In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 1-7 [Access article in PDF] Clinical Practice, Science, and the Unconscious Douglas McConnell Neil Pickering Keywords psychotherapy, cognitive science, neuroscience, computational view of mind. This volume of Philosophy, Psychiatry, & Psychology is devoted to questions about the unconscious mind. The philosophical complexities and difficulties associated with the unconscious are many and, despite widespread confusion and disagreement as to the (...) nature of the unconscious mind, it is used as a concept informing psychotherapy. It is therefore not surprising that papers in a special edition on the unconscious might be weighted heavily toward uncovering a justifiable conceptual niche for the unconscious and elaborating on some of the main conceptual connections. Although this makes for a slightly more philosophical edition of PPP than usual, those perhaps less interested in philosophy and more interested in actual psychiatric practice can incorporate the concepts and insights developed in these papers into their practice as they see fit.The three main articles take three quite distinct approaches to the unconscious. Schechtman (2005) addresses the need for a theory of personal identity to incorporate the unconscious and presents one that does so by developing some central Lockian intuitions. Church (2005) investigates whether the kinds of things happening in the unconscious can be explained by cognitive operations not normally associated with consciousness, specifically, spatial structuring of experience. McConnell and Gillett (2005) clarify some of Lacan's ontology of the mind where the language encountered and used by the subject provides the structure for their unconscious.The aim of this introduction is to ask and try to answer a question that logically precedes those raised in the articles in the light of the therapeutic use of the unconscious. When dealing with psychoanalysis or psychoanalytic concepts in an Anglo-American context, the struggle that psychoanalysis has had and continues to have in a psychiatric domain ruled by science is never far from the spotlight. Indeed Hinshelwood (2005) also picks up the importance of this conflict when replying to McConnell and Gillett. It seems to be historically true that the unconscious has fallen out of favor in scientific and psychiatric circles (it is no surprise that psychiatric training is largely based in "hard," that is, biological and biochemical science) particularly over the last 50 years or so. But is the scientific skepticism to be found about the use of the unconscious well-founded? And how does the continued utilization [End Page 1] of the unconscious by the therapist fit into current practice given this skepticism? Psychotherapy and the Unconscious In psychotherapy, the therapist and the client together construct a story that explains why the client is having some form of difficulty in his or her life. The stated aim is to enable the client to overcome this difficulty by gaining an understanding of what has generated it. Doing so may be a first step to dealing with that conflict. For example, an office worker who is scared of the boss and whose life at work is a misery as result may come to think that the boss is a reminder of some threatening figure from childhood and that the reaction is a regression to infantile behavior. Knowing this, the fear of the boss can be revisited—perhaps reconfigured, perhaps overcome—and life may improve. In the process of therapy, the relation of the figure from childhood to the boss is made conscious. But it was still operative before it was made explicit, even though the client did not realize it and some would say that the client's unconscious had somehow buried the memory from childhood or hidden from the client the relation of this memory of a threatening figure to the boss.A description of the content of the unconscious is, then, an intentional description involving the client's thought life, one made to help an individual understand otherwise unintelligible (to that individual) feelings, beliefs, desires, actions, and so on. Subjects' intentions are their normatively structured mental representations of, and attitudes toward, the world (e.g., "He is my boss"; "I am afraid of him"). An intentional unconscious description then takes an intentional form... (shrink)

"This work is designed to be an introduction to abnormal psychology. The problems considered, however, belong equally to normal psychology. The present volume consists of selected lectures (with the exception of four) from courses on abnormal psychology delivered at the Tufts College Medical School (1908-10) and later at the University of California (1910). These again were based on a series of papers on the Unconscious published in the Journal of Abnormal Psychology (1908-9) of which they are elaborations. Since (...) the lectures were delivered a large amount of new material has been incorporated and the subject matter considered in more detail and more exhaustively than was practical before student bodies. The four additional lectures (X, XI, XII and XIII) appeared in abbreviated form in the same Journal (Oct., Nov., 1912) under the title "The Meaning of Ideas as Determined by Unconscious Settings." As the subconscious and its processes are fundamentals both in the structure of personality and in the many mechanisms through which personality, normal and abnormal, finds expression, the first eight lectures are devoted to its exposition. Indeed, the subconscious is not only the most important problem of psychology, it is the problem. The study of its phenomena must be preliminary to that of the functioning mechanisms of both the normal mind and of those special pathological conditions--the psycho-neuroses--which modern investigators are tracing to its perversions. It ought to be possible to construct the theory of the subconscious by inductive methods on the basis of facts of observation just as any theory of the physical sciences is constructed. This task I have set before myself as well as that of giving precision to our conception of the theory and taking it out of the domain of philosophical concepts. With this purpose in view I have endeavored to apply the method of science and construct the theory by induction from the data of observation and experiment. I have divided the subconscious into two classes, namely (1) the unconscious, or neural dispositions and processes, and (2) the coconscious, or actual subconscious ideas which do not enter the content of conscious awareness. In these lectures I have also endeavored (Lectures XIV-XVI) to develop the phenomena of the emotional innate dispositions which I conceive play one of the most fundamental parts in human personality and in determining mental and physiological behavior. Experimental methods and the well-known clinical methods of investigation have been employed by me as far as possible. The data made use of have been derived for the most part from my own observations, though confirmatory observations of others have not been neglected. Although a large number and variety of subjects or cases have been studied, as they have presented themselves in private and hospital practice, the data have been to a large extent sought in intensive studies, on particular subjects, carried on in some cases over a period of many years. These subjects, because of the ease with which subconscious and emotional phenomena were either spontaneously manifested or could be experimentally evoked, were particularly suitable for such studies and fruitful in results. It is by such intensive studies on special subjects, rather than by casual observation of many cases, that I believe the deepest insight into mental processes and mechanisms can be obtained. The favorable reception which was given to the first edition of this work has tempted me in preparing a new edition at the request of the publishers to incorporate four additional chapters dealing with the general principles underlying the structure and dynamic elements of human personality (Lecture XVII) and a study of a special problem in personality in which these principles are involved, namely, the psychogenesis of multiple personality as illustrated by a study of the case known as B.C.A. (Lectures XVIII-XX)." (PsycINFO Database Record (c) 2012 APA, all rights reserved). (shrink)

Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American (...) Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Chapter 1 First Person Access to Mental States. Mind Science and Subjective Qualities -/- Abstract. The philosophy of mind as we know it today starts with Ryle. What defines and at the same time differentiates it from the previous tradition of study on mind is the persuasion that any rigorous approach to mental phenomena must conform to the criteria of scientificity applied by the natural sciences, i.e. its investigations and results must be intersubjectively and publicly controllable. In Ryle’s view, philosophy (...) of mind needs to adopt an antimentalist stance to achieve this aim. Antimentalism not only definitively rejects the idea that mind is a substance separated from the body, it also denies that mental phenomena radically differ from physical phenomena by virtue of several unique features. Most problematically, mental phenomena have a conscious character (mental states are related to specific qualitative feelings) and are accessible only to the first-person (only the subject knows directly what s/he is experiencing inside his/her mind). Ryle takes a strong stance on antimentalism going so far as to maintain that an approach to mind which aims to meet the criteria of scientificity set by the natural sciences must avoid any reference to internal, unobservable mental states. In his view (which is considered a specifically philosophical version of psychological behaviorism and also addresses questions put forward in psychological research), mental states can be redescribed in terms of behavioral dispositions. In this chapter, we address the historical roots of the antimentalist view and analyze its relation to the later tradition of research on mind. We show that, compared to the antimentalist stance, functionalism and cognitivism take a step back when they maintain that direct reference to mental states is necessary since mental states cause and therefore explain human behavior. This step backwards is often interpreted as a return to mentalism. However, this is only partially true. Indeed, we suggest that these later traditions retain one important element of Ryle’s antimentalism, i.e. the idea that mental states must be uniquely identified using external and publicly observable criteria, while excluding any reference to introspection and those qualitative dimensions of a mental state, which are accessible only to the first-person. According to the perspective we put forward, this epistemological stance has continued to influence contemporary research on mind and current philosophical and psychological theories which both tend to exclude the subjective qualities of human experience from their accounts of how the mind works. The issue we raise here is whether this is legitimate or whether subjective qualities do play a role with respect to the way our mind works. The conclusion of this chapter anticipates the argument the book makes in in favor of this latter position, starting from a particular angle, i.e. the problem of how we categorize concepts related to our internal states. -/- Chapter 2 The Misleading Aspects of the Mind/Computer Analogy. The Grounding Problem and the Thorny Issue of Propriosensitive Information -/- Abstract. After the crisis of behaviorism, cognitivism and functionalism became the predominant models in the field of psychology and of philosophy, respectively. Their success is mainly due to the new key they use for interpreting mental processes: the mind/computer analogy. On the basis of this analogy, mental operations are seen as cognitive processes based on computations, i.e. on manipulations of abstract symbols which are in turn understood as informational unities (representations). This chapter identifies two main problems with this model. The first is how these symbols can relate to and communicate with perception and thus allow us to identify and classify what we perceive through the senses. Here we limit ourselves to presenting this issue in relation to the classical symbol grounding problem originally put forward by Harnad on the basis of Searle’s Chinese room argument. An attempt to address the problem raised here will be made in chap. 3. The second point we discuss in relation to the mind/computer analogy concerns the idea of information it fosters. Indeed, following this analogy, information is something available in the external world which can be captured by the senses and transmitted to the central system without being influenced or modified by the procedures of transmission. This perspective does not take into account that – unlike computers – in living beings information is acquired by means of the body. As Ulric Neisser has already pointed out, the body is itself an informational source that provides us with additional sensory experience that influences (modifies or complements) the information extracted from the external world by the senses. To develop this line of analysis and to determine exactly what information is provided by the body and how this might influence cognition, we examine Sherrington’s and Gibson’s positions. Moving on from their views, we qualify bodily information in terms of ‘proprioception’. We use ‘proprioception’ in a broad sense to describe any kind of experience we have of our internal states (including postural information as well as sensations related to the general state of the body and its parts). Following Damasio’s and Craig’s studies, we further elaborate this position, arguing that living beings are equipped with an internal propriosensitive monitoring system which maps all the changes that constantly occur in our body and that give us perceptual (‘proprioceptive’ or propriosensitive) information about what happens inside us. Moreover, relying on Goldie’s and Ratcliffe’s view, we show that emotional information can also be considered as a form of ‘proprioception’ which contributes to determining everything we perceive. This analysis leads us to the second main thesis of this book: ‘proprioception’ is a form of internal perception and it is an essential component of the sensory information we can access and use for all cognitive purposes. -/- Chapter 3 Semantic Competence from the Inside: Conceptual Architecture and Composition -/- Abstract. Concepts are essential constituents of thought: they are the instruments we use to categorize our experience, i.e. to classify things and group them together in homogeneous sets. Here we define concepts as the internal mental information (representations) that allows us, among other things, to master words in natural language. By analyzing the way in which individuals master word meanings we explore a number of hypotheses regarding the nature of concepts. Following Diego Marconi’s research, we differentiate between two kind of abilities that underpin lexical competence – so-called ‘referential’ and ‘inferential competence’ – and we suggest that, in order to support these abilities, concepts must also include two corresponding kinds of information, i.e. inferential and referential information. We point out that the most widely used and acknowledged theories of concepts do not make this distinction, instead broadly characterizing the information used for categorization in terms of propositionally described feature lists. However, we show that while feature lists can explain inferential competence, they do not account for referential competence. To address the issue of referential competence we examine Ray Jackendoff’s hypothesis that to account for the possibility of linking perceptual and conceptual information we need to assume the existence of a (visual) representation that encodes the geometric and topological properties of objects and bridges the gap between the percept and the concept. Furthermore, we analyze the extension of this work by Jesse Prinz who introduced the notion of a proxytype, a perceptual representation of a class of objects that incorporates structural and parametric information related to their appearance. However, as we point out, proxytypes can only explain the relationship between perception and concepts with respect to instances that can be perceived through the senses and that belong to the same class by virtue of their physical similarity. We suggest that this notion be extended to include larger conceptual classes. To accomplish this, we further develop Mark Johnson, George Lakoff and Jean Mandler’s idea of a schematic image and argue that conceptual representations include a perceptual schema. Perceptual schemata are non-linguistic, structured experiential gestalts (patterns or maps) that make use of information taken from all sensory modalities, including body perception. They accomplish a quasi-conceptual function: they allow us to recognize and to classify different instances. In this work, we hypothesize that perceptual schemata are an essential component of concepts, but not identical to them. Instead, we suggest that concepts include both perceptual and propositional information with perceptual schemata providing the ‘perceptual core concept’ that grounds related propositional information. -/- Chapter 4 In the Beginning There Were Categories. The Bodily Origin of Prelinguistic Categorical Organization: The Example of Folkbiological Taxonomies -/- Abstract. Studies of categorization in psychology and the cognitive sciences have made use of the notions of ‘category’ and ‘concept’ without precisely defining what is meant by either; in fact, often these terms have been used as synonyms, making it difficult to address specific issues related to conceptual development. This chapter begins by discussing the definitions of, as well as the distinctions between, ‘categories’ and ‘concepts’ in the classical philosophical tradition (Aristotle, Kant and Husserl). We introduce our view of categories with reference to Husserl. Categorization is defined as the way in which our experience is originally (pre-linguistically) organized in a passive and fully unconscious manner on the basis of universal structuring principles. Conceptualization is explained as a later process in which the earlier categorical macro-classes are further subdivided into more specific and detailed sets; this later process also relies on linguistic learning and exposure to culture. On the basis of Ray Jackendoff, Jean Mandler, George Lakoff and Mark Johnson’s work, we hypothesize that categorization is a two-step process that begins with the formation of homogeneous sets of entities partitioned into regions that describe the ontological boundaries of the objects that humans perceive (categories) and continues at a later stage with the development of more specific classifications (concepts). In this chapter, we mainly address three related issues: Why should we assume that there is categorical organization which precedes the development of a conceptual system? How do categories and concepts relate to each other? Shall we hypothesize that categories are innate or that they are formed before concepts on the basis of information and organizational structure available at a very early developmental stage? We show that categorical partitions are necessary for categorization and, following Mandler, that the general categories we form at an early age do not match our adult superordinate concepts. As for the third issue, we argue that there might be no need to assume that categories are innately present in the human mind, since their formation can be explained – at least in certain cases – by basic mechanisms that work on body (propriosensitive) information. This hypothesis will not be discussed in general, but in relation to a particularly relevant example of categorical partition, i.e. the folk-biological dichotomy between ANIMATE/INANIMATE. This is compared with other dichotomies that derive from it, but are not directly categorical such as LIVING/NON-LIVING and BIOLOGICAL/NON-BIOLOGICAL. -/- Chapter 5 Internal States: From Headache to Anger. Conceptualization and Semantic Mastery -/- Abstract. Here we ask if we can also apply the distinction between referential and inferential competence we introduced in Chapter 3 to words that do not refer to things that are perceived using the external senses, especially to words/concepts that denote bodily experiences (such as pain, thirst, hunger, etc.) or emotions. We introduce and discuss the hypothesis that – even though such words/concepts do not refer to intersubjectively identifiable entities in the external world – they do have a kind of referent that can be accessed via direct perception, more specifically ‘proprioception’, as we have defined it in terms of all propriosensitive information we can consciously access. In the first part of the chapter, we specifically consider terms denoting bodily experiences such as ‘pain’ or ‘hunger’ and argue that their referents are identified and classified from a first-personal point of view on the basis of four main characteristics: their specific intensity, their localization in the body, their co-occurrence with other signals and above all their specific qualitative sensations. Emotions are addressed in the second part of the chapter. We suggest that there is a continuity between bodily experiences and emotions. In particular, we argue for a perceptual theory of emotions in line with that proposed by James and Lange at the end of the 19th century and developed more recently by authors such as Damasio (see also chap. 2§5, §6). The hypothesis we put forward is that the referential information that supports the categorization of emotions and therefore also our mastery of terms referring to emotions consists in the perception (i.e. the ‘proprioception’) of those bodily states and changes in bodily states which constitute our emotional experience. In the context of this discussion we examine some objections to this line of reasoning that arise from a cognitivist perspective and following authors such as Oatley, Johnson-Laird and Frijda, we distinguish between basic emotions that can be identified and classified solely on the basis on how they feel and complex emotions whose identification and classification additionally depends on cognitive factors. To describe how emotions are identified and classified on the basis of how they feel, we rely on Marcel and Lambie’s distinction between an ‘emotion state’ and an ‘emotion experience’. Both notions indicate kinds of feelings that we consciously experience. However, they describe first-order and second order emotion awareness respectively. The emotion state is the feeling we have of the bodily states and changes that occur when we are experiencing an emotion, while the emotion experience is the fully developed and integrated emotion we both experience and are, with reflection, aware of experiencing. On the basis of this differentiation, we also show that the same characteristics that aid in the identification and classification of bodily experiences (specific qualitative sensations; somatic localization; specific intensity; presence/absence of specific concomitant sensations) can also be used for the identification and classification of emotions – at least basic emotions. In the last two sections of the chapter we present some clinical evidence on the semantic competence of people who suffer from Alexithymia and Autism Spectrum Disorder which supports the conclusions of our preceding analyses. -/- Chapter 6 The ‘Proprioceptive’ Component of Abstract Concepts -/- Abstract. In this chapter, we address the issue of whether the mastery of abstract words requires only inferential knowledge and thus, if the concepts that support the mastery of abstract words include only linguistic information. We start by differentiating the notions of ‘abstract’ and ‘general’ which are often erroneously confused. We then identify a strict definition of abstract, as contrasted with ‘concrete’, that applies to words or concepts whose referent cannot be experienced by the senses. We argue that abstract words/concepts would be better described as theoretical, because they are usually conceived as structured sets of inferential knowledge expressed linguistically; that is, as small theories. Pointing out parallels with Carnap’s analysis of this issue in philosophy of science, we hypothesize that words/concepts denoting non-observable entities are not all ‘equally theoretical’, because their link to sensory experience can be stronger or weaker. We revive the distinction, inspired by Quine, between theoretical and intertheoretical concepts/words. This distinction relies on the fact that the former – unlike the latter – retains a strong, although indirect, connection with perception. In Quine’s discussion, perception is understood uniquely in terms of observability, i.e. of external sensory experience. Here we argue, however, that bodily, ‘proprioceptive’ (i.e. propriosensitive) experience can also serve to referentially ground theoretical (i.e. abstract) concepts/words. We frame this issue using the example of the theoretical concept ‘freedom’ and Lakoff’s hypothesis that this concept is developed on the basis of bodily information. We contrast this with the example of ‘democracy’ which more closely resembles an intertheoretical concept/word. Furthermore, we show that one of the classical views put forward in psycholinguistic research to explain how abstract concepts are mentally represented – i.e. Paivio’s Dual Coding Theory – points in the same direction as our analysis. The same is true of Barsalou’s work suggesting that we use internal information to understand at least some abstract words. To sustain this position, we put forward two lines of evidence: the first comes from psycholinguistic studies while the second examines deficits of semantic competence exhibited by people with Autism Spectrum Disorder. On the basis of our analysis, we put forward a classification that distinguishes between different kinds of concreteness and different degrees of abstraction: concepts/words referring to body experiences and basic emotions are described as analogous to concrete concepts/words because they are grounded in perceptual (i.e. propriosensitive) experience, while abstract concepts/words are considered more or less abstract depending on whether they are intratheoretical (and rely entirely on inferential information) or theoretical (and are partially grounded in perceptual – or more often in propriosensitive perceptual – information). In the last section of the chapter we consider two scales that have been used in psycholinguistic research to measure the degree of concreteness vs. abstractness of words and we show that – used conjointly – they can provide a measure of the internal vs. external grounding of specific words. (shrink)

In _Work and the Evolving Self_, Steven Axelrod begins to remedy this serious oversight by setting forth a comprehensive psychoanalytic perspective on work life. Consonant with his analytic perspective, Axelrod sets out to illuminate the workplace by examining the psychodynamic meaning of work throughout the life cycle. He begins by exploring the various dimensions of work satisfaction from a psychoanalytic perspective and then expands on the relationship between work life and the adult developmental process. This (...) developmental perspective frames Axelrod's central task: an examination of the typical work-related problems encountered in clinical practice, beginning with a psychodynamic definition of a "work disturbance." Moving on to treatment issues, Axelrod elaborates on the manner in which assessment, supportive, and exploratory interventions all enter into the treatment of work disturbances. Axelrod concludes by considering issues of career development that emerge in individual psychotherapy and exploring the psychological implications of dramatic changes now taking place in the workplace. As such, _Work and the Evolving Self_ is an impressive contribution to the task with which psychoanalytic therapists are increasingly engaged: that of broadening their identities and treatment approaches in a world that increasingly demands flexibility and innovation. (shrink)

