This chapter contains sections titled: References Further reading.

IntroductionOne in three adolescents frequently consume unhealthy snacks, which is associated with negative developmental outcomes. To date, it remains unclear how intrapersonal factors account for food choices in adolescents. Guided by the dual-pathway model, the current study aimed to: (1) examine the joint contribution of inhibitory control and attentional bias in predicting unhealthy food choices in adolescents, and (2) determine whether this mechanism is more pronounced in adolescents who experience loss of control over eating (LOC).Materials and (...) MethodsA community sample of 80 adolescents (65% female; 10–17 years old,Mage= 13.28,SD= 1.94) was recruited. Based on a self-report questionnaire, 28.7% of this sample reported at least one episode of LOC over the past month. Food choice was assessed using a computerized food choice task. Both inhibitory control and attentional bias were measured with behavioral tasks (go/no-go and dot probe task, respectively). Binary logistic regressions were conducted to address the research questions.ResultsInhibitory control and attentional bias did not significantly interact to predict unhealthy food choices. However, there was a significant three-way interaction between inhibitory control, attentional bias and LOC. For adolescents without LOC, the combination of poor inhibitory control and low attentional bias was significantly associated with unhealthy food choice. Surprisingly, for adolescents with LOC, there was no significant association between unhealthy food choice and inhibitory control or attentional bias.DiscussionDual-pathway processes do not seem to add to the explanation of food choice behavior for adolescents with LOC. For adolescents who do not experience LOC, those with poor inhibitory control combined with low attentional bias might be at particular risk for making unhealthy food choices. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities (...) relating to drugs, drug paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved”, dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior. But the actions of addicts, even of those who seem to want to abstain from drugs, seem to be guided by reasons. In this paper, I argue that we can explain this fact, consistent with continuing to maintain that addiction involves a loss of control, by understanding addiction as involving an oscillation between conflicting judgments. I (...) argue that the dysfunction of the mesolimbic dopamine system that typifies addictions causes the generation of a mismatch between the top-down model of the world that reflects the judgment that the addict ought to refrain from drugs, and bottom-up input caused by cues predictive of drug availability. This constitutes a powerful pressure toward revising the judgment and thereby attenuating the prediction error. But the new model is not stable, and shifts under the pressure of bottom-up inputs in different contexts; hence the oscillation of all-things-considered judgment. Evidence from social psychology is adduced, to suggest that a similar process may be involved in ordinary cases of weakness of will. (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared (...) assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

The neuropsychoanalytic approach solves important aspects of how to use our understanding of the brain to treat patients. We describe the neurobiology underlying motivation for healthy behaviors and psychopathology. We have updated Freud’s original concepts of drive and instinct using neuropsychoanalysis in a way that conserves his insights while adding information that is of use in clinical treatment. Drive (Trieb) is a pressure to act on an internal stimulus. It has a motivational energic source, an aim, an object, and is (...) terminated by the satisfaction of a surge of serotonin. An instinct (Instinkt) is an inherited pattern of behavior that varies little from species to species. Drives are created by internal/ventral brain factors. Instincts require input from the outside that arrive through dorsal brain structures. In our model unpleasure is the experience of unsatisfied drives while pleasure if fueled by a propitious human environment. Motivational concepts can be used guide clinical work. Sometimes what had previously described psychoanalytically as, “Internal conflict,” can be characterized neurobiologically as conflicts between different motivational systems. These motivational systems inform treatment of anxiety and depression, addiction in general and specific problems of opioid use disorder. Our description of motivation in addictive illness shows that the term, “reward system,” is incorrect, eliminating a source of stigmatizing addiction by suggesting that it is hedonistic. Understanding that motivational systems that have both psychological and brain correlates can be a basis for treating various disorders. Over many papers the authors have described the biology of drives, instincts, unpleasure and pleasure. We will start with a summary of our work, then show its clinical application. (shrink)

