In lieu of an abstract, here is a brief excerpt of the content:Clinicians’ “Folk” Taxonomies and the DSM: Pick Your PoisonG. Scott Waterman (bio)Keywordsnosology, classification, diagnosis, psychopathologyWith attention turning to the process of formulating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; e.g., Kendler et al. 2008), the study by Flanagan and Blashfield (2007) of the similarities and differences between clinicians’ “folk” taxonomies and psychiatry’s official one is timely, and its lessons are in need (...) of analysis. In this commentary I first address questions raised by the existence of multiple de facto taxonomies, and by the characteristics of those taxonomies themselves, before focusing attention on the DSM diagnostic system and its attributes that make acceptance by its constituencies far less than complete. Although the aim of Flanagan’s and Blashfield’s study is explicitly descriptive rather than normative, it provides an important opportunity to examine the extent to which our taxonomies serve the purposes for which they were constructed—whether by experts or by clinicians.There are certainly reasons to expect significant deviations between clinicians’ everyday taxonomies and the official one. Perhaps the most glaring reason is the fact that—even if it were desirable—no one can be familiar with the enormous number of categories codified by the DSM. On the other hand, the remarkable hegemony of the DSM—in the education and training of physicians and clinical psychologists, in clinical communication, and in the ubiquitous administrative functions of billing and coding—makes such deviations at least somewhat surprising and in need of scrutiny and explanation. The first question, however, is whether one should be concerned by the existence (surprising or otherwise) of multiple taxonomies. Flanagan and Blashfield make the compelling case that, given the high rate at which Americans seek clinical attention for psychiatric problems, the stakes are commensurately high for our efforts at categorizing those problems in valid and useful ways. And the extent to which a gulf exists between the way psychiatry and clinical psychology are written about and taught on the one hand, and conceptualized and practiced by clinicians on the other, invites a multitude of problems—among which cynicism about our disciplines may be one of the most pernicious.At least as important as their finding of only moderate correlations between clinicians’ taxonomies [End Page 271] and that of the DSM are the characteristics of clinicians’ diagnostic systems themselves. One potentially major artifact of their methodology, however, must be borne in mind: the instruction to the clinicians in their study to “[p]ut together the diagnoses that have similar treatments…” (emphasis mine). Although they cite previous work (Flanagan and Blashfield 2006) in defense of the proposition that such instruction did not unduly influence their findings, it was certainly an avoidable potential problem, which itself likely reflects the history of our clinical disciplines in which the treatment cart frequently pulled the diagnosis horse. It is, therefore, not unlikely that clinicians’ taxonomies might emphasize treatment considerations even if they had not been directed to do so. The fallacious reasoning behind such intuitively appealing practice, however, must be exposed. The implicit assumption that treatment response is a proxy for other important characteristics of illnesses is predicated on the false proposition that our treatments exert their effects via similar mechanisms across the various indications for their uses, thus allowing us to infer from such responses that what was awry in the first place among the conditions for which a given treatment is effective must be closely related. Categorizing mania and trigeminal neuralgia together by virtue of their shared responses to anticonvulsant therapy, or considering autoimmune platelet deficiencies to be closely related to abdominal trauma due to the fact that each sometimes requires splenectomy, are examples of the potential results of acting on that false premise.Another parameter on which the clinicians in the current study based their nosologies—most explicitly by the “dimensional experts”—is the “environmental” versus “biological” one. Given that a coherent dichotomy would either distinguish environmental from genetic etiological factors, or would contrast psychological (i.e., subjective or first-person) from biological (i.e., objective or third-person) manifestations of illness, a taxonomy one of whose axes purports to represent an environmental/biological continuum cannot... (shrink)

Psychiatry's relation to the rest of medicine is ambivalent. Its legitimacy as a specialty is often conceived as being closely linked to its fidelity to the fundamental paradigms of medicine, especially the centrality of diagnosis and the association of diagnosis with treatment indications. However, as Gagné-Julien notes, a major impetus behind the quest for a solution to the demarcation problem in psychiatry is "growing concerns regarding over-medicalization". Although it could appear that these two considerations point in opposite directions, both arguably (...) would be served by what Gagné-Julien labels "a satisfying definition" of mental disorder. Such a... (shrink)