_Clinical Interaction and the Analysis of Meaning_ evinces a therapeutic vitality all too rare in works of theory. Rather than fleeing from the insights of other disciplines, Dorpat and Miller discover in recent research confirmation of the possibilities of psychoanalytic treatment. In Section I, "Critique of Classical Theory," Dorpat proposes a radical revision of the notion of primary process consonant with contemporary cognitive science. Such a revised conception not only enlarges our understanding of the analytic process; it also (...) provides analysis with a conceptual language that can articulate meaningful connections with a growing body of empirical research about the development and nature of human cognition. In Section II, "Interactional Theory," Miller reverses the direction of inquiry. He begins with the literature on cognitive development and functioning, and proceeds to mine it for concepts relevant to the clinical process. He shows how a revised understanding of the operation of cognition and affect can impart new meaning to basic clinical concepts such as resistance, transference, and level of psychopathology. In Section III, "Applications and Exemplifications," Dorpat concludes this exemplary collaboration by exploring select topics from the standpoint of his and Miller's new psychoanalytic theory. At the heart of the authors' endeavor it "meaning analysis," a concept that integrates an up-to-date model of human information processing with the traditional goals of psychoanalysis. The patient approaches the clinical encounter, they argue, with cognitive-affective schemas that are the accumulatice product of his life experience to date; the manifold meanings ascribed to the clinical interaction must be understood as the product of these schemas rather than as distortions deriving from unconscious, drive-related fantasies. The therapist's goal is to make the patient's meaning-making conscious and thus available for introspection. (shrink)

Weaving together state-of-the-art research, theory, and clinical insights, this book provides a new understanding of the unconscious and its centrality in human functioning. The authors review heuristics, implicit memory, implicit learning, attribution theory, implicit motivation, automaticity, affective versus cognitive salience, embodied cognition, and clinical theories of unconscious functioning. They integrate this work with cognitive neuroscience views of the mind to create an empirically supported model of the unconscious. Arguing that widely used psychotherapies--including both psychodynamic (...) and cognitive approaches--have not kept pace with current science, the book identifies promising directions for clinical practice. Subject areas/Key words: unconscious processes, human consciousness, psychoanalysis, psychoanalytic theory, implicit learning, implicit memory, implicit motivation, automaticity, cognition, subconscious, psychodynamic psychotherapy, mind, computational neuroscience, empirical research Audience: Clinical psychologists, psychiatrists, psychoanalysts, and other mental health practitioners, as well as researchers and students of clinical and personality psychology and psychopathology. (shrink)

The recent process of deinstitutionalization of the psychiatric treatment system, in both Denmark and other European countries, has relied heavily on the involvement in treatment and recovery of cohabitant relatives of diagnosed people. However, political objectives regarding depression and involvement rely on a limited body of knowledge about people’s ways of managing illness-related problems in everyday life. Drawing on a discursive notion of gender laid out by Raewyn Connell, the aim of the article is to elucidate how the involvement (...) of relatives is guided by an extra- individual rationale about gender and caregiving, and how this gendered discourse might frame different challenges and burdens, depending on the gender of the diagnosed person and the cohabitant relative. Drawn from a larger, multisited field study on involvement processes in Danish psychiatry, t he article is based on field notes and 21 interviews with seven heterosexual couples. The analysis shows that gender works as a decisive premise for the division of caregiving labour among the couples, and clarifies how the couples’ gendered institution is disrupted after the onset of depression. The article argues that gender-blind involvement strategies could produce divergent treatment outcomes and varying social effects in relation to couples’ everyday family lives. (shrink)

The Hannover qualifying programme ‘ethics consultation in hospitals’, conducted by a four-institution cooperation partnership, is an interdisciplinary, scientifically based programme for healthcare professionals interested in ethics consultation services and is widely acknowledged by hospital managements and healthcare professionals. It is unique concerning its content, scope and teaching format. With its basic and advanced modules it has provided training and education for 367 healthcare professionals with 570 participations since 2003 (until February 2010). One characteristic feature is its attractiveness for health professionals (...) from different backgrounds. Internationally, the Hannover programme is one of the few schedules with both academics and non-academics as target groups and a high participation rate of physicians. The concept of the Hannover programme is in great demand, and its schedule is continuously optimised through evaluation. The goals of enabling healthcare professionals from different professional backgrounds to define and reflect ethical problems, to facilitate and support the process of decision-making and to work out structures for their own institutions seem to have been achieved. However, in order to obtain effective and sustainable results, participation in the programme should be supplemented regularly by in-house training sessions or individual expert consultations. Future challenges include new thematic courses and providing a network for former participants, especially when they come from non-academic hospitals. The network is a reasonable platform to discuss participants' experiences, successes and pitfalls. A further task will be research on how the programme's concept can support the sustainability of ethics structures in the various institutions. (shrink)

During the current financial crisis, the need for an alternative to a laissez-faire ethics of capitalism (the Milton Friedman view) becomes clear. I argue that we need an order ethics which employs economics as a key theoretical resource and which focuses on institutions for implementing moral norms. -/- I will point to some aspects of order ethics which highlight the importance of rules, e.g. global rules for the financial markets. In this regard, order ethics (“Ordnungsethik”) is the (...) complement of the German conception of “Ordnungspolitik” which also stresses the importance of a regulatory framework. This framework is needed not to tame the market, but to make it more profitable in the long run. -/- The conception of order ethics relies heavily on contractarianism, especially on James Buchanan’s work. Unlike many other conceptions of ethics, it does not start with an aim to achieve, but rather with an account of what the social world – in which ethical norms have to be implemented – is like. Our social world is different from the pre-modern one. Pre-modern societies played zero-sum games in which people could only gain significantly at the expense of others. And the types of ethics that we are still used to today have been developed within these pre-modern societies. -/- Modern societies, by contrast, can be characterised – by economists and other social theorists alike – as societies with continuous growth. This growth has only been made possible by the modern competitive market economy which enables everyone to pursue his own interests within a carefully devised institutional system. In this system, positive sum games are played, which makes it in principle possible to improve the position of every individual at the same time. Most kinds of ethics, however, resulting from the conditions of pre-modern societies, ignore the possibility of win-win-situations and instead require us to be moderate, to share, to sacrifice, as this would have been functional in zero-sum games. These conceptions distinguish – in more or less strict ways – between self-interest and altruistic motivation. Self-interest, more often than not, is ultimately seen as something evil. -/- Such an ethics cannot be functional in modern societies. Ethical concepts lag behind. Within zero-sum games, it was necessary to call for temperance, for moderate profits, or for a condemnation of lending money at interest. Within positive-sum games, however, the morally desired result of a social process cannot be brought about by changes in motivation, by switching from ‘egoistic’ to ‘altruistic’ motivation. The second theoretical element introduced by order ethics is the distinction between actions and rules, which was already mentioned. Traditional ethics concerns actions: It calls directly for changes in behaviour. This is a consequence of pre-modern conditions as reconstructed before: People in the pre-modern world were only able to control their actions, not so much however the conditions of their actions. In particular, rules like laws, constitutions, social structures, the market order, and also ethical norms have remained stable for centuries. In modern societies, this situation has changed entirely. The rules governing our actions have increasingly come under our control. -/- In this situation, ethics has to focus on rules. Morality must be incorporated in incentive-compatible rules. Direct calls for changes in behaviour without changes in the rules lead only to an erosion of compliance with moral norms. Individuals that continue to behave ‘morally’ will be singled out, because the incentives have not been changed. Moral norms which are to be justified cannot require people to abstain from pursuing their own advantage. People abstain from taking ‘immoral’ advantages only if adherence to ethical norms yields greater benefits over the planned sequence of actions than defection in the single case. Thus ‘abstaining’ is not abstaining in the long run, it is rather an investment in expectations of long-term benefits. By adhering to ethical norms, I become a reliable partner for interactions. The norms do indeed constrain my actions, but they simultaneously expand my options in interactions. And people consent to rules only if these rules hold greater advantages for them, at least in the long run. -/- In general, ethics cannot require people to abandon their individual calculation of advantages. However, it may suggest improving one’s calculation, by calculating in the long run rather than in the short run, and by taking into account the interests of our fellows, as we depend on their acceptance for reaching an optimal level of well-being, especially in a globalized world full of interdependence. -/- The problem of implementation can now be placed at the beginning of a conception of order ethics, justified with reference to the conditions of modern societies I have sketched. Under the conditions of pre-modern societies, an ethics of temperance had evolved that posed simultaneously the problems of implementation and justification. The implementation of well-justified norms or standards could then be regarded as unproblematic, because the social structures allowed for a direct face-to-face enforcement of norms. Pre-modern societies not only favored an ethics of temperance, they also had the instrument of face-to-face-sanctions within their smaller and non-anonymous communities. This instrument is no longer functional in modern anonymous societies, and so we have to face up to the problem of implementation right at the start of our ethical conception. Simultaneously, an order ethics relies on the implementation of sanctions for enforcing incentive-compatible rules. In modern societies, rules and institutions, to a large extent, must fulfil the tasks that were, in pre-modern times, fulfilled by moral norms, which in turn were sanctioned by face-to-face sanctions. Norm implementation in modern societies thus works by setting adequate incentives in order to prevent the erosion of moral norms, which would happen if ‘moral’ actors were systematically threatened with exploitation by other, less ‘moral’ actors. -/- This conception of order ethics is then elaborated further in the area of business ethics. -/- . (shrink)

For over thirty years, Lynne Layton has heeded the call for a social psychoanalysis and produced a body of work that examines unconscious process as it operates both in the social world and in the clinic. In this volume of Layton's most important papers, she expands on earlier theorists' ideas of social character by exploring how dominant ideologies and culturally mandated, hierarchical identity prescriptions are lived in individual and relational conflict. Through clinical and cultural examples, Layton (...) describes how enactments of what she calls 'normative unconscious processes' reinforce cultural inequalities of race, sex, gender, and class both inside and outside the clinic, and at individual, interpersonal, and institutional levels. Clinicians, academics, and activists alike will find here a deeper understanding of the power of unconscious process, and are called on to envision and enact a progressive future in which vulnerability and interdependency are honored and systemic inequalities dismantled. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict (...) or come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

