Social Constructivism about the disease concept has generally been taken to ignore the fundamental biological reality underlying diseases, as well as to fall foul of several apparently compelling objections. In this paper, I explain how the metaphysical relation of grounding can be used to tie a socially constructed account of diseases and their classification to their underlying biological and behavioural states. I then generalize the position by disambiguating several varieties of normativism, including a particularly strong ‘placeholder’ version of social constructivism, (...) and showing that the grounding approach is available to each. I go on to provide what I believe to be the first attempt at a full semantics for disease-talk and disagreement, before using the placeholder to demonstrate on that basis that the most troublesome objections to normativism can be avoided even by very strong versions of the position. (shrink)

If mental illnesses are externally constituted, then so are somatic illnesses. Will Davies makes a persuasive case for externalism in psychiatry; as I show here, parallel examples exist in somatic medicine.

The question of whether medical and psychiatric judgements involve a normative or evaluative component has been a source of wide and vehement disagreement. But among those who think such a component is involved, there is considerable further disagreement as to its nature. In this article, I consider several versions of Aristotelian normativism, as propounded by Christopher Megone, Michael Thompson and Philippa Foot, and Martha Nussbaum. The first two, I claim, can be persuasively rebutted by different modes of liberal pluralist challenge (...) — respectively, pluralism about structures of social organisation and pluralism about biological forms. Nussbaum's version, by contrast, is alert to the need for pluralism; I argue, however, that the Aristotelian aspects of her theory hamper her pursuit of those pluralistic aims. (shrink)

According to Chomsky and his followers, language as a biological phenomenon is a property of individual minds and brains; its status as a social phenomenon is merely epiphenomenal and not a proper object of scientific study. On a rival view, the individual's biological capacity for language cannot be properly understood in isolation from the linguistic environment, which it both depends on for its operation and—in collaboration with other speakers—builds and shapes for future generations. I argue here for the rival view (...) by demonstrating firstly its greater consonance with several themes in current biological theory, and secondly its ability to answer two well‐known philosophical challenges to generative linguistics due to Quine and Kripke. (shrink)

Werkhoven’s ‘A Dispositional Theory of Health’ is an important and original contribution to debates about the disease concept, which persuasively demonstrates that dispositions must play some role in a full account of what it is to be healthy or ill. Unfortunately, as a theory, it cannot as it stands be correct.I first demonstrate what appears to be a significant, and possibly fatal, flaw; the proliferation of dispositions which Werkhoven’s theory requires makes impossible, at least in the absence of significant further (...) metaphysical work, the comparative numerical judgements on which its account of health and illness are based. I then demonstrate two further problems, concerning the exclusion of ‘technological’ dispositions from those under consideration, and a large class of compensatory biological functions which Werkhoven’s theory seems to have overlooked. (shrink)

Werkhoven’s ‘A Dispositional Theory of Health’ is an important and original contribution to debates about the disease concept, which persuasively demonstrates that dispositions must play some role in a full account of what it is to be healthy or ill. Unfortunately, as a theory, it cannot as it stands be correct.I first demonstrate what appears to be a significant, and possibly fatal, flaw; the proliferation of dispositions which Werkhoven’s theory requires makes impossible, at least in the absence of significant further (...) metaphysical work, the comparative numerical judgements on which its account of health and illness are based. I then demonstrate two further problems, concerning the exclusion of ‘technological’ dispositions from those under consideration, and a large class of compensatory biological functions which Werkhoven’s theory seems to have overlooked. (shrink)

In this paper, I outline and defend a commonly-held moral view which has received surprisingly little sustained philosophical attention. This view, which I call the ‘authority of conscience,’ states that believing ourselves to have moral obligations to act in a certain way does in fact create an obligation to act in that way. Although I do not provide a positive case for the principle of authoritative conscience, beyond its popularity and intuitive force, I defend it against several prima facie objections. (...) I then go on to demonstrate that the principle does not entail any anti-realist metaethical commitments, and is therefore compatible in particular, and contrary to appearances, with plausible formulations of moral realism. (shrink)