What is the role and value of pleasure in addiction? Foddy and Savulescu have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model (...) of addiction. Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction. Well don't get me wrong, I love using mate. If I could use successfully I would. I'd still be using. I love using. I just don't like the shit that comes with it. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clarifying the Relationship Between Vice and Mental Disorder: Vice as Manifestation of a Psychological DysfunctionMichael B. First (bio)KeywordsDSM-IV, psychiatric diagnosis, impulse control disorders, sexually violent predator commitmentIndividuals generally present for psychiatric evaluation for one of two reasons: either because they themselves are suffering from a psychiatric symptom that causes distress (e.g., severe panic) or impairs their ability to function effectively (e.g., memory loss), or else they are (...) brought to clinical attention because their behavior or attitudes are considered by others to be problematic. There are a wide range of behaviors that fall into this second category. In some cases, the individual is pressured to seek treatment because of the negative impact that a behavior has on a relationship partner (e.g., sexual dysfunction, anger outbursts) or an employer (e.g., excessive alcohol use). Often, however, the external trigger for a clinical evaluation falls under Sadler’s definition of vice, that is, criminal (illegal) behaviors or attitudes that could be considered “wrongful” or “immoral” in the social arena because the behavior violates the law or an important social more.Given that one of the most important goals of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is to facilitate clinical practice (First et al. 2004) and in doing so provide a diagnostic code to cover any patient that might present himself or herself to a mental health professional, the DSM has evolved over its various editions to become a veritable laundry list of psychological and behavioral ills, some of which may constitute a violation of the rights of others or society. The DSM-III (and its successors) have adopted a descriptive approach wherein disorders are defined in terms of their presenting surface symptomatology, which was necessitated by the field’s lack of knowledge about the underlying etiology of mental disorders. Given this reliance on presenting symptoms, it is therefore inevitable that some disorders are defined in terms of behaviors that can be considered vices. For example, impaired impulse [End Page 35] control often leads to acting out behavior that, at its mildest is inappropriate, and at its most severe is destructive to self and others. Many of the disorders cited by Sadler as being vice-laden fall into this category, namely, pyromania (failure to resist impulses to set fires), kleptomania (failure to resist impulses to steal), intermittent explosive disorder (failure to resist aggressive impulses), certain forms of substance abuse (i.e., those involving possession and use of illegal substances) and paraphilias (i.e., those involving nonconsenting victims).It is important to clarify from the outset that the criteria for determining whether a behavior is a “vice” (i.e., whether it is illegal or immoral) is not equivalent to the criteria for determining whether a behavior is indicative of a mental disorder. According to the DSM-IV-TR definition, a mental disorder is conceptualized as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychiatric Association [APA] 2000, xxxi). The definition warns against considering “deviant behavior[s] (e.g., political, religious, or sexual)” and “conflicts that are primarily between the individual and society” to be evidence of mental disorder except in those cases in which the “deviance or conflict is a symptom of a dysfunction in the individual.” Thus, when considering whether a particular “vice” behavior is a component of a mental disorder, it is crucial to determine whether the behavior is a manifestation of an underlying psychological dysfunction, such as a dysfunction in impulse control. If so, it may potentially be appropriate for that individual to be treated as “medically ill” in addition to, or instead of, being treated simply as a criminal.Let us examine some illustrative examples of cases that demonstrate the relationship between vice and mental disorders and the different ways in which the legal and mental health systems might deal with such cases. Consider the case of an individual who breaks... (shrink)

Online gambling companies claim that they are ethical providers. They seem committed to corporate social responsibility (CSR) practices that are aimed at preventing or minimising the harm associated with their activities. Our empirical research employed a sample of 209 university student online gamblers, who took part in an online survey. Our findings suggest that the extent of online problem gambling is substantial and that it adversely impacts on the gambler's mental and physical health, social relationships and academic performance. Online problem (...) gambling seems to be related to the time spent on the Internet and gambling online, parental/peer gambling and binge drinking. As our findings show that there are harmful repercussions associated with online gambling, we argue that companies in this controversial sector cannot reach the higher level of CSR achieved by other industries. Nevertheless, they can gain legitimacy on the basis of their CSR engagement at a transactional level, and so, by meeting their legal and ethical commitments and behaving with transparency and fairness, the integrity of the company can be ensured. We also argue that current failures in the implementation and control of CSR policies, the reliance on revenue from problem gamblers' losses, and controversial marketing activities appear to constitute the main obstacles in the prevention or minimisation of harm related to online gambling. As online gambling companies must be responsible for the harm related to their activities, we suggest that CSR policies should be fully implemented, monitored and clearly reported; all forms of advertising should be reduced substantially; and unfair or misleading promotional techniques should be banned. The industry should not rely on revenue from problem gamblers, nor should their behaviour be reinforced by marketing activities (i.e. rewards). We realise, however, that it is unrealistic to expect the online gambling industry to prioritise harm prevention over revenue maximisation. Policy makers and regulators, therefore, would need to become involved if the actions suggested above are to be undertaken. CSR is paramount to minimise harm and provide a healthier user experience in this business sector, but it also poses marketing dilemmas. We support a global collaborative approach for the online gambling industry, as harm related to gambling is a public health issue. (shrink)