The book deals with the complex notion of process worked out by Alfred N. Whitehead, a notion that includes his deep revision of the concepts of time and space. Throughout his whole career, Whitehead emphasized the importance of process for the account of reality. The book discusses Whitehead's concept of process starting from his works in mathematics, logic and epistemology of the natural sciences, in order to pave the way for a better understanding of Whitehead's speculative (...) philosophy. The focus is on the relationship between concrescence and transition, seen as deeply correlated and reciprocally determined. In this perspective, the book offers a reinterpretation of Whitehead's most enigmatic proposal: the event of subjectivity interpreted as a process of subjectivation. This poses the problem of the endurance of subjectivity. The book suggests that this problem is solved by Whitehead through is appropriation of Plato's notion of chora, seen as the "place" of a processual subject. (shrink)

This thesis mounts an attack against accounts of perceptual justification that attempt to analyze it in terms of evidential justifiers, and has defended the view that perceptual justification should rather be analyzed in terms of non-evidential justification. What matters most to perceptual justification is not a specific sort of evidence, be it experiential evidence or factive evidence, what matters is that the perceptual process from sensory input to belief output is reliable. I argue for this conclusion in the following (...) way. Chapter 1: The Arguments from HallucinationChapter 1 presents a skeptical argument from hallucination that starts from a premise about the alleged introspective indistinguishability of perception and hallucination, and concludes that perceptual knowledge is impossible. Underlying this argument are certain assumptions about the nature of perceptual justification, and different responses to the argument portray different views of perceptual justification. Evidentialism and dogmatism both reject the premise that appearances do not provide evidence sufficient for perceptual knowledge, although they disagree about the precise nature of the appearances. Epistemological disjunctivism rejects the premise that introspectively indistinguishable experiences provide the same evidence, while upholding the idea that some sort of evidence, namely factive evidence, is necessary for perceptual justification and knowledge. Process reliabilism rejects the premise that evidence is necessary for perceptual knowledge on the grounds that even perceptual justification can be obtained without evidence, as long as the cognitive process producing the belief is reliable.Chapter 2: EvidentialismChapter 2 starts by introducing some motivations for experientialist views of perceptual justification, such as evidentialism and dogmatism, which hold that conscious experiences evidentially justify perceptual beliefs. These motivations have to do with their ability to accommodate the New Evil Demon Intuition that demon-deceived subjects have justified perceptual beliefs and the Blindsight Intuition that blindsighters do not have justified perceptual beliefs. However, experientialist views are also faced with a Sellarsian dilemma: either experience is construed as non-propositional, but then the proposed evidential relation is unclear, or experience is construed as propositional, but then it is ad hoc to hold that they can evidentially justify without being justified themselves.Chapter 2 continues with a discussion of evidentialism, which grasps the first horn of this dilemma. I argue that evidentialism cannot adequately explain why a non-propositional experience constitutes evidence for this rather than that belief, and also does not provide any account of how to determine which belief fits an evidence-set which partly consists out of non-propositional experiences. Although a reliabilist version of evidentialism can provide a better account of these matters, it suffers from counter-intuitive predictions about justification and a conception of evidence that is so liberal that it could even include blindsighters and clairvoyants as having such evidence.Chapter 3: DogmatismChapter 3 focuses on variants of dogmatism, a theory of perceptual justification that grasps the second horn of the Sellarsian dilemma by holding that a perceptual experience with the content that p is sufficient for immediate prima facie justification of the belief that p. I first argue that dogmatism should identify perceptual experiences with high-level conscious states to accommodate the problem of novice vs. expert identification and the problem of the speckled hen. I then argue that this version of dogmatism still fails to meet a certain explanatory challenge which I dub the `Distinctiveness Problem'. Dogmatism should explain what is so distinctive about perceptual experience that enables it, in contrast with desire and imagination, to evidentially justify the belief that p without, in contrast with belief, being justified itself.Phenomenalist answers to this problem fail because they either do not provide a distinctive property of perceptual experience, or else provide a property that is reducible to or possibly caused by beliefs. In both cases, dogmatism would have the result that intuitively unjustifying experiences, such as imaginations, nevertheless become capable of justifying beliefs. Moreover, phenomenalists still need some explanation of why phenomenology is epistemically relevant at all.A new variant of the problem of the speckled hen is an intuitive illustration of this point against dogmatists. If a perceptual experience that p is not reliably connected to the fact that p or the belief that p, then beliefs based on this experience simply will not be intuitively justified. One possible response to this problem incorporates reliability into the content of experience in the sense that an experience cannot have the content that p if it is not reliably connected to both the fact that p and the belief that p. However, this will lose the motivation from the New Evil Demon Scenario, and will make large concessions towards reliabilism.Chapter 4: Epistemological DisjunctivismGiven these problems for experientialist views of perceptual justification, chapter 4 focuses on a different evidential account of justification: epistemological disjunctivism. According to the Justified True Belief version of Epistemological Disjunctivism, the fact that I see that p is the factive and reflectively accessible evidence in virtue of which I know that p. I argue that JTBED faces formidable problems: first, it cannot adequately deal with the basis problem, second, it cannot accommodate the New Evil Demon Intuition, third,it faces the problem of hyper-intellectualization, and fourth, it has no good account of reflective access.Knowledge First Epistemological Disjunctivism, in contrast, holds that seeing that p just is a way of knowing that p. The fact that I see that p constitutes my justification for believing that p, even though it is not necessary for my knowledge that p. Although this view solves most of the above problems, I argue that KFED still faces a challenge of its own: its notion of justification is so strong that justification entails knowledge but is not itself entailed by it. This means that it too faces a hyper-intellectualization objection because it cannot accommodate animal justification, and that it too will struggle to accommodate the New Evil Demon Intuition.Nevertheless, there is something to the epistemological disjunctivist idea that higher-order capabilities are important to perceptual justification. Specifically, higher-order capabilities provide one with a way of accommodating the Blindsight Intuition without appealing to the notion of experiential evidence: blindsighters are epistemically worse off than normal human perceivers because they lack higher-order beliefs about how they are gaining their information. If one holds that these higher-order beliefs provide a special sort of justification for perceptual beliefs, then blindsighters lack this type of justification. Chapter 5: Process ReliabilismAfter displaying the problems of several evidential accounts of perceptual justification, chapter 5 introduces a non-evidential account: process reliabilism. The classic version of this view holds that the reliability of a belief-forming process is necessary and sufficient for the prima facie justification of a specific set of beliefs, namely, those that arise out of belief-independent processes. Two classic major problems for this view consist of counterexamples to both the necessity and sufficiency of reliability for justification. Although the Generality Problem raises some difficulties for reliabilism, they do not appear to be insurmountable.The second part of chapter 5 focuses on a variety of process reliabilism, inferentialist reliabilism, that is explicitly aimed at responding to clairvoyance cases. According to inferentialist reliabilism, one should distinguish between basic and non-basic beliefs, where basic beliefs are those that result out of the non-inferential operation of an inferentially opaque cognitive system that developed in a natural way. Reliability is only sufficient for the justification of basic beliefs, while non-basic beliefs also require conditional reliability and justification of the beliefs on which they are based.This distinction between basic and non-basic beliefs is meant to answer the challenge arising out of clairvoyance cases because these are all supposedly cases in which the resulting beliefs arenon-basic. However, I argue that the beliefs in these cases come out as non-basic primarily because of the etiological constraint on cognitive systems, a constraint that is unfortunately undermotivated. It seems that beliefs can be justified even if they are produced by a cognitive system that developed by accident, or by a system that was artificially designed to produce those beliefs. So even though the inferentialist reliabilist might have a point in distinguishing between basic and non-basic beliefs, it is still in need of a different response to clairvoyance cases. Chapter 6: Rejoinders for ReliabilismChapter 6 improves on the inferentialist reliabilist account of justification by presenting a different way of dealing with the clairvoyance cases and New Evil Demon Scenario. I start from the empirically plausible idea that we know that we are perceiving when we are perceiving, not because of the use of experiential evidence, but rather, because of an unconscious source-monitoring mechanism. I then argue that the existence of such a source-monitoring mechanism could be used to explain why clairvoyance cases actually have to do with defeat rather than absence of prima facie justification: beliefs that pop up in our head should be recognized as stemming from untrustworthy sources, and so we acquire defeating higher-order beliefs about the first-order beliefs. I also argue that this defeat should be able to occur even if the higher-order beliefs are themselves unjustified. This defeater-account of clairvoyance is preferable to several externalist alternatives. Making reliability relative to a specific world seems rather ad hoc, and further requirements on justification, such as evidence-based belief, cognitively integrated belief, or properly produced belief, all appear unnecessary and are susceptible to adapted versions of the clairvoyance case.I further argue for an alternative inferentialist reliablist response to the New Evil Demon Intuition which treats it as mistaken rather than correct. The New Evil Demon Intuition might arise because of a mistaken view of actual perceptual justification as having to do with experiential evidence. This mistaken view could be explained by the fact that experience is actually reliably connected to belief and is often cited in response to a knowledge-challenge. If this is a correct analysis of the New Evil Demon Intuition, then there is an element of question-begging involved when this scenario is still pressed against inferentialist reliabilists who do not adhere to the experientialist assumption it presupposes.With the inferentialist reliabilist account in hand,we are able to see that many of the premises of the epistemological argument from hallucination are problematic. Evidence does not appear to be required for perceptual knowledge, as perceptual justification does not even require such evidence. Moreover, if we accept a reliabilist model of introspection, then we are often able to know on the basis of introspection that we are perceiving rather than hallucinating. Once one gets clear about the alternatives, it becomes apparent that the argument thrives on internalist assumptions about justification and knowledge that one need not accept. (shrink)

The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent—or informed refusal—is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee (...) to serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. (shrink)