Debates about the concept of disease have traditionally been framed as a competition between two conflicting approaches: naturalism, on the one hand, and normativism or social constructivism, on the other. In this article, we lay the groundwork for a naturalistic form of social constructivism by dissociating the presumed link between value-free conceptions of disease and a broadly naturalistic approach; offering a naturalistic argument for a form of social constructivism; and suggesting avenues that strike us as especially promising for filling in (...) the details of an alternative approach and addressing the most obvious objections. (shrink)

Erving Goffman’s “Asylums” is a key text in the development of contemporary, community-orientated mental health practice. It has survived as a trenchant critique of the asylum as total institution, and its publication in 1961 in book form marked a further stage in the discrediting of the asylum model of mental health care. In this paper, some responses from a range of disciplines to this text, 50 years on, are presented. A consultant psychiatrist with a special interest in cultural psychiatry and (...) mental health legislation, two collaborating psychotherapists in adult and forensic mental health, a philosopher, and a recent medical graduate, present their varying responses to the text. The editors present these with the hope of encouraging further dialogue and debate from service users, carers, clinicians, and academics and researchers across a range of disciplines. (shrink)

In addiction, apparently causally significant phenomena occur at a huge number of levels; addiction is affected by biomedical, neurological, pharmacological, clinical, social, and politico-legal factors, among many others. In such a complex, multifaceted field of inquiry, it seems very unlikely that all the many layers of explanation will prove amenable to any simple or straightforward, reductive analysis; if we are to unify the many different sciences of addiction while respecting their causal autonomy, then, what we are likely to need is (...) an integrative framework. In this paper, we propose the theory of “Externalist” or “4E” – for extended, embodied, embedded, and enactive – cognition, which focuses on the empirical and conceptual centrality of the wider extra-neural environment to cognitive and mental processes, as a candidate for such a framework. We begin in Section 2 by outlining how such a perspective might apply to psychiatry more generally, before turning to some of the ways it can illuminate addiction in particular: Section 3 points to a way of dissolving the classic dichotomy between the “choice model” and “disease model” in the addiction literature; Section 4 shows how 4E concepts can clarify the interplay between the addict’s brain and her environment; and Section 5 considers how these insights help to explain the success of some recovery strategies, and may help to inform the development of new ones. (shrink)

Following Wesley Hohfeld's pioneering analyses, which demonstrated that the concept of ownership conflated a variety of distinct legal relations, a deflationary regarding those relations as essentially unconnected held sway for much of the subsequent century. In recent decades, this theory has been thought too diffuse; it seems counterintuitive to insist, for instance, that rights of possession and alienation over a property are associated only contingently. Accordingly, scholars such as James Penner and James Harris have advanced theories that revive the concept (...) of ownership, identifying some instances of property as and regarding others as conceptually subsidiary. I propose a new interpretation of the bundle theory, based on David Lewis's idea of among physical particles. I critically examine the major antibundle positions, arguing that their criticisms result from confusion about the claims of the bundle theory, which remains the best account of property rights available. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a (...) strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Grammar is now widely regarded as a substantially biological phenomenon, yet the problem of language evolution remains a matter of controversy among Linguists, Cognitive Scientists, and Evolutionary Theorists alike. In this paper, I present a new theoretical argument for one particular hypothesis—that a Language Acquisition Device of the sort first posited by Noam Chomsky might have evolved via the so-called Baldwin Effect . Close attention to the workings of that mechanism, I argue, helps to explain a previously mysterious feature of (...) the Language Acquisition Device—the sheer variety of languages it allows the child to learn—thereby revealing a far stronger case than adherents of the hypothesis have previously supposed. A further unheralded consequence of the hypothesis is a conceptual shift in the Chomskyan understanding of language, wherein the essentially public nature of language is freshly emphasised. This has the effect of bringing the Chomskyan view into closer accord with Saussurean accounts of language, as well as with recent trends in evolutionary theory. (shrink)