The theme of this issue of Ethical Perspectives is the French tradition in liberal thought, and the unique contribution that this tradition can make to debates in contemporary liberalism. It is inspired by a colloquium held at the Katholieke Universiteit Leuven in December of 2008 entitled “In Search of a Lost Liberalism: Constant, Tocqueville, and the singularity of French Liberalism.” This colloquium was held in conjunction with the retirement of Leuven professor and former Dean of the Institute of Philosophy, André (...) Van de Putte, who found much inspiration in this tradition. A revised version of his valedictory lecture from the conference serves as the final contribution to this issue. Much contemporary liberal political philosophy is currently done in conversation with a line of liberal thinkers starting with John Locke, running through Immanuel Kant and John Stuart Mill, and culminating in the work of John Rawls and his followers. The reasons for the enormous appeal of this philosophical tradition are, among other things, the combination of the central role of the intuitively appealing value of individual liberty with a strong rationalistic, universalistic, and normative character. The thread running through most of these liberal theories is a commitment to what the French liberal Benjamin Constant referred to as “the liberty of the moderns,” that is, liberty in a negative sense, as a lack of interference in one’s activity from others and from government. This focus has expanded over time to include a richer body of civil, political, social, economic and cultural rights, for instance, in the work of liberal thinkers who have tried to integrate the insights of communitarian thought and discourse ethics in their work. However, the emphasis on individual liberty in the negative sense continues to be the normative and theoretical touchstone and default position for many contemporary liberal theories. The limitation of the canon of liberal thought to the aforementioned authors and themes deprives the contemporary debate of a rich source of ideas: the French liberal tradition. Montesquieu, considered to be the father of this tradition, provides a good example of how it can enrich current debates in liberal theory. Montesquieu’s work evinces a keen eye for the dynamics of power relations and the limitations of the power of the better rational argument. His insight that power can sometimes only be checked by an equal and opposing power, so that a system of separation and balance of powers is necessary in order to preserve liberty, is reflected in the foundations of most modern democracies. Montesquieu also argues that contingent environmental, historical, social and economic conditions play a dramatic role in determining what kind of government is appropriate for a particular society. On his view, ignoring these facts when framing a government can inadvertently end in despotism. Montesquieu’s observations challenge us to reexamine some of contemporary liberalism’s universalist and rationalist claims. Benjamin Constant is most famous for his distinction between two kinds of liberty: the liberty of the ancients and the liberty of the moderns. The ancient form of liberty manifested itself in the active political participation of citizens in the ancient republic. While this form of government and decision-making was suitable for small, homogeneous city-states, Constant argues that it is impracticable for large modern nation-states. Hence, the concept of modern liberty shifts to an emphasis on the rule of law and the non-interference of the state in private matters. This form of liberty is familiar to us from contemporary liberalism – and Constant cherishes this form of freedom as much as any liberal does today. However, his position is complex: he also argues that the liberty of the ancients should not be neglected. Active political participation is needed to ensure that the government is executing its duty of preserving the modern form of liberty by publicly pointing out violations. The contemporary relevance of Constant’s work is clear when we consider the alleged “democratic deficit” that plagues the EU and international institutions such as the UN, the IMF, and the World Bank. Not only does this democratic deficit threaten the modern form of liberty by placing decision-making processes out of sight of the people, it also threatens citizens’ sense of self-respect derived from self-governance. Constant’s argument for the necessity of combining the liberty of the ancients with that of the moderns provides a fruitful resource for confronting these contemporary issues. Tocqueville’s work on liberalism benefits from his opportunity to observe a society founded on liberal democratic principles – the United States of America – in action. In his Democracy in America, he examines the social consequences, both intended and unintended, of building a society on ‘the equality of conditions’, as he defines ‘democracy’. Tocqueville sees a tension between the democratic value of equality and the aristocratic value of the rule of the best. He observes that democratic societies do not necessarily choose the best leaders and instead promote mediocrity instead of virtue, talent, and excellence. Democracy also confronts citizens with the threat of ‘soft despotism’, where a government that preserves the outer signs of the liberty of the moderns nevertheless controls the behavior of its citizens in minute detail through a system of detailed rules ostensibly aimed at their welfare. This paternalism is an even more insidious threat to liberal values than the hard variety of despotism, since it is so difficult to detect and done in the name of liberal values themselves. Taking Tocqueville’s observations seriously would add complexity to attempts to theorize about the modern social-democratic welfare state. The contributions to this issue supplement and critique mainstream liberal thought and its relation to contemporary issues through a serious engagement with the French liberal tradition. Annelien De Dijn’s contribution discusses Bertrand de Jouvenel, a lesser-known 20th Century representative of the French political tradition she terms ‘aristocratic liberalism’. This tradition has its roots in the work of Montesquieu, and emphasizes the importance of intermediary bodies, most importantly the aristocracy, in providing a check to the top-down power of despotic state authorities and the bottom-up power of revolutionary leveling tendencies, both of which threaten liberty. De Dijn situates Jouvenel in this tradition, but then indicates an important difference between his thought and that of his predecessors: his most significant work, On Power, is not only on French history, but on European history. Pointing to the enthusiastic reception of this work in the Anglophone world, she suggests that the rise of totalitarianism in Europe gave the anti-totalitarian features of aristocratic liberalism a broader appeal. Valentino Lumowa’s paper concerns Constant’s classic text, The Liberty of the Ancients Compared with that of the Moderns. Lumowa argues that in order to understand Constant’s piece, we must be aware that its two parts were written under different historical circumstances and decipher the argumentative thrust inherent in the text. Following Stephen Holmes, he argues that to understand the shift Constant made in the second part of the text, we should read it within the context of the increasing influence of the ultra-Royalists in the legislature during the Bourbon Restoration. However, in contrast to Holmes, he contends that the spirit of both civic and individual freedom, which enlivens representative system, is the backbone of the text in its unity. Demin Duan’s essay investigates an apparent ambivalence between liberal and imperialist tendencies in the work of Alexis de Tocqueville, which has already drawn some attention from Tocquevillian scholars. These interpretations of Tocqueville and his writings on empire generally agree that Tocqueville stands in a recognized tradition of liberalism, which is characterized by respect for human rights, individual freedom and a sense of universal humanism. On this standard view, Tocqueville’s support of imperialism represents nothing but an unfortunate breach of his own otherwise consistent liberal thinking. Duan’s article questions this standard position. By questioning the assumption of Tocqueville’s liberalism in the first place, he tries to gauge the influence of both the old republican tradition and the new liberal perspective on his thinking. In conclusion, he argues that Tocqueville’s overall thought, especially his notion of freedom, is very much informed by an old republican tradition. His support of French imperialism could be better understood from this perspective rather than be rendered simply as a deviation from liberal norms. Pawel Marczewski’s contribution is an attempt to show that Tocqueville’s conception of liberty transcends the divisions between negative and positive aspects of freedom. He begins by juxtaposing this conception with the opposition drawn by Constant between liberty of the ancients and liberty of the moderns. While Tocqueville and Constant shared a concern for the preservation of individual rights, Tocqueville was much more reluctant to accept the modern loss of the communal dimension of liberty. He did not accept the view that jouissances privées, private pleasures, are the main compensation that the modern world has to offer for the lost ancient treasure of political participation. The essay then looks into the relevance of Tocqueville’s standpoint for current debates between liberal defenders of negative freedom and republican advocates of freedom as non-domination. Participants on both sides of the debate seem to be so devoted to showing that their particular approach provides the best guarantees against actual and possible threats to liberty that they overlook the fact that their definitions of freedom remain significantly similar. By arguing that ‘to be free is to be guided by one’s own will’, contemporary republicans, as well as their liberal counterparts, move along the lines drawn by Constant towards private pleasures. By questioning the inevitability of this turn, Tocqueville provides us with a valuable contribution to these discussions in contemporary political philosophy. Finally, André Van de Putte’s contribution, an adaptation of his emeritus speech that closed the conference on French Liberalism, appeals to Tocqueville in order to draw attention to the importance of intermediary, dialogical bodies in mitigating the implicit despotic tendencies of the democratic drive to equality. In Tocqueville’s view, the transition from the feudal corporate inequality to democratic individual equality was not a clean break. Rather, this transition is a continual process of democratization that is driven by a desire for equality, or egalité des conditions. This dissolution of distinctions of estate, class and status has the unintended consequence of concentrating the diffuse power of these entities into a centralized state, which is responsible for ensuring the equality of all under the law. This process leaves increasingly isolated and atomized individuals to face the power of a monolithic state in defense of their freedom, and moves toward a soft, paternalistic despotism. Constant’s freedom of the moderns is not sufficient to protect individuals from this centralized power. Democracy also requires the political freedom of the ancients. Van de Putte argues for a system in which atomized individuals organize themselves into intermediary bodies that, in a Montesquieuian balance of powers, can enter into dialogue with each other and the state on more equitable terms. Van de Putte’s contribution closes with a plea for a conception of democracy as a regime of dialogue. (shrink)