In this profound and subtle study, a practising psychoanalyst explores the dynamics of the interaction between the patient and the analyst. Michael Feldman draws the reader into experiencing how the clinical interaction unfolds within a session. In doing so, he develops some of the implications of the important pioneering work of such analysts as Klein, Rosenfeld and Joseph, showing in fine detail some of the ways in which the patient feels driven to communicate to the analyst, not only (...) in order to be understood by him, but also in order to affect him. The author's detailed descriptions of the clinical process allow the reader to follow the actual process that enables the patient to get into contact with thoughts and feelings of which he or she was previously unconscious or only vaguely aware. Feldman makes the reader aware of the constant dynamic interaction between the patient and the analyst, each affecting the other. He shows how the analyst has to find a balance between doubt, uncertainty and confusion in himself and through this process may arrive at an understanding of what is happening, and by formulating this understanding the analyst can make a significant contribution to the process of psychic change. This collection of essays not only throws light on fascinating questions of technique, but also reflects on elements that are fundamental to psychoanalytic work. It is essential reading for practising psychoanalysts and those in training, as well as anyone with a general interest in the psychoanalytic relationship between the client and the therapist in the consulting room. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Searle and the ‘Deep Unconscious’”Dan Lloyd (bio)Can another person know my thoughts with better authority than I know them myself? With his affirmative answer to this question, Freud invented the twentieth-century human, a being whose mind is accessible to scrutiny from outside, and whose attempts at conscious self-explanation are at best partial and in many cases wrong. Even as Freud’s scientific influence wanes, the shift of (...) authority he inaugurated is still gathering strength. Now the mind is open to many outsiders. Not only psychoanalysts, but behaviorists, cognitive scientists, and neuroscientists are all striving to read my mind, and yours. Against this historical sea change stands the solitary John Searle, whose work is consistently animated by fierce adherence to first person authority and surly attacks of any theory that could be exploited to undermine that authority. To most readers Searle’s positions seem stubbornly anti-scientific and covertly dualistic, despite his insistence to the contrary. And since science is good and dualism is bad, Searle’s arguments have become standing obstacles for theorists to discuss, debate, or dismiss.Buttressing his insistence on first person authority, Searle defends a Cartesian view of mental representation or intentionality, holding that an intentional entity is a conscious entity, either in actuality or potentiality. Deeply unconscious representations are therefore impossible. Eric Gillett has joined the debate just here with a pointed critique of Searle’s argument (also discussed in Lloyd 1990). Gillett performs a double service by challenging Searle’s premises and offering some positive grounds for the deep unconscious. I agree with Gillett that establishing the existence of deeply unconscious representations requires a theory of intentionality that is independent of conscious awareness. Ruth Millikan’s evolutionary teleology is an excellent candidate, in its pursuit of real function and real content (vs. “as-if” interpretation) for mental items.Some questions remain. First, if deeply unconscious entities are clinically important, then in addition to a defense-in-principle of their existence we will need some method of identifying specific deep representations in particular cases. Millikan’s functionalism links content to broad biological and environmental contexts, and thereby seems to be an unwieldy tool for content ascription. If deeply unconscious representations get their content in the way Millikan describes, how can the clinician make use of them?Second, and more important, Millikan’s theory shares with many others the ambition to explain all intentional entities, conscious and unconscious alike. This leads to a new dualism of mental contents, a split between intentional content and conscious content, since the comprehensive theory of intentionality will assign mental content both [End Page 201] shallow and deep, irrespective of consciousness. This is a perplexity that transcends particular theories of intentionality, since what my mental states represent seems at least partly dependent on my environment or context, but my current state of consciousness is exclusively dependent on my brain. How, in theory, can these two concepts of content be reconciled?In sum, deeply unconscious representations do not come cheap. One way to escape the new dualism of content is to deny that the deep entities are representations. Instead, they might be dispositions or the “mechanisms, instinctual drives, structures, and energies which can never become conscious under any conditions,” as Gillett suggests. (In Lloyd 1994 I explore the possibility of a dispositional unconscious understood via connectionism.) On this view, mental content could remain within our first person authority, while the causal processes that manage that content remain out of sight. I wouldn’t have to guess what I’m thinking, but I would depend on the sciences of the mind to tell me how I come to think it.Related ArticlesFeature Article: Searle and the "Deep Unconscious"Commentary: Commentary by LloydDan Lloyd Dan Lloyd, Department of Philosophy, Trinity College, Hartford, CT 06106, U.S.A.ReferencesLloyd, D. 1990. Loose connections: Four problems with Searle’s argument for the ‘Connection Principle.’ Behavioral and Brain Sciences 13: 615–16. Google ScholarLloyd, D. 1994. Connectionist hysteria: Reducing a Freudian case study to a network model. Philosophy, Psychiatry, & Psychology 1, no. 2: 69–88. Google ScholarCopyright © 1996 The Johns Hopkins University Press... (shrink)

Characterizing the relationships between conscious and unconscious processes is one of the most important and long-standing goals of cognitive psychology. Renewed interest in the nature of consciousness — long considered not to be scientifically explorable —, as well as the increasingly widespread availability of functional brain imaging techniques, now offer the possibility of detailed exploration of the neural, behavioral, and computational correlates of conscious and unconscious cognition. This entry reviews some of the relevant experimental work, highlights the (...) methodological challenges involved in establishing the extent to which cognition can occur unconsciously, and situates ongoing debates in the theoretical context provided by current thinking about consciousness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Martin Heidegger and OntologyEmmanuel Levinas (bio)The prestige of Martin Heidegger 1 and the influence of his thought on German philosophy marks both a new phase and one of the high points of the phenomenological movement. Caught unawares, the traditional establishment is obliged to clarify its position on this new teaching which casts a spell over youth and which, overstepping the bounds of permissibility, is already in vogue. For once, (...) Fame has picked one who deserves it and, for that matter, one who is still living. Anyone who has studied philosophy cannot, when confronted by Heidegger’s work, fail to recognize how the originality and force of his achievements, stemming from genius, are combined with an attentive, painstaking, and close working-out of the argument—with that craftsmanship of the patient artisan in which phenomenologists take such pride. In this study, it is important for us to understand, above all, the true intentions of our author, to illuminate what he thinks really needs to be said, and to surmise what is most critical for him.To get to the heart of Heidegger’s system, it seems fitting to begin with a problem that is generally familiar. We choose the problem of knowledge, a deeper understanding of which takes us to the very threshold of Heidegger’s thought. For this problem, central to modern philosophy, is one of the main obstacles of modern philosophy that Heidegger wishes to surmount. Neo-Kantianism, which takes knowledge as the philosophical problem of the first rank, is the movement against which Heidegger rebels with all his strength. We have, thus, every chance of gaining access to his thought by the main door, so to speak. Once inside the system we will try to trace its outlines, 2 reserving, for a second part of our work, the determination of Heidegger’s place in the history of ideas, especially in the phenomenological movement, as well as of his relations with the philosopher to whom he owes so much—Edmund Husserl. 31In its most general form, the problem of the theory of knowledge has a critical significance. It consists in delineating a domain where knowledge can be certain and in determining the criteria for the legitimate scope of knowledge. But this problem, as normal and as simple as it may appear, has deeper roots. That knowledge should need a criterion at all presupposes that truth is not identical to all that is known and that the course [End Page 11] of things can fail to correspond with the course of thought. “How does knowledge correspond to being?” is a more profound formulation of the problem of knowledge.But we are not going to touch anymore on the primordial phenomenon that generates the problem. The problem of correspondence between thing and thought presupposes a free activity of thought and its isolation in relation to the object. It is precisely this presupposition which renders their harmony and even their contact problematic. “How does the subject take leave of itself to attain the object?” is what the problem of knowledge, in the last analysis, boils down to. Its true source is thus the concept of “subject” as elaborated by modern philosophy. The cogito presided over the subject’s birth. The cogito was the affirmation of the privileged nature of the subject’s immanent sphere, of its unique place in existence; hence, the cogito was the specificity of the subject’s connection to the rest of reality, the sui generis nature which opens up the passage from immanence to transcendence, the passage from ideas contained in the thinking substance to 4 their “formal existence.”The concept of the subject, understood as a substance having a specific position in the entire domain of being, presents us with difficulties of two kinds. First, how do we understand this leave-taking from the self which the thinking substance brings about and which displays an entirely original aspect? Indeed, we could say that thought, in reaching out toward objects, does not actually take leave of itself, since its objects—considered as ideas and contents of thought—are, in a certain sense, already within it. In order to make sense of this paradox, Descartes... (shrink)

Debates over affirmative action are often frustratingly uninformative and inconclusive. In this work Capaldi goes beyond criticizing that policy to clarify why the debaters miss each other's points. He begins by attacking affirmative action and establishes the need to explore the theory supporting it. Following this exploration he concludes that this policy involves dangerous fundamental changes in the structure of society and outlines a response. The timing of the publication of the book was such that it was unable to (...) take into account the Grove City decision. Its analysis of the kinds of thought characteristic of both sides of the debate, however, is very useful when examining the current debate over the appropriate response to that decision. (shrink)

In the public interest: autonomy and resistance to methods of standardising nurses’ advice and practices from a health call centre in Perth, Western Australia The history of nursing is replete with examples of nurses battling for autonomy over their education, knowledge and work practices. The latest battleground is HealthDirect, Australia's first medial call centre, where nurses are required to meet externally imposed clinical standards while satisfying legal and financial obligations. These objectives are arguably achieved when nurses assess callers’ (...) health problems via computerised algorithms that determine an appropriate plan of action. That way, nurses’ subjective responses to callers are ruled out. To ensure nurses comply with the standard processes, calls are monitored randomly and surreptitiously in formal and informal ways. This paper explores how nurses respond to standard procedures and surveillance, in order to argue that nurses’ input partially drives reform processes. Nurses continue to seek autonomy over the advice they give and how their work is evaluated but are constrained by structural power relations. (shrink)