The Experimental Philosophy (“X-Phi”) movement applies the methodology of empirical sciences – most commonly empirical psychology – to traditional philosophical questions. In its radical, “negative” form, X-Phi uses the resulting empirical data to cast doubt on the reliability of common philosophical methods, arguing for radical reform of philosophical methodology.In this paper I develop two connected methodological worries about this second enterprise. The first concerns the data elicited by questionnaires and other empirical survey methods; recent work in political science suggests that (...) such surveys frequently do not elicit the participants’ candid judgements, but rather their expressions of certain attitudes and identifications. This possibility stymies the arguments from experimental data to a radical overhaul of philosophical methodology. The second builds on recent work by L.A. Paul and Kieran Healy concerning social science methodology, applying it to the use of those methods in X-Phi. It concerns experimental design where the treatment investigated is a “transformative” one; since a philosophical education is plausibly one such treatment, doubt is cast on any claim that apparent differences between the judgements of philosophers and ordinary folk has implications for philosophical methodology. (shrink)

Can biological facts explain human morality? Aristotelian ‘virtue’ ethics has traditionally assumed so. In recent years Alasdair MacIntyre has reintroduced a form of Aristotle’s ‘metaphysical biology’ into his ethics. He argues that the ethological study of dependence and rationality in other species—dolphins in particular—sheds light on how those same traits in the typical lives of humans give rise to the moral virtues. However, some goal-oriented dolphin behaviour appears both dependent and rational in the precise manner which impresses MacIntyre, yet anything (...) but ethically ‘virtuous’. More damningly, dolphin ethologists consistently refuse to evaluate such behaviour in the manner MacIntyre claims is appropriate to moral judgement. In light of this, I argue that virtues—insofar as they name a biological or ethological category—do not name a morally significant one. (shrink)

The philosophical dispute about linguistic normativity is one battlefield in a larger war over the nature of language as an object of scientific study. For those influenced by Wittgenstein, language involves following — or failing to follow — public, prescriptive rules; for Chomsky and his followers, language is a property of individual minds and brains, and the grammatical judgements of any mature individual speaker — her competence — cannot be, in any linguistic sense, “wrong”. As I argue here, the recent (...) “doge meme” internet fad provides surprising evidence for the prescriptivist view. Normative attitudes towards linguistic practices are a ubiquitous feature of those practices, and there is no principled basis on which to regard them as non-linguistic. (shrink)

It has been hypothesized that psychedelic experiences elicit lasting psychological benefits by altering narrative selfhood, which has yet to be explicitly studied. The present study investigates retrospective reports (n = 418) of changes to narrative self that participants believe resulted from, or were catalysed by, their psychedelic experience(s). Responses to open-ended questions were analysed using inductive and deductive thematic coding and interpreted within agent-centred approaches to development and well-being. Themes include decentred introspection, greater access to self-knowledge, positive shifts in self-evaluation (...) processes, greater psychological and behavioural autonomy, and enhanced connectedness with others and the world. While this explorative qualitative study offers some initial support for the explanation that changes to narrative self are a cornerstone of psychedelics' therapeutic and transformative potential, methodological and recruiting limitations preclude the ability to make objective claims and generalizations. Future scientific research is necessary to further elucidate this hypothesized mechanism. (shrink)

In this paper, I explore the links between liberal political theory and the evaluative nature of medical classification, arguing for stronger recognition of those links in a liberal model of medical practice. All judgments of medical or psychiatric "dysfunction," I argue, are fundamentally evaluative, reflecting our collective willingness or reluctance to tolerate and/or accommodate the conditions in question. Illness, then, is "socially constructed." But the relativist worries that this loaded phrase evokes are unfounded; patients, doctors, and communities will agree in (...) the vast majority of cases about what counts as illness. Where they cannot come to agreement, however, we are faced with precisely the sort of dispute about values and ways of life that the institutions of the liberal state are designed to accommodate. I accordingly sketch a model of medical practice, based loosely on Jürgen Habermas's political theories, designed to maximize both our awareness and our understanding of these disputes. (shrink)

The article “Ethical Responsibilities for Companies that Process Personal Data” (McCoy et al. 2023) provides a principled and pragmatic ethical framework for companies collecting, sharing, and usin...