While some form of loss of control is often assumed to be a common feature of the diverse manifestations of addiction, it is far from clear how loss of control should be understood. In this paper, I put forward a concept of decrease in control in addiction that aims to fill this gap and thus provide a general framework for thinking about addictive behavior. The development of this account involves two main steps. First, (...) I present a view of degrees of control as the degree to which an agent would be responsive to potential or counterfactual sufficient reasons to do otherwise. Second, I sketch an account of the relevant control-undermining factors in addiction that is consonant with my proposed view of degrees of control. Being a high-level functional property, reasons-responsiveness is particularly well suited to frame an account of control-undermining factors that is doubly pluralistic: it encompasses the contribution of factors both internal and external to the agent, and it is consistent with various proposals as to the precise nature of the anomaly taking place in the psychology of addiction. (shrink)

The considerable prominence of internet addiction (IA) in adolescence is at least partly explained by the limited knowledge thus far available on this complex phenomenon. In discussing IA, it is necessary to be aware that this is a construct for which there is still no clear definition in the literature. Nonetheless, its important clinical implications, as emerging in recent years, justify the lively interest of researchers in this new form of behavioral addiction. Over the years, studies have associated (...) IA with numerous clinical problems. However, fewer studies have investigated what factors might mediate the relationship between IA and the different problems associated with it. Ours is one such study. The Italian version of the SCL-90 and the IAT were administered to a sample of almost 800 adolescents aged between 16 and 22 years. We found the presence of a significant association between IA and two variables: somatization (β = 7.80; p < 0.001) and obsessive-compulsive symptoms (β = 2.18; p < 0.05). In line with our hypothesis, the results showed that somatization predicted the relationship between obsessive-compulsive symptoms and IA (β = −2.75; t = −3.55; p < 0.001), explaining 24.5% of its variance (ΔR2 = 1.2%; F = 12.78; p < 0.01). In addition, simple slopes analyses revealed that, on reaching clinical significance (+1 SD), somatization showed higher moderation effects in the relationship between obsessive-compulsive symptoms and IA (β = 6.13; t = 7.83; p < 0.001). These results appear to be of great interest due to the absence of similar evidence in the literature, and may open the way for further research in the IA field. Although the absence of studies in the literature does not allow us to offer an exhaustive explanation of these results, our study supports current addiction theories which emphasize the important function performed by the enteroceptive system, alongside the more cited reflexive and impulsive systems. (shrink)