We think less than we think. My thesis moves from this suspicion to show that standard accounts of intentional action can't explain the whole of agency. Causalist accounts such as Davidson's and Bratman's, according to which an action can be intentional only if it is caused by a particular mental state of the agent, don't work for every kind of action. So-called automatic actions, effortless performances over which the agent doesn't deliberate, and to which she doesn't need to pay (...) attention, constitute exceptions to the causalist framework, or so I argue in this thesis. Not all actions are the result of a mental struggle, painful hesitation, or the weighting of evidence. Through practice, many performances become second nature. Think of familiar cases such as one's morning routines and habits: turning on the radio, brushing your teeth. Think of the highly skilled performances involved in sport and music: Jarrett's improvised piano playing, the footballer's touch. Think of agents' spontaneous reactions to their environment: ducking a blow, smiling. Psychological research has long acknowledged the distinctiveness and importance of automatic actions, while philosophy has so far explained them together with the rest of agency. Intuition tells us that automatic actions are intentional actions of ours all the same (I have run a survey which shows that this intuition is widely shared): not only our own autonomous deeds for which we are held responsible, but also necessary components in the execution and satisfaction of our general plans and goals. But do standard causal accounts deliver on the intentionality of automatic actions? I think not. Because, in automatic cases, standard appeals to intentions, beliefs, desires, and psychological states in general ring hollow. We just act: we don't think, either consciously or unconsciously. On the reductive side, Davidson's view can't but appeal to, at best, unconscious psychological states, the presence and causal role of which is, I argue, inferred from the needs of a theory, rather than from evidence in the world. On the non-reductive side, Bratman agrees, with his refutation of the Simple View, that we can't just attach an intention to every action that we want to explain. But Bratman’s own Single Phenomenon View, appealing to the mysterious notion of 'motivational potential', merely acknowledges the need for refinement without actually providing one. So I propose my own account of intentional action, the 'guidance view', according to which automatic actions are intentional: differently from Davidson and Bratman, who only offer necessary conditions in order to avoid the problem of causal deviance, I offer a full-blown account: E's phi-ing is intentional if and only If phi-ing is under E's guidance. This account resembles one developed by Frankfurt, with the crucial difference that Frankfurt – taking 'acting with an intention' and 'acting intentionally' to be synonymous – thinks that guidance is sufficient only for some movement being an action, but not for some movement being an intentional action. I argue that, on the other hand, Frankfurt's concept of guidance can be developed so that it is sufficient for intentional action too. In Chapter One I present and defend my definition of ‘automatic action’. In Chapter Two I show that such understanding of automatic actions finds confirmation in empirical psychology. In Chapter Three I show that Davidson's reductive account of intentional action does not work for automatic actions. In Chapter Four I show that the two most influential non-reductive accounts of intentional action, the Simple View and Bratman's Single Phenomenon View, don't work either. And in Chapter Five I put forward and defend my positive thesis, the 'guidance view'. Also, in the Appendix I present the findings of my survey on the intentionality of automatic actions. (shrink)

This article seeks to demonstrate the centrality of maintenance and repair to an understanding of modern societies and, particularly, cities. Arguing that repair and maintenance activities present a kind of 'missing link' in social theory, which is usually overlooked or forgotten, the article begins by recalling Heidegger's concept of material things as being 'ready to hand'. The main elements of practices of repair and maintenance are then elaborated on so as to help establish the argument that, by focusing on failure (...) and breakdown in technical artefacts and systems, their vital contribution can be brought to the fore. The article then moves on to suggest that prevailing cultural constructions, and imaginations, of the 'infrastructure' that sustains modern societies, actively work to push repair and maintenance activities beyond the attention of social science. To exemplify these arguments, the article explores in detail some of the repair and maintenance activities that sustain, first, the nexus between computer communications and electricity and, second, the system of automobility. The article concludes by excavating a politics of repair and maintenance in modern cities and societies. (shrink)

This paper argues that the innovation of an ordering source parameter in the standard Lewis-Kratzer semantics for modals was a mistake, at least for English auxiliaries like ‘ought’, and that a simpler dyadic semantics (as proposed in my earlier work) provides a superior account of normative uses of modals. I programmatically investigate problems arising from (i) instrumental conditionals, (ii) gradability and “weak necessity”, (iii) information-sensitivity, and (iv) conflicts, and show how the simpler semantics provides intuitive solutions given three basic (...) moves: (1) an end-relational analysis of normative modality, (2) a “most” analysis of “weak necessity”, and (3) well-motivated appeals to pragmatics. I conclude with metasemantic observations about the desiderata for a semantics for ‘ought’. (shrink)

_Intersubjective Processes and the Unconscious _looks at how the minds of the therapist and the patient interact with each other in a profound and unconscious way: a concept first described by Freud. This book expands Freud’s ideas further and examines how these have been greatly elaborated by contributions from the Kleinian School as well as from the work of Bion. It explores how, together, patient and therapist co-create a narrative through these unconscious intersubjective processes. Topics of (...) discussion include: the unconscious dimensions of intersubjective processes an historical overview of Freudian, Kleinian and Bionian contributions an integrated theory of the nature of unconscious intersubjective processes the central importance of dreaming in intersubjective processes the clinical implications of this intersubjective model The author offers in-depth clinical examples and case vignettes to illustrate the application of these principles when working with trauma, countertransference dreams and supervision. As such, this book will be invaluable to all psychoanalysts and psychotherapists interested in the topic of intersubjectivity as well as those who want to learn more about the interactional dimensions of Freud, Klein and Bion. (shrink)

Can we learn without consciousness? When the eminent neuropsychologist, Lawrence Weiskrantz first coined the term 'blindsight' to describe a condition whereby a patient could demonstrate that they were aware of some object, yet insist that they were completely unaware of its existence, the response from some in the scientific community was one of extreme skepticism. Even now, there are those who question the existence of unconscious learning, and the topic remains one of the most actively researched and debated in (...) psychology. In recent years evidence for unconscious processing across a range of sensory modalities have come from studies of vision, audition, memory, emotion, and action. Never before have these studies of unconscious processing in the different senses been brought together into a single volume. In a book dedicated to Lawrence Weiskrantz, some of the leading psychologists and cognitive neuroscientists of the day explain what we know about unconscious processing in the different senses. Including contributions from, amongst others, David Milner, Jon Driver, Alan Cowey, and Ray Dolan, the book presents a state of the art account of what we now know about 'the unconscious'. The book will provide a fascinating account for students and researchers in psychology, cognitive neuroscience, and philosophy. (shrink)

The article provides a philosophical reconstruction of the composition of key motives in the phenomenological project of Mark Richir, who is known for his criticism of the symbolic institution. Following Richir’s deep inspiration in Schelling’s philosophy allows to find connections between his theory of the phenomenological unconscious and affectivity, his commentaries concerning Greek mythology and mythological thinking in La Naissance de Dieux—and his political theory. Along with general historical and philosophical comments on a number of translations of Schelling into (...) French, Richir repeatedly refers to Schelling in his own theoretical arguments. The research shows how some of Richir’s concepts — in particular, his interpretation of the phenomenological unconsciousness, myth, the Protean nature of power, the change of grand epochs as a change of types of the symbolic institutions of power—can be understood on the basis of relevant passages from Schelling’s philosophy, and how a semantic genealogical connection between them can be built. By considering the importance of the phenomenological unconsciousness in the course of phenomenalization process as described in Richir’s works, it is proposed to contrast the interpretation of the unconsciousness, which retains its simple mystery and the ways of dealing, with it in Richir’s version: while psychoanalysis is striving for the “disenchantment” of the unconsciousness by means of translating it into the symbolic language and transferring the living potentiation of meaning into the reproduction of a symptom. Richir’s phenomenological appeal to mythology turns out to be a non-trivial shift from theoretical philosophy to practical philosophy. The article also pays attention to the theory of power in Richir and Lefort, which presumably dates back to La Boétie. It is proposed to reveal the antithesis of the imaginary policy of the despot proposed by Richir, reproducing the symbolic institution of power and supporting the transcendental illusion of the need for control and order in the form of a kind of “hypnosis”—and real politics as a praxis of freedom. (shrink)

: The key concept is "vertigo of secularization." It relates to the fears that societies experience when understanding the need to ground their political orders as separated from religion. The erosion of values produces vertigos around the world. We need to understand better these kinds of processes because only by doing so can we keep that fear and violence from taking precedence over the hard working tasks of building up a global political community.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt (...) to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision‐making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real‐life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt (...) to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement‐based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Clinic as Testing Ground for Moral Theory: A European ViewHans-Martin Sass (bio)A Philosopher’s View of Theory in the Clinical SettingThe clinic is a testing ground for theories. I am not clinician; I am a philosopher who has been in the clinic only as a patient or as an ethicist who never has had the final word nor was ever intended to have the final word. I have (...) learned that in the clinical setting general norms and conceptualizations in the Kantian sense must be tailored to real-life situations. From the philosophical schools of analytical reasoning, I learned the skills needed to analyze words and meanings and to dissect problems and so-called “solutions.” But even more impressive are the methodological skills of differential diagnosis, looking at medical problems from different angles and using different methods and instruments. The detail- and patient-oriented work of the clinician provides an excellent model of methodological clarity and professional devotion for a philosopher who assists those working for the “good of the patient.” That model has led to the development of what I call a theory and methodology of differential ethics. [End Page 351]Differential ethics is normative ethics, as it does not give up norms in favor of situational utility. Differential ethics does not venture out empty-handed in order to explore and find principles pre-existing in a given situation; rather it brings basic values and principles along with it and tries to discover the shape they must take and the priority they must be given in the situation at hand. Differential ethics differentiates between general norms and mid-level principles, virtues, and visions that must be introduced and protected effectively and specifically according to different scenarios (Sass 1993). From this European point of view, I shall briefly explain my position and comment on (1) the controversy between principlism and virtue theory, (2) differentiating and balancing, and (3) the importance of trust, both as a principle and as a virtue in the clinical setting.Principlism Versus Virtue Theory: A Mistaken ControversyFrom a European perspective, I find that the debate between the schools of virtue-theory and principlism in the United States is a mistaken controversy. The real conflict between the schools of thought is not methodology, but content. Tom Beauchamp (1995) gives examples of how one language or method can be translated into the other, and Edmund Pellegrino and David Thomasma (1988, p. 206) have formulated a rule for the virtuous physician that, in the language of principlism, reads “respect for autonomy,” but in the language of virtue theory reads “To assist my patients to make choices that coincide with their own values or beliefs, without coercion, deception, or duplicity.”In different situations, however, some systems of reference are more authoritative and effective than others. Appealing to professional virtues would be the most efficacious way to address an audience coherent in attitudes and concerned about personal character. Reaffirmation of personal and professional obligations in secular fraternities or religious communities works best when it includes an appeal to virtues in the language of the humanist tradition, moral theology, or professional ethics.But there are other situations in which authoritative attitudes and expectations are absent and society in general is searching for common, often dormant, principles that will hold it together whatever specific disagreements arise. Such a situation was present in 1978 when the Belmont Report (National Commission 1978) presented principles—respect for autonomy, nonmaleficence, beneficence, justice—and not virtues to guide moral and political reflections on and reactions to the ethical, legal, and social implications of modern biomedicine in a multi-faceted and multi-cultural society.The formal difference between the systems of principlism, virtue theory, and value theory becomes even less important when clinical-ethical questionnaires are used to understand specific scenarios or cases and to assess different options for proceeding. Thus, my first thesis is: Case discussion, scenario assessment, [End Page 352] and open questionnaires, rather than definite guidelines, bridge the difference between virtue theory and principlism, since such processes can employ any one language or a combination of all three.Differentiating and BalancingMy second thesis is: Whatever system of reference is used... (shrink)