When we sit down to write an article that we plan to submit for publication, it is usually because we have completed some piece of empirical or conceptual work that has led us to conclusions we wish to share with our scholarly communities. In this instance, though, my essay under discussion was itself the means by which I sought to draw some conclusions about my recent experiences. Contrary to my initial plans—and my custom—I began writing without a clear idea of (...) where I would wind up. The commentaries, taken as a whole, affirm that my ambivalence about the topic at hand—fully revealed to me while formulating the article—came through, albeit in different ways to different commentators. And... (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Jennifer Nagel (2010) has recently proposed a fascinating account of the decreased tendency to attribute knowledge in conversational contexts in which unrealized possibilities of error have been mentioned. Her account appeals to epistemic egocentrism, or what is sometimes called the curse of knowledge, an egocentric bias to attribute our own mental states to other people (and sometimes our own future and past selves). Our aim in this paper is to investigate the empirical merits of Nagel’s hypothesis about the psychology involved (...) in knowledge attribution. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

has proposed an interesting and novel Bayesian analysis of the Quine-Duhem (Q–D) problem (i.e., the problem of auxiliary hypotheses). Strevens's analysis involves the use of a simplifying idealization concerning the original Q–D problem. We will show that this idealization is far stronger than it might appear. Indeed, we argue that Strevens's idealization oversimplifies the Q–D problem, and we propose a diagnosis of the source(s) of the oversimplification. Some background on Quine–Duhem Strevens's simplifying idealization Indications that (I) oversimplifies Q–D Strevens's argument (...) for the legitimacy of (I). (shrink)

By and large, we think is a useful reply to our original critique of his article on the Quine–Duhem problem. But, we remain unsatisfied with several aspects of his reply. Ultimately, we do not think he properly addresses our most important worries. In this brief rejoinder, we explain our remaining worries, and we issue a revised challenge for Strevens's approach to QD.

The American Indian Movement, founded in 1968 in Minneapolis, burst into that turbulent time with passion, anger, and radical acts of resistance. Spurred by the Civil Rights movement, Native people began to protest the decades--centuries--of corruption, racism, and abuse they had endured. They argued for political, social, and cultural change, and they got attention. The photographs of activist Dick Bancroft, a key documentarian of AIM, provide a stunningly intimate view of this major piece of American history from 1970 to 1981. (...) Veteran journalist Laura Waterman Wittstock, who participated in events in Washington, DC, has interviewed a host of surviving participants to tell the stories behind the images. The words of Russell Means, Dennis Banks, Clyde Bellecourt, Eddie Benton Banai, Pat Bellanger, Elaine Salinas, Winona LaDuke, Bill Means, Ken Tilsen, Larry Leventhal, Jose Barreiro, and others tell the stories: the takeovers of federal buildings and the Winter Dam in Wisconsin, the founding of survival schools in the Twin Cities, the Wounded Knee trials, international conferences for indigenous rights, the Trail of Broken Treaties Caravan and the Longest Walk for Survival, powwows and camps and United Nations actions. This is the inside record of a movement that began to change a nation. Dick Bancroft has been the unofficial photographer for the American Indian Movement since 1970. He has traveled the world to take these photographs. Laura Waterman Wittstock, a writer and media consultant, covered the early years of the American Indian Movement as a journalist. Rigoberta Menchú Tum, recipient of the 1992 Nobel Peace Prize, is an activist for indigenous rights in Guatemala. (shrink)

Most explanations of the rational authority of testimony provide little guidance when evaluating individual pieces of testimony. In practice, however, we are remarkably sensitive to the varying epistemic credentials of testimony: extending trust when it is deserved, and withholding it when it is not. A complete account of the epistemology of testimony should, then, have something to say about when it is that testimony is trustworthy. In the typical case, to judge someone trustworthy requires judging them to be competent and (...) sincere. In this essay we develop an exchange-based account of testimony that shows how those who receive testimony are in a position to evaluate the sincerity of speakers. (shrink)