Case-based instruction has been regarded by many as a viable alternative to traditional lecture-based education and training. However, little is known about how case-based training techniques impact training effectiveness. This study examined the effects of two such techniques: (a) presentation of alternative outcome scenarios to a case, and (b) conducting a structured outcome evaluation. Consistent with the hypotheses, results indicate that presentation of alternative outcome scenarios reduced knowledge acquisition, reduced sensemaking and ethical decision-making strategy use, and reduced decision ethicality. Conducting (...) a structured outcome evaluation had no impact on these outcomes. Results indicate that those who use case-based instruction should take care to use clear, less complex cases with only a singular outcome if they are seeking these types of outcomes. (shrink)

Although case-based training is popular for ethics education, little is known about how specific case content influences training effectiveness. Therefore, the effects of (a) codes of ethical conduct and (b) forecasting content were investigated. Results revealed richer cases, including both codes and forecasting content, led to increased knowledge acquisition, greater sensemaking strategy use, and better decision ethicality. With richer cases, a specific pattern emerged. Specifically, content describing codes alone was more effective when combined with short-term forecasts, whereas content embedding codes (...) within context was more effective when combined with long-term forecasts, leading to greater knowledge acquisition and sensemaking strategy use. (shrink)

This study examined how structuring case-based ethics training, either through (a) case presentation or (b) prompt questions, influences training outcomes. Results revealed an interaction between case presentation and prompt questions such that some form of structure improved effectiveness. Specifically, comparing cases led to greater sensemaking strategy use and decision-ethicality when trainees considered unstructured rather than structured prompts. When cases were presented sequentially, structuring prompts improved training effectiveness. Too much structure, however, decreased future ethical decision making, suggesting that there can be (...) too much of a good thing when structuring case-based ethics education. Implications for designing ethics training programs are discussed. (shrink)

Individuals engage in moral cleansing, a compensatory process to reaffirm one's moral identity, when one's moral self-concept is threatened. However, too much moral cleansing can license individuals to engage in future unethical acts. This study examined the effects of incentives and consequences of one's actions on cheating behavior and moral cleansing. Results found that incentives and consequences interacted such that unethical thoughts were especially threatening, resulting in more moral cleansing, when large incentives to cheat were present and cheating explicitly harmed (...) others. Implications are discussed in terms of ethics training, using incentives as motivators, and the depersonalized norms of science. (shrink)

The effectiveness of case-based learning in ethics education varies widely regarding how cases are presented. Case process instruction may impact case-based ethics education to promote sensemaking processes, ethical sensemaking strategy use, and ethical decision making (EDM) quality. This study examined two teaching techniques, notes and review, and participants completed note-taking and review activities examining a case-based scenario during an ethics education course. Results suggest that providing case notes in outline form improves sensemaking processes, strategy use, and EDM quality. In addition, (...) combining processes of provided notes and passive review results in incremental, additive performance via certain ethical sensemaking strategies and EDM quality. (shrink)

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include (...) a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sensemaking processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed. (shrink)

Case-based reasoning has long been used to facilitate instructional effectiveness. Although much remains to be known concerning the most beneficial way to present case material, recent literature suggests that simplifying case material is favorable. Accordingly, the current study manipulated two instructional techniques, incremental case presentation and forecasting outcomes, in a training environment in an attempt to better understand the utility of simplified versus complicated case presentation for learning. Findings suggest that pairing these two cognitively demanding techniques reduces satisfaction and detracts (...) from the effectiveness of the learning approach. Implications regarding the use of instructional techniques in training programs are discussed. (shrink)

The growing prevalence of misleading information (i.e., bullshit) in society carries with it an increased need to understand the processes underlying many people’s susceptibility to falling for it. Here we report two studies (N = 412) examining the associations between one’s ability to detect pseudo-profound bullshit, confidence in one’s bullshit detection abilities, and the metacognitive experience of evaluating potentially misleading information. We find that people with the lowest (highest) bullshit detection performance overestimate (underestimate) their detection abilities and overplace (underplace) those (...) abilities when compared to others. Additionally, people reported using both intuitive and reflective thinking processes when evaluating misleading information. Taken together, these results show that both highly bullshit-receptive and highly bullshit-resistant people are largely unaware of the extent to which they can detect bullshit and that traditional miserly processing explanations of receptivity to misleading information may be insufficient to fully account for these effects. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