Stuart Kauffman here presents a brilliant new paradigm for evolutionary biology, one that extends the basic concepts of Darwinian evolution to accommodate recent findings and perspectives from the fields of biology, physics, chemistry and mathematics. The book drives to the heart of the exciting debate on the origins of life and maintenance of order in complex biological systems. It focuses on the concept of self-organization: the spontaneous emergence of order widely observed throughout nature. Kauffman here argues that self-organization (...) plays an important role in the emergence of life itself and may play as fundamental a role in shaping life's subsequent evolution as does the Darwinian process of natural selection. Yet until now no systematic effort has been made to incorporate the concept of self-organization into evolutionary theory. The construction requirements which permit complex systems to adapt remain poorly understood, as is the extent to which selection itself can yield systems able to adapt more successfully. This book explores these themes. It shows how complex systems, contrary to expectations, can spontaneously exhibit stunning degrees of order, and how this order, in turn, is essential for understanding the emergence and development of life on Earth. Topics include the new biotechnology of applied molecular evolution, with its important implications for developing new drugs and vaccines; the balance between order and chaos observed in many naturally occurring systems; new insights concerning the predictive power of statistical mechanics in biology; and other major issues. Indeed, the approaches investigated here may prove to be the new center around which biologicalscience itself will evolve. The work is written for all those interested in the cutting edge of research in the life sciences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 87-94 [Access article in PDF] Talk and the Nature of Delusions:Defending Sociocultural Perspectives on Mental Illness Eugenie Georgaca Keywords discourse, social constructionism, delusions, psychosis, mental illness, context It is very pleasing to see writers from philosophy, psychiatry and psychology, the three disciplines represented by this journal, debating the issue of delusions. The majority of the papers in this volume set out to determine (...) the underlying mechanisms responsible for delusions. As such, they offer themselves as discussions of the etiological factors of the formation and maintenance of delusions. My paper analyzes the interactional presentation and negotiation of statements that would be considered as delusional. This led some commentators (Ghaemi 2004; Sass 2004) to argue that the analysis of talk about delusions is useful, but cannot be extended to claims about the nature of delusions. In the following section, I discuss the ways in which analyzing interactions can be useful in clinical research and practice. Subsequently, I identify and critically discuss the assumptions about the nature of delusions that underlie these criticisms and the majority of the papers in this volume. The Usefulness of the Study of Interaction My paper can be seen as part of a growing body of studies that attempt to elucidate the role of interactional and discursive processes in the identification and management of disorders (Barrett 1988; Coulter 1975; Hak 1989; Pollner 1975; Smith 1978; Soyland 1994). Microsociological and ethnographic studies look at the properties of client-professional interaction with the aim of clarifying the tacit skills and knowledges used in such encounters. Palmer (2000), for example, argues that the recognition of disorder is a social and interactional issue both in the sense that the judgment of disorder is based on social criteria and in the sense that diagnosis is an interpersonal process with its own inherent social order. The aim, therefore, of analyzing professional-client interactions would be to articulate the properties of this implicit social order. Other researchers argue that diagnosis is not a process of identification or recognition of disorder, but rather a process of active construction of disorder and of transforming the person to a mental patient. Barrett's (1988) analysis of the transformation of a [End Page 87] person to a "person suffering from schizophrenia" and subsequently a "schizophrenic" through interviewing and report writing is an excellent example of this kind of work.The application of this approach to the field of delusions would attempt to address the issue of how delusions are diagnosed and managed through the interactions between the delusional patient and the clinician. In this paper and in previous work (Georgaca 1996, 2000) I showed that statements that have been diagnosed as delusional are presented and argued through using appropriate conversational strategies, drawing on socially meaningful systems of knowledge and applying appropriate rules of evidence. Moreover, I argued that there was no way in which these disagreements over competing versions of reality could be definitely settled conversationally, and that instances of breakdown in communication were due not to the delusional version being proven wrong, but to lack of explanatory frameworks within which the competing versions could be negotiated. At least in the exchanges analyzed, the criteria of implausibility, conviction, and incorrigibility were shown not to apply.Clinicians do not customarily investigate the truth of patient claims against empirical data (Maher 1992), which means that they have to judge claims on the basis of the patient's presentation in the diagnostic interview. Because there are no technical guidelines for the assessment of truth and falsity, plausibility and implausibility, rationality and irrationality, clinicians have to rely on personal judgment. The question then is on what grounds the clinician's personal judgment is granted the status of determining the truth of someone else's claim and in what capacity clinicians are called to make such decisions. I will not pursue this argument any further here. The point I want to make is that the analysis of professional-client interactions foregrounds the active role of professionals in clinical decisions and questions the criteria upon which decisions are... (shrink)

Social studies of interdisciplinary science investigate how scientific collaborations approach complex challenges that require multiple disciplinary perspectives. In order for collaborators to meet these complex challenges, interdisciplinary collaborations must develop and maintain integrative capacity, understood as the ability to anticipate and weigh tradeoffs in the employment of different disciplinary approaches. Here we provide an account of how one group of interdisciplinary fog scientists intentionally catalyzed integrative capacity. Through conversation, collaborators negotiated their commitments regarding the ontology of fog systems and (...) the methodologies appropriate to studying fog systems, thereby enhancing capabilities which we take to constitute integrative capacity. On the ontological front, collaborators negotiated their commitments by setting boundaries to and within the system, layering different subsystems, focusing on key intersections of these subsystems, and agreeing on goals that would direct further investigation. On the methodological front, collaborators sequenced various methods, anchored methods at different scales, validated one method with another, standardized the outputs of related methods, and coordinated methods to fit a common model. By observing the process and form of collaborator conversations, this case study demonstrates that social studies of science can bring into critical focus how interdisciplinary collaborators work toward an integrated conceptualization of study systems. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind the (...) Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

Background Increasing social pluralism adds to the already existing variety of heterogeneous moral perspectives on good care, health, and quality of life. Pluralism in social identities is also connected to health and care disparities for minoritized patient (i.e. care receiver) populations, and to specific diversity-related moral challenges of healthcare professionals and organizations that aim to deliver diversity-responsive care in an inclusive work environment. Clinical ethics support (CES) services and instruments may help with adequately responding to these diversity-related moral (...) challenges. However, although various CES instruments exist to support healthcare professionals with dealing well with morally challenging situations in healthcare, current tools do not address challenges specifically related to moral pluralism and intersectional aspects of diversity and social justice issues. This article describes the content and developmental process of a novel CES instrument called the Diversity Compass. This instrument was designed with and for healthcare professionals to dialogically address and reflect on moral challenges related to intersectional aspects of diversity and social justice issues that they experience in daily practice. Methods We used a participatory development design to develop the Diversity Compass at a large long-term care organization in a major city in the Netherlands. Over a period of thirteen months, we conducted seven focus groups with healthcare professionals and peer-experts, carried out five expert interviews, and facilitated four meetings with a community of practice consisting of various healthcare professionals who developed and tested preliminary versions of the instrument throughout three cycles of iterative co-creation. Results The Diversity Compass is a practical, dialogical CES instrument that is designed as a small booklet and includes an eight-step deliberation method, as well as a guideline with seven recommendations to support professionals with engaging in dialogue when they are confronted with diversity-related moral challenges. The seven recommendations are key components in working toward creating an inclusive and safe space for dialogue to occur. Conclusions The Diversity Compass seeks to support healthcare professionals and organizations in their efforts to facilitate awareness, moral learning and joint reflection on moral challenges related to diversity and social justice issues. It is the first dialogical CES instrument that specifically acknowledges the role of social location in shaping moral perspectives or experiences with systemic injustices. However, to make healthcare more just, an instrument like the Diversity Compass is not enough on its own. In addition to the Diversity Compass, a systemic and structural approach to social justice issues in healthcare organizations is needed in order to foster a more inclusive, safe and diversity-responsive care and work environment in health care organizations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spiritually Bilingual:Buddhist Christians and the Process of Dual Religious BelongingJonathan HomrighausenSociologists studying convert Buddhism in America have found that a surprisingly large number of Buddhists also identify as Christian.1 However, little empirical literature examines these Buddhist-Christian “dual religious belongers.”2 This study aims to fill that gap. Based on extensive interviews with eight self-identified “Buddhist Christians” of varying levels of doctrinal and experiential understanding, this study examines the conversion (...) process of these dual belongers and how they combine these religious traditions. Building on Michael von Brück’s contention that one’s first religion is like a mother tongue, I compare taking on a second religious tradition to learning a second language.3 As practitioners become more “fluent” in the second religion, they differentiate the two religions more clearly while combining them more seamlessly in their daily lives.methodologyThis study employs grounded theory and a qualitative, inductive methodology. Grounded theory is designed to elucidate the dynamic changes involved in a social process, with rich descriptions of categories and explanations for variations between different people’s experiences.4 While the use of qualitative methods with a small sample size means that my results have little statistical significance, such methods have been used in recent research on conversion and dual belonging and yield deep theoretical insight.5Eight participants for this study were solicited via word of mouth, personal acquaintance, and posting in a Buddhist-Christian Yahoo Group. In particular, I focused on Buddhist-Catholic practitioners to limit my sample group. Interviews were conducted and recorded in person or on the phone over a three-month period in fall, 2011. Interviews were open-ended, each lasting from sixty to ninety minutes. Several participants later received a draft of the paper to ensure they felt adequately represented; five participants responded. Names of participants have been changed for [End Page 57] confidentiality. To complement these interviews, I also incorporate written accounts of Buddhist-Christian conversion from both Catholic and Protestant authors.6participants’ backgroundsIt can be difficult to define Buddhist identity in the West, as many people who regularly practice meditation in a sangha do not self-identify as Buddhist.7 This study focuses on those who both practice Buddhist and Christian spirituality and belong to religious groups of both traditions. The eight participants have a range of religious expertise and commitment to both traditions. In terms of Catholic identity, six are laypeople (one in a secular religious order), one a priest, and one a nun. Three participants are theology professors. Seven have been Catholics from birth. One spent a decade living in a Buddhist monastery, two of them are roshis, and five give Buddhist teaching or meditation instruction formally. Seven of them practice various forms of Ch’an or Zen, while one practices Tibetan Buddhism.Cathy went not from Catholicism to Buddhism, but from Buddhism to Catholicism. A former Mormon and Unitarian, she began learning meditation at a Ch’an temple. This Ch’an temple normally only reached out to the Chinese community, but there was a Taiwanese nun there who wanted to reach out to non-Chinese community members. After practicing there for a few years, Cathy moved to another location, where she could not find any sangha that fit her needs. After attending Mass with a friend, she decided to become Catholic because she needed a community. It was not a hard transition for Cathy, who described feeling in meditation “some kind of entity, whether you call it God or Creator or atomic process.” She was confirmed as a Catholic in 2011.Rachel has been a nun for fifty years and a practicing Zen Buddhist for thirty, ten of those years living and working in a Zen monastery in the mountains of California. She described feeling an emptiness in her faith, a lack of practical knowledge of how to attain the spiritual goals that her Catholic tradition had for her. After hearing Zen teacher Cheri Huber speak at a conference, she took Huber on as her teacher. She has facilitated meditation workshops for many years. Though meditation instruction is not her full-time ministry, “meditation is my life … so in a sense... (shrink)