Sinan Dogramaci has recently developed a view according to which the function of epistemic evaluations—like calling someone’s behavior “rational” or “irrational”—is to encourage or discourage the behavior evaluated. This view promises to explain the rational authority of testimony, by describing a social practice that promotes the coordination of epistemic procedures across a community. We argue that Dogramaci’s view is unsatisfactory, for two reasons. First, the social practice at its heart is vulnerable to free riders. Second, even if the problem of (...) free riders can be solved, it “alienates” epistemic agents from the testimony that they receive, in that, though they will accept testimony from their fellows, they will have no reason to do so. We argue that a more satisfactory view can be had if we couple the genuine insights that are to be found in Dogramaci’s proposal with the recognition that testimony is an excludible good that is often distributed according to market forces. It is this fact about test.. (shrink)

Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

By and large, we think Strevens’s [6] is a useful reply to our original critique [2] of his paper on the Quine–Duhem (QD) problem [5]. But, we remain unsatisfied with several aspects of his reply (and his original paper). Ultimately, we do not think he properly addresses our most important worries. In this brief rejoinder, we explain our remaining worries, and we issue a revised challenge for Strevens’s approach to QD.

Kant’s critique/doctrine distinction tracks the difference between a canon for the understanding’s proper use and an organon for its dialectical misuse. The latter reflects the dogmatic use of reason to attain a doctrine of knowledge with no antecedent critique. In the 1790s, Fichte collapses Kant’s distinction and redefines dogmatism. He argues that deriving a canon is essentially dialectical and thus yields an organon: critical idealism is properly a doctrine of science or Wissenschaftslehre. Criticism is furthermore said to refute dogmatism, by (...) which Fichte means Spinozism. Schelling repudiates Fichte’s position in his Philosophical Letters by reviving Kant’s distinction. First, ‘critique’ for Schelling names a canon that is valid for all systems—including Spinozism—and thus favours none—not even the Wissenschaftslehre. Second, Schelling coins ‘dogmaticism’ to refer to what Kant calls ‘dogmatism’: reason’s uncritical claim to doctrine. Hence, he says all systems—even Fichte’s—are susceptible to the ‘enthusiasm’ of mistaking themselves for doctrines or ‘objects of knowledge’, instead of subjectively valid ‘objects of freedom’. I reconstruct Schelling’s argument for reviving Kant’s distinction, while noting two consequences for German idealism. First, if criticism favours no system, a system’s origin cannot be an act of knowledge, e.g., intellectual intuition, but only an act of endorsement. Second, if dogmaticism entails enthusiasm, a system’s goal cannot be absolute knowledge, but only infinite striving. Hence, by retrieving Schelling’s notion of dogmaticism, we can both gain a better understanding of the Letters and register the impact of a core Kantian distinction on the German idealist project. (shrink)

© 2015 NATCO, The Organization for Transplant Professionals.Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article (...) is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

We present several new studies focusing on “salience effects”—the decreased tendency to attribute knowledge to someone when an unrealized possibility of error has been made salient in a given conversational context. These studies suggest a complicated picture of epistemic universalism: there may be structural universals, universal epistemic parameters that influence epistemic intuitions, but that these parameters vary in such a way that epistemic intuitions, in either their strength or propositional content, can display patterns of genuine cross-cultural diversity.

According to the ethical system of eudaimonism, a philosophy that predates Aristotle, individuals have a responsibility to recognize and live in accordance with their daimon or "true self." The daimon refers to the potentialities of each person, the realization of which represents the greatest fulfillment in living of which each is capable. The daimon is an ideal in the sense of being an excellence, a perfection toward which one strives and, hence, it can give meaning and direction to one's life. (...) Eudaimonia, then, is activity in accordance with one's daimon. This is what is considered worth having in life. Since Aristotle in the Nicomachean Ethics is concerned with the proper ends of human functioning, he rejects the view of eudaimonia as a subjective state equivalent to, or similar to, hedonic enjoyment. But if psychologists are to be able to make productive use of the Aristotle's conception of eudaimonia, it must be rendered in a form more congenial to the field. In pursuing this goal, I have found it necessary to take several significant departures from the Aristotelian perspective, while I have endeavored to remain true to Aristotle's ethical objectives. The most important of these departures is to consider eudaimonia to have a subjective component embodying the experiences that flow from efforts to live in truth to one's daimon by striving to develop one's aptitudes and talents for purposes deemed worth having in life. 2012 APA, all rights reserved). (shrink)