Empirical evidence suggests that while people hold the capacity to control their data in high regard, they increasingly experience a loss of control over their data in the online world. The capacity to exert control over the generation and flow of personal information is a fundamental premise to important values such as autonomy, privacy, and trust. In healthcare and clinical research this capacity is generally achieved indirectly, by agreeing to specific conditions of informational exposure. (...) Such conditions can be openly stated in informed consent documents or be implicit in the norms of confidentiality that govern the relationships of patients and healthcare professionals. However, with medicine becoming a data-intense enterprise, informed consent and medical confidentiality, as mechanisms of control, are put under pressure. In this paper we explore emerging models of informational control in data-intense healthcare and clinical research, which can compensate for the limitations of currently available instruments. More specifically, we discuss three approaches that hold promise in increasing individual control: the emergence of data portability rights as means to control data access, new mechanisms of informed consent as tools to control data use, and finally, new participatory governance schemes that allow individuals to control their data through direct involvement in data governance. We conclude by suggesting that, despite the impression that biomedical big data diminish individual control, the synergistic effect of new data management models can in fact improve it. (shrink)

In this chapter I argue that there is a normative aspect to self-control that is not captured by the purely procedural account to be drawn from dual process theories of cognition – which we only uncover when we consider what self-control is for and why it is valuable. For at least a significant sub-group of addicts their loss of control over their drug use may not be due to a lack or depletion of cognitive (...) resources. Rather it may be that they have little confidence in their ability to exert control over their circumstances and shape the life they would value having and the person they would value being. (shrink)

Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse (...) of drugs and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

ABSTRACT Choice theorists such as George Ainslie and Gene Heyman argue that the drug-seeking behaviour of addicts is best understood in the same terms that explain everyday choices. Everyday choices, they claim, aim to maximise the reward from available incentives. Continuing drug-use is, therefore, what addicts most want given the incentives they are aware of but they will change their behaviour if and when better incentives become available. This model might explain many typical cases of addiction, but there are hard (...) cases that pose a problem. In these hard cases the addicted individual does not cease using drugs in the face of consequences that are so adverse it is implausible that they are unaware of more rewarding paths of action. These cases force the choice theorist into a dilemma: either these addicts? drug use does not count as action and so is best described by a neurobiological model, or reference to ?reward? in these cases means merely ?motivated? and so provides no explanatory power. We propose a different model of motivation that takes self-conception into account. We show how that can better explain the hard cases of addiction and also inform our understanding of recovery and self-control. (shrink)

Marc Lewis argues that addiction is not a disease, it is instead a dysfunctional outcome of what plastic brains ordinarily do, given the adaptive processes of learning and development within environments where people are seeking happiness, or relief, or escape. They come to obsessively desire substances or activities that they believe will deliver happiness and so on, but this comes to corrupt the normal process of development when it escalates beyond a point of functionality. Such ‘deep learning’ emerges from consumptive (...) habits, or ‘motivated repetition’, and although addiction is bad, it ferments out of the ordinary stuff underpinning any neural habit. Lewis gives us a convincing story about the process that leads from ordinary controlled consumption through to quite heavy addictive consumption, but I claim that in some extreme cases the eventual state of deep learning tips over into clinically significant impairment and disorder. Addiction is an elastic concept, and although it develops through mild and moderate forms, the impairment we see in severe cases needs to be acknowledged. This impairment, I argue, consists in the chronic automatic consumption present in late stage addiction. In this condition, the desiring self largely drops out the picture, as the addicted individual begins to mindlessly consume. This impairment is clinically significant because the machinery of motivated rationality has become corrupted. To bolster this claim I compare what is going on in these extreme cases with what goes on in people who dissociate in cases of depersonalization disorder. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

“A Liberal Account of Addiction‘ is a major contribution to the discussion of addiction, its treatment, and the social and policy issues which arise from it. Questioning as it does many generally accepted assumptions about addictive behavior, particularly the use of hard drugs, it will provoke even those who do not agree with it to rethink their positions. Many of its suggestions are relevant also, in my opinion, to thinking about other areas of psychiatric interest. Nevertheless, I want to (...) argue that its authors have perhaps not freed themselves sufficiently from some common assumptions, in particular about the nature of mental disorder, and that their argument might benefit from such liberation. The central assumption that I have in mind is that understanding human actions is nothing but understanding the brain activity that accompanies them. If so, then a pattern of behavior can count as a ’mental disorder’ in any clinically or legally relevant sense only if it is the result of a brain disease, causing a breakdown in normal brain functioning. Starting from this assumption, the authors seek to show, by means of evidence from neuroscience, that addiction to drugs does not have a unique ’neural substrate,’ distinct from that of any other kind of pleasure-seeking behavior. When we have a pleasurable experience of any kind, as they point out, dopamine is normally released within the brain. This, they say, activates the ’reward’ pathways, making the person more likely to repeat the behavior that gives rise to the pleasurable experience in questionÑwhether it is eating, sex, or injecting heroin. Addiction, they argue, is therefore just a tendency to repeat an intensely pleasurable experience, whatever the nature of that experience might be. The particular chemistry of the substance involved in this particular form of pleasure is, they argue, irrelevantÑall that matters is that the experience it gives someone is pleasant. Addiction, they. (shrink)