Clinical ethics consultation (CEC) has become all about right technique. When we encounter a case of conflict or confusion, clinical ethicists are expected to deploy a standardized, repeatable, and rationally defensible method for working toward a recommendation and/or consensus. While it has been noted previously that our techniques of CEC often foreclose on its internal goods, there remains an assumption that we must just find the _right_ efficient technique and the problem would be solved. In this paper, I (...) question that assumption, arguing that any standardized, identically repeatable model of CEC will pull us counterproductively away from ethical reflection, and toward the values of modern _techne_: primarily efficiency, efficacy, and repeatability. This is because standardized techniques of CEC pull the dynamism of being into what Catherine Pickstock calls “identical repetition,” a technologized ontology, which is fundamentally at odds with what being is. And, since ethics is a search for the good of being, avoiding the ontological heart of being severely restricts ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:MIMETIC THEORY AND THE PROGRAM OF ALCOHOLICS ANONYMOUS Lillian E. Dykes Memphis, Tennessee No prophet can claim to bring a final message unless he says things mat will have a sound of reality in the ears of victims.... (William James, The Variety ofReligious Experience) Is it possible to live nonviolently? The works of René Girard involve us in understanding of the Gospel's revelation of the mechanisms of violence and (...) nonviolence, but how is one to begin applying the Gospel to end violence? If Girard shows us thatviolence is the basis ofall culture and religion, where does one find a new model today? Ifthe shift from human to transcendent mediation results only in personal destruction, then why bother? IfGirard is correct, and the power ofthe nonviolent Gospel is moving like a vapor through the world, where are the people who are living non-violently? Is there corroboration for Girard's statement, "A new kind ofhumanity is in the process of gestation; it will be both very similar to and very different from the one featured in the dreams of our Utopian thinkers" (Things Hidden 445)? Ifit were possible to show that someone, somewhere were able to live in community without the protection ofscapegoating, following their lead might save us from the spirals ofviolence we arecreating. Ifone could find a design or an application ofGirard's theories, with confirmation that the resultis peace, would people be willingto consider giving upthe protection of violence? Some demonstration that Girard's understanding of Gospel Lillian E. Dykes91 non-violence is practical and possible seems necessary in order to hasten a non-violent cure for our violent world. Perhaps we must accept on faith that it is possible to live non-violently. Ifit were not, then why would the Gospels have ever been written and why have they persisted? In my examination ofhistorical applications ofnonviolence, it seemed that whenever non-violence was implemented, the results were remarkable. Of course, we think of Jesus, Paul, Francis, Gandhi, and Martin Luther King...but they are all dead and most ofthem were murdered. Yet there is a modern community where Girard's theories ofnon-violence through the relinquishment ofhuman mediation is being lived out daily. And, thankfully, it is a flourishing community that experiences healing and renewal through the practice ofwhat René Girard terms "the abandonment ofmimetic desire" (Things Hidden 430). The world is witnessing the healing power of non-violence without knowingthatGospel non-violence is involved. Millions ofmen andwomen are attempting to live non-violently in the "Utopian" community ofGirard and the Gospels without havingread Girard and withoutthe need to believe in the truth ofthe Gospels. It seems to me that the twentieth century has seen the establishment of a community not based upon scapegoating but, rather, upon having been scapegoated. It is a fellowship ofthe Spirit that distinguishes itself by being a fellowship ofbelievers without "religious" scapegoating. Itresembles first century Christianity and is experiencingthe same explosive growth. This phenomenon is what I call the non-violent "religion" ofAlcoholics Anonymous. In this Fellowship of A. A. we can see what might be called, in Girardian terms, a community of scapegoats. Since 1935 there has been a laboratory wherein the theories of René Girard are beingapplied. Bill Wilson, anothervisionary, intuitedthe underlying mimetic principles which Girard shows us, and implemented his understandings in orderto escape the violence1 ofhis addiction to alcohol. Though he did not articulate what he discovered in the way that René Girard has, Wilson found a way to break free ofmimetic desire. He knew that to continue to drink would result in his death (AA 13). Though he did not speak ofhis dilemma in terms ofmimetic crisis, he found a way out of alcoholism by exchanging the mediator of his desires. What Girard discovered and now describes is demonstrated by the practical applications 1In the words of Jack Alexander, "There is a close resemblance between the criminal psychopath and the alcoholic mind. Both are grandiose, resentful, defiant, and hating of authority; both unconsciously destroy themselves trying to destroy others" (Pass it on 364). 92Mimetic Theory andAlcoholic Anonymous contained in the writings of Wilson, in the book Alcoholics Anonymous, with its Twelve Steps, and the Twelve Traditions... (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)

Recent authors have drawn attention to a new kind of defeating evidence commonly referred to as higher-order evidence. Such evidence works by inducing doubts that one’s doxastic state is the result of a flawed process – for instance, a process brought about by a reason-distorting drug. I argue that accommodating defeat by higher-order evidence requires a two-tiered theory of justification, and that the phenomenon gives rise to a puzzle. The puzzle is that at least in some (...) situations involving higher-order defeaters the correct epistemic rules issue conflicting recommendations. For instance, a subject ought to believe p, but she ought also to suspend judgment in p. I discuss three responses. The first resists the puzzle by arguing that there is only one correct epistemic rule, an Über-rule. The second accepts that there are genuine epistemic dilemmas. The third appeals to a hierarchy or ordering of correct epistemic rules. I spell out problems for all of these responses. I conclude that the right lesson to draw from the puzzle is that a state can be epistemically rational or justified even if one has what looks to be strong evidence to think that it is not. As such, the considerations put forth constitute a non question-begging argument for a kind of externalism. (shrink)

As part of a wider program that studies the legislative creation process regarding work conditions in the Argentine Republic, the purpose of this research is to examine the different ways in which the written press represents, on one hand, the formulation and approval process of the Labor Risk Law reform, which concluded on 25 October 2012 with the passing of Law 26,773, and, on the other hand, the scope, content, and sense of said regulation. The perspective of (...) the research is interdisciplinary, its methodology is qualitative, and the process guiding the textual analysis is inductive and hermeneutic. The corpus is made up of the news related to the studied legislative process. The news analysis was carried out according to the proposal of a Sociological and Linguistic Discourse Analysis. Thus, the argumentative strategies and the linguistic resources deployed were associated with the interpretive models of reality underlying those texts, and moreover, the similarities and differences among the various news articles were examined as regards the representation of working conditions; workers and employers and their respective rights and obligations; the legitimacy, need, and legality of the regulation passed; the scope of the protection granted to workers; and the effect of this regulation on workers’ constitutional rights and guarantees. (shrink)

In order to exchange knowledge, humans need to share a common lexicon of words as well as to access the world models underlying that lexicon. What is a natural process for a human turns out to be an extremely hard task for a machine: computers can’t represent knowledge as effectively as humans do, which hampers, for example, meaning disambiguation and communication. Applied ontologies and NLP have been developed to face these challenges. Integrating ontologies with (possibly multilingual) lexical resources (...) is an essential requirement to make human language understandable by machines, and also to enable interoperability and computability across information systems and, ultimately, in the Web. This book explores recent advances in the integration of ontologies and lexical resources, including questions such as building the required infrastructure (e.g., the Semantic Web) and different formalisms, methods and platforms for eliciting, analyzing and encoding knowledge contents (e.g., multimedia, emotions, events, etc.). The contributors look towards next-generation technologies, shifting the focus from the state of the art to the future of Ontologies and Lexical Resources. This work will be of interest to research scientists, graduate students, and professionals in the fields of knowledge engineering, computational linguistics, and semantic technologies. (shrink)

Adrian Piper joins the ranks of writer-artists who have provided much of the basic and most reliable literature on modern and contemporary art. Out of Order, Out of Sight is an artistic and intellectual autobiography and an (occasionally scathing) commentary on mainstream art, art criticism, and American culture of the last twenty-five years. Piper is an internationally recognized conceptual artist and the only African American in the early conceptual art movement of the 1960s. The writings in Out of (...) class='Hi'>Order, Out of Sight trace the development of her thinking about her artwork and the art world, and her evolving awareness of herself as a creative, racial, and gendered subject situated in an often limiting and always absurd cultural and social context. (shrink)

Background: The health professionals are involved in the paths of care for patients with different medical conditions. Their life is frequently characterized by psychopathological outcomes so that it is possible to identify consistent burdens. Besides the possibility to develop pathological outcomes, some protective factors such as resilience play a fundamental role in facilitating the adaptation process and the management of maladaptive patterns. Personal characteristics and specific indexes such as burdens and resilience are essential variables useful to study in-depth ongoing (...) conditions and possible interventions. The study was aimed at highlighting the presence and the relations among factors as personal variables, burdens, and resilience, to understand health professionals' specific structure and functions.Methods: The observation group was composed of 210 participants, 55 males, and 155 females, aged from 18 to 30 years old with a mean age of 25.92 years old. The study considered personal characteristics of the subjects, such as age, gender, years of study, days of work per week, hours of work per week, and years of work. Our study had been conducted with the use of measures related to burdens and resilience.Results: The performed analyses consisted of descriptive statistics, correlations, and regressions among the considered variables. Several significant correlations emerged among personal characteristics, CBI, and RSA variables. Specifically, age and work commitment indexes appeared to be significantly related to the development of burdens, differently from the years of study. Significant correlations emerged among personal and RSA variables, indicating precise directions for both domains. Age and gender were identified as predictors to perform multivariate regression analyses concerning CBI factors. Significant dependence relations emerged with reference to all CBI variables.Conclusion: Pathological outcomes and resilience factors represent two sides of the health professionals' experiences, also known as “invisible patients.” Greater knowledge about present conditions and future possibilities is a well-known need in literature so that the current analyses considered fundamental factors. In line with state of the art, future studies are needed in order to deepen elusive phenomena underlying maladjustment. (shrink)