature and all life as sacred.