The form of life which has the desire for or will to control over emergence at its core is, if not the dominant, then at least one of the more significant ones in late modern culture. To be in control over emergence requires a considerable degree of sovereignty. In this contribution I have made an attempt to outline and contrast three rather basic images or models of what might be called radical sovereignty, i.e., the (...) vital-reflexive-transgressive one (which is referred to here as Nietzsche type 1), the existential-reflective-transcendent one (Nietzsche type 2), and the ambivalent-creative-transformative one (Nietzsche type 3). The analysis of paintings by post-war artists such as Jackson Pollock, Mark Rothko, and Paul Rebeyrolle is used to illustrate how the aforementioned types of radical sovereignty may have emerged, fully-fledged, in art, in the wake of the Second World War. (shrink)

This paper tries to show that the naturalistic view of addiction is mired in contradictions that stem from reducing the addict to a weak-willed subject who loses control over his or her body. From a phenomenological perspective, addiction reveals itself to be a habit which eventually becomes harmful, but has its primary sources in the embodied needs of a worldly subject. The aim of this paper is to uncover the dimensions of the lived addiction that are neglected in (...) the contemporary naturalistic discourse: the lived-body and the worldly context of the addict. Firstly, we try to do justice to the variety of addictions by underlying that their new and surprising forms are determined by the intersubjective tissue wherein the subject operates. Secondly, the loss of control in addiction, how the subject deals with the tendency to satisfy a need, is experienced as powerlessness, as expressed in the accounts of ecstasy addicts regarding altered states of mind. The last section of this paper will argue that this sense of powerlessness cannot be equated with a weakness of the will because a strong, forceful will engenders the same vertigo of being prey to strange powers. The embodied aspect of addiction and the spontaneous, bodily need it saturates will clarify further this claim. (shrink)

Background A significant number of women experience childbirth as traumatic. These experiences are often characterised by a loss of control coupled with a perceived lack of support and inadequate communication with health care professionals. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods A longitudinal Grounded Theory Methods (GTM) study involving 9 women was (...) conducted. Over half of the participants had a formal diagnosis of PTSD and/or PND related to the previous birth. Interviews were carried out at 3 timepoints perinatally. These findings are from the first interviews at 12-20 weeks. Results From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analysing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience, and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective caesareans to freebirth. Some women felt well supported by those around them, including health care professionals, partners, friends and family. Others did not, and were anticipating conflict in trying to assert their birth choices. Many early relationships with health care professionals were characterised by fear and mistrust. Discussion Women who have previously experienced a traumatic birth become pregnant again, have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with health care professionals at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control. (shrink)

Since the wife-husband team of Anne Case and Angus Deaton popularized the term deaths of despair, psychologists have become more interested in decoupling despair from clinical depression and anxiety. Despair’s central marker is the loss of hope. It is characterized by feelings of social and spiritual isolation, meaninglessness, hopelessness, helplessness, demoralization, and shame. Causes of despair are complex, ranging from individual (e.g., grief, bad health, addiction, abuse), to societal (e.g., social and cultural dislocation, unemployment, economic disaster, poverty), to (...) a combination of both. Sometimes, acknowledging and/or addressing despair’s material causes is enough. But the problem with despair is that it tends to generate a vicious cycle of self-defeat. Often, it manifests in self-perpetuating negative cognitive biases, self-defeating emotional reactions, and self-destructive behavior. To break free, the person must address the psychological and spiritual roots of her despair. Here, I offer insights from a Christian tradition grounded in the monastic spirituality of the Desert Fathers in the hopes that these might help a therapist seeking to do just that. After distinguishing between an emotion and a sin of despair, I locate the latter’s roots in the vices of acedia and pride. Finally, I point to the virtue of humility as a traditional cure for despair. (shrink)

The diagnosis of death by neurological criteria (colloquially known as ‘brain death’) is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies diagnosed dead by neurological criteria. This paper sets out 10 different Catholic responses to the current crisis of confidence and assesses them in relation to (...) a Catholic understanding of philosophical anthropology. Having considered each of these responses, none is found to provide good grounds for the moral certainty about death needed for current transplant practice to be ethically acceptable. Unless adequate grounds for the use of neurological criteria can be restored, current transplantation practice will have become what Pope John Paul II called a ‘furtive, but no less serious and real, form of euthanasia’. (shrink)

Recent advances in natural language processing have given rise to a new kind of AI architecture: the language agent. By repeatedly calling an LLM to perform a variety of cognitive tasks, language agents are able to function autonomously to pursue goals specified in natural language and stored in a human-readable format. Because of their architecture, language agents exhibit behavior that is predictable according to the laws of folk psychology: they function as though they have desires and beliefs, and then (...) make and update plans to pursue their desires given their beliefs. We argue that the rise of language agents significantly reduces the probability of an existential catastrophe due to loss of control over an AGI. This is because the probability of such an existential catastrophe is proportional to the difficulty of aligning AGI systems, and language agents significantly reduce that difficulty. In particular, language agents help to resolve three important issues related to aligning AIs: reward misspecification, goal misgeneralization, and uninterpretability. (shrink)