Forty‐nine subjects judged the relevancy of sentence parts of a word problem (the Allsports problem). Patterns of subjects' judgments suggest three problem‐solving heuristics: a SETS heuristic, a TIME heuristic, and a QUESTION heuristic. Presentation of the question before the problem tends to suppress SETS and TIME heuristics. A computer program (ATTEND) is presented to simulate subjects' behavior on the Allsports problem. The program is context‐sensitive in that it can change a relevance judgment upon the acquisition of further information. Averaged subject (...) judgments and ATTEND judgments agree for 87% of the items. (shrink)

Some anthropogenic environmental changes that produce net benefits for the current generation will also produce foreseeable net harms to future generations. Well recognized as “time-lag effects,” these changes are environmental issues with strongly differential benefits and burdens between generations. Some of the world’s largest environmental issues fall into this category, including biodiversity loss and global climate change. The intractability of these issues for Western governments is not merely a practical problem of avoiding unpopular policy options; it is a theoretical problem (...) for liberal democracy. Current conceptions of political legitimacy authorize governments to act for the benefit of their respective current citizens but not for future generations. A liberal democratic government is not authorized to enact policies for the benefit of future generations if so doing would entail unwanted constraints on the current electorate. To do so would fall beyond the jurisdiction—the legitimate scope of decision making—of government. The result is an entire category of environmental issues that is largely beyond the jurisdiction of government to resolve. These are ultra vires (beyond jurisdiction) environmental issues. To the extent that the concept of sustainability embodies intergenerational justice, then current conceptions of political legitimacy are impeding sustainability. (shrink)

Psychological and philosophical perspectives are employed in an exploration of the reasons particular individuals experience an activity as personally expressive while others may find the same activity neutral or even aversive. The relationships between personal expressiveness and intrinsic motivation, flow, and self-actualization are considered. The construct of personal expressiveness is shown to have its roots in eudaimonistic philosophy. Living in a manner consistent with one's daimon or "true self" gives rise to a cognitive-affective state labeled "eudaimonia" that is distinguishable from (...) hedonic enjoyment. A personally expressive personality pattern is described integrating concepts from diverse theories including a sense of personal identity, self-actualization, an internal locus of control, and principled moral reasoning. A series of empirical investigations is proposed to test the theoretical concepts of personal expressiveness advanced. (shrink)

This book presents G. A. Cohen's Gifford Lectures, delivered at the University of Edinburgh in 1996. Focusing on Marxism and Rawlsian liberalism, Cohen draws a connection between these thought systems and the choices that shape a person's life. In the case of Marxism, the relevant life is his own: a communist upbringing in the 1940s in Montreal, which induced a belief in a strongly socialist egalitarian doctrine. The narrative of Cohen's reckoning with that inheritance develops through a series of sophisticated (...) engagements with the central questions of social and political philosophy. In the case of Rawlsian doctrine, Cohen looks to people's lives in general. He argues that egalitarian justice is not only, as Rawlsian liberalism teaches, a matter of rules that define the structure of society, but also a matter of personal attitude and choice. Personal attitude and choice are, moreover, the stuff of which social structure itself is made. Those truths have not informed political philosophy as much as they should, and Cohen's focus on them brings political philosophy closer to moral philosophy, and to the Judeo-Christian ethical tradition, than it has recently been. (shrink)

A highly original reading of Immanuel Kant that demonstrates his interest in the social realm of human interaction.

Containing selected papers on the fundamentals and applications of Complexity Science, this multi-disciplinary book presents new approaches for resolving complex issues that cannot be resolved using conventional mathematical or software models. Complex Systems problems can occur in a variety of areas such as physical sciences and engineering, the economy, the environment, humanities and social and political sciences. Complexity Science problems, the science of open systems consisting of large numbers of diverse components engaged in rich interaction, can occur in a variety (...) of areas such as physical sciences and engineering, the economy, the environment, humanities and social and political sciences. The global behaviour of these systems emerges from the interaction of constituent components and is unpredictable but not random. The key attribute of Complex Systems is the ability to self-organise and adapt to unpredictable changes in their environment. (shrink)

A leading figure in neuroaesthetics makes the case that aesthetic experience can be meaningfully measured by the tools of neuroscience.