This paper presents 59 new studies (N = 72,310) which focus primarily on the “bat and ball problem.” It documents our attempts to understand the determinants of the erroneous intuition, our exploration of ways to stimulate reflection, and our discovery that the erroneous intuition often survives whatever further reflection can be induced. Our investigation helps inform conceptions of dual process models, as “system 1” processes often appear to override or corrupt “system 2” processes. Many choose to uphold their intuition, even (...) when directly confronted with simple arithmetic that contradicts it – especially if the intuition is approximately correct. (shrink)

This chapter explores the personal and professional obstacles faced by Humanities and Social Science scholars contemplating pre-publication of their scholarly work in an on-line network. Borrowing a theoretical framework from the radical educational theorist Ivan Illich, it also develops the idea that pre-publication networks offer higher education a bottom-up, decentralized alternative to business-modeled e-learning. If learners would only embrace this more anarchical medium, appreciating writing for pre-publication as a process of open-ended discovery rather than product delivery, then the prospect of (...) deinstitutionalizing e-learning could become an exciting new reality. The chapter’s methodology is a combination of normative-theoretical analysis and small sample (n=2) case study based on the author’s personal and professional experiences. While the generalizability (or external validity) of the conclusions is limited, the author hopes to motivate further inquiry into the connection between on-line pre-publication and e-learning. (shrink)

BackgroundAcute myocardial infarction (AMI) research is challenging as it requires enrollment of acutely ill patients. Patients are generally in a suboptimal state for providing informed consent. Patients’ understanding to verbal assents have not been previously examined in AMI research. Patients Acceptance and Comprehension to Written and Verbal Consent (PAC–VC) compared patients’ understanding and attitudes to verbal and written consents in AMI RCTs.MethodsPAC–VC recruited patients from 3 AMI trials using both verbal N = 12 and written N = 6 consents. We (...) compared patients’ understanding using two survey questionnaires. The first questionnaire used open-ended questions with multiple choice answers. The second questionnaire used a 5-point Likert scale to measure patients understanding and attitudes to the consent process. Overall answers average scores were categorized into three groups: Adequate understanding (71–100) %, Partial understanding (41–70)% and Inadequate understanding (0–40)%.ResultsResponses showed patients with verbal assent had adequate understanding to most components of informed consent, close to those of written consent. Most patients did not read written information entirely and believed that it is not important to make a final decision. Patients favoured to have written information be part of the consent but not necessarily presented during the initial consent process. Patients felt less pressured in the verbal assent arm than those of written consent.ConclusionPatients had adequate understanding to most components of verbal assent and comparable to those of written consent. Utilizing verbal assents in the acute care setting should be further assessed in larger trials. (shrink)

ABSTRACT Drawing upon cross-sectional research with pre- and in-service police officers in the U.K. (N = 571), this paper reports on the moral reasoning strategies favored by the respondents in dealing with bespoke work-related moral quandaries specific to the professional practice of policing. The dominant form of moral reasoning in dealing with those dilemmas was deontological (rule-based). The second most frequently selected reasoning strategy was virtue ethical. Further analysis of the police research data indicated that those with an undergraduate degree (...) were significantly more likely to adopt virtue ethical and consequentialist-utilitarian reasoning strategies than those who did not have an undergraduate degree. (shrink)

Shane Glackin's 2019 Philosophical Quarterly article aims to offer a framework for understanding the philosophical debate about the nature of disease and utilise this framework to reply to several standard objections to normativist theories of disease. Specifically, Glackin claims his model avoids three central challenges to normativism, which we term the ‘Flippancy Problem’, ‘Repugnancy Problem’, and the ‘Explanatory Problem’. Although we find Glackin's framework helpful in clarifying the terrain of the debate, we argue these three challenges (...) continue to afflict his preferred construal of the normativist/social constructivist position. (shrink)

Introduction -- Marion's claims -- The hermeneutic structure of phenomenality -- The theory of saturated phenomena -- Events -- Dazzling idols and paintings -- Flesh as absolute -- The face as irregardable icon -- Revelation : the phenomenon of God's appearing -- Conclusion: Revising the phenomenology of givenness.