Addiction: A Philosophical Approach CHAPTER ABSTRACTS “Introduction: Dismantling the Catchphrase” by Candice Shelby Shelby dismantles the catchphrase “disease of addiction.” The characterization of addiction as a disease permeates both research and treatment, but that understanding fails to get at the complexity involved in human addiction. Shelby introduces another way of thinking about addiction, one that implies that is properly understood neither as a disease nor merely as a choice, or set of choices. Addiction is a phenomenon emergent from a complex (...) dynamic system that is at once physical, psychological, social, and more. “A Philosophical Analysis of Addiction” by Candice Shelby Shelby brings much-needed clarity to the discourse surrounding the topic of addiction. Arguing that addiction can neither properly be understood as a disease nor as merely a set of choices, Shelby exposes the weaknesses of both approaches. She shows that addicted persons do not exhibit the elements characteristic of compulsion, nor does an account of addiction in terms of weakness of will, or irrational choosing, provide a satisfying explanation. Instead, by replacing traditional substance ontology with process ontology, and accepting the reality of emergent entities, a coherent account of persons, minds, and addiction can be provided. A fundamental philosophical shift is necessary to see that bodies, minds, values, and addictions are all part of the natural world. “Addiction at the Individual Level” by Candice Shelby Shelby discusses the most influential accounts of addiction as it is understood at the purely individual level. From hedonic theories to incentive sensitization, to habit theories of addiction, to behavioral theories and the ego depletion theory, Shelby considers a variety of approaches to understanding addiction in individuals, as framed in both psychological and in neuroscientific terms. She notes some important caveats that should be considered before accepting the research regarding addiction at the individual level, namely that the scanning studies that are so popularly used to characterize addiction in neurobiological terms are ambiguous, and rely on numerous assumptions that may be false, and that certainly mislead. Shelby provides much-needed critique of both disease and choices models as they characterize addiction at the individual level. “Addiction and the Local Environment” by Candice Shelby Shelby argues that human addiction cannot be understood without serious consideration of the individual’s local environment, her home and family. From the gestational environment to interactions with caregivers during post-natal development to the adult environment in which people become addicted, Shelby shows that no one becomes an addict in a vacuum. Stress is a major influence in the environment throughout life, and has serious consequences for addictive vulnerability. Genetic influences as well are important to addictive vulnerability, but genes always express in interaction with their environment. Social acceptance or rejection is another particularly important factor in the local environment with respect to both coming to be addicted and transitioning out of it. “The Relation Between Addiction and Culture” by Candice Shelby Shelby provides a groundbreaking analysis of the relation between addicts and the cultures that breed them. In this cultural critique, Shelby shows that addictions to certain substances have historically been both the solution to the problem of how to grow economies and control people, and a problem for economic productivity and controlling citizens. Not all cultures have even the concept of addiction, while others, such as the contemporary Western world, and the U.S. in particular, seem to foster it. Shelby shows that addiction is both a cultural construct and, from another way of thinking about it, the result of conditions created by particular cultures. Social inequities, alienation, driving capitalism, and in particular the power of pharmaceutical companies, all contribute to the spiraling endemic of addiction. “Addiction and Meaning” by Candice Shelby Shelby provides a unique argument that understanding how meanings work is essential to a complete analysis of addiction. Individuals experiencing addiction and those who care about and for them often utterly fail to communicate. This is because their respective systems of meanings come to be significantly different. Meanings are not, Shelby argues, best understood in the symbolic terms that characterized the theory of language in the 20th century, but are better apprehended as emotion-rich prototypes carved from repeated interaction with the world. Becoming addicted essentially changes one’s entire system of meanings. Requisite to transitioning out of addiction is a Gestalt-type shift in one’s system of meanings. This holistic way of understanding meanings also provides one level of explanation of what happens when an addict relapses. “The Phenomenology of Addiction and its Implications” by Candice Shelby One way of judging theories of addiction is by how well they capture the phenomenal descriptions that addicts give of their own experiences. Shelby considers variations on 5 basic patterns of addictive experience through the eyes of particular individuals who lived through addictive periods, and shows how even the most influential theories of addiction fail to capture all of them. She argues that an important implication of taking the details of individuals’ addictive stories seriously is that addiction must be understood as a personal phenomenon emergent from a particular complex dynamic system. As her theory of addiction would lead one to expect, no two addicts are the same, and no single-focus theory can explain why not. “Possibilities for Transitioning Out of Addiction” by Candice Shelby Shelby provides numerous strategies for transitioning out of addiction. Given that the vast majority of addiction treatment programs currently available are 12-step based and only successful about 5-8% of the time, it is essential that other approaches be undertaken. Shelby canvasses a variety of options for helping addicted individuals to make the transition out of their troubled pattern of thinking and behaving. From direct brain interventions to drugs to trauma therapy to exercise and nutrition to habit reformation to use of narrative and changing one’s social context as ways of redefining the self, Shelby shows that the possibilities for transitioning out of addiction are legion. Perhaps the best approach is to understand addiction treatment in terms of providing physical, psychological, and social tool kits. “Addiction Emerges from a Complex Dynamic System” by Candice Shelby Shelby considers whether there truly exists such a thing as “an addict” or “addictive thinking” in the universal sense. She concludes that within the context of disruptive substance use or repetitive engagement in certain activities, ordinary human cognitive biases and behavior patterns are categorized as addictive. Addiction, she argues, is best understood as an irreducible human reality, emergent from a sufficiently complex dynamic system (an organism with self-awareness, within a particular cultural milieu) that is both shaped by and contributes to the shaping of its environment. Attempts to simplify addiction into one or a few dimensions may create a solvable problem, but by doing so they fail to solve the real one. (shrink)

TikTok has one of the most advanced algorithm systems and is the most addictive as compared to other social media platforms. While research on social media addiction is abundant, we know much less about how the TikTok information system environment affects users’ internal states of enjoyment, concentration, and time distortion, which in turn influences their addiction behavior. To fill this gap, this study collects responses from 659 adolescents in China aged between 10 and 19 years old, and the data (...) is then analyzed using Partial Least Square. We find that the system quality has a stronger influence than information quality in determining adolescents’ experience with TikTok and that the flow experience has significant direct and indirect effects on TikTok addiction behavior. Notably, this study finds that TikTok addiction is determined by users’ mental concentration on the medium and its content. Several theoretical insights from the stimulus–organism–response model and the flow theory are used to explain the findings. (shrink)

Architecture and Deconstruction Case of Peter Eisenman and Bernard Tschumi -/- Introduction Towards deconstruction in architecture Intensive relations between philosophical deconstruction and architecture, which were present in the late 1980s and early 1990s, belong to the past and therefore may be described from a greater than before distance. Within these relations three basic variations can be distinguished: the first one, in which philosophy of deconstruction deals with architectural terms but does not interfere with real architecture, the second one, in which (...) a collaboration between Jacques Derrida and a group of architects interested in his concepts is commenced, and the third one, in which completed or only designed objects or new concepts of deconstruction created by architects gain their supremacy over philosophy. The following book analyses these three possible ways, first of all with the reference to Peter Eisenman and Bernard Tschumi. -/- Peter Eisenman -/- Misreading… and Other Errors -/- The issue of relations between Peter Eisenman’s work and philosophy of deconstruction may be referred to his activity more than ten years preceding his direct collaboration with Jacques Derrida (in 1985) and organisation of the exhibition Deconstructivist Architecture at Museum of Modern Art in New York (in 1988). As soon as at the stage of designing the first houses (House I-III, 1967-1970), which almost entirely inscribed in formalistic aesthetics of Modernism, the architect analysed the problem of architecture dependence on its assumptions. All his later designs may be treated as consequence of this initial interest in relations between practice and theory, and at the same time as an introduction to manipulations later on led at the level of metaphysics of architecture. Beginning with the issue of presence, considered in comments to House VI (1972), the number of ideas having their analogies in philosophy of deconstruction increased. The text entitled The End of the Classical: The End of the Beginning, The End of the End (1984), in which Eisenman criticised questions of representation in architecture, its delusive strive for truth and comparably unattainable attempts at ultimate definition of elementary rules, should be acclaimed the breaking point. This attitude was extended by numerous strategies disturbing architecture rules defined at metaphysical level in an essay Moving Arrows, Eros, and Other Errors: an Architecture of Absence (1986). The issue of Eisenman’s passage from formalism to deconstruction has already been much discussed in the literature (Rosalind Krauss, Thomas Patin among others), still it should be mentioned that the threads similar to Derrida’s concept included in Eisenman’s writing reveal untranslatability of architecture and philosophy. -/- Choral Works or Separate tricks -/- In 1985-1986 a series of seven disputes between Jacques Derrida and Peter Eisenman took place. The pretext for them were designs concerning Parc de la Villette in Paris. The situation of many months of collaboration between a notable philosopher of the second half of the 20th c. and an architect that already had a huge theoretical oeuvre, ended up with a publication of a large volume entitled Chora L Works and it became at the same time a vast study area for historians of contemporary architecture and philosophers. Derrida’s contribution to concept works were his considerations over the idea of chôra, the properties related to this concept were about to be reflected in shapes of the park. Therefore, Chora L Works became an example of the abilities of contemporary art, both in its capability of translation from philosophical ideas to artistic forms and its resistance to tradition of representing in architecture some phenomena and values originating outside this discipline. In the final period of their collaboration both interlocutors started to polemicise with each other more decidedly, what became a separate part of their thought exchange. The exchange of letters between Derrida and Eisenman at the turn of 1989 ended up the period of their direct contacts, nevertheless, at this time precisely a large group of experts in issues of deconstruction joined the discussion and extended the revealed in the former dispute problems into more than ten years of further considerations and publications. Except for a long text by Jeffrey Kipnis, who had participated in the meetings of the philosopher and the architect, there appeared also comments of researchers of artistic theories (K. Michael Hays, Thomas Patin), philosophers (Andrew Benjamin), and even experts in Greek literature (Maria Theodorou or Ann Bergren). Following these debates a contemporary reflection on architecture has saturated with indeed numerous concepts originating in philosophy of deconstruction. -/- Architecture which imitates mute philosophy -/- The series of Jacques Derrida and Peter Eisenman meetings, which took place in the period of 1985-1987, induced many authors to make comments. Some of them (Jeffrey Kipnis, Ann Bergren, Maria Theodorou) developed the subject of chôra which was introduced to the discussion by Derrida. The problem that was about to be solved was the question of tying up the concept of chôra with architecture, including Eisenman’s architecture and the series of meetings within frames of Chora L Works project. Kipnis on this occasion paid attention to chôra and its character of anachronia which infects any being created within chôra. In other words any event has its counterpart (analogon) in another, earlier event. He demonstrated the similarity of structure of many events and statements from the times of Derrida and Eisenman’s meetings to the almost identical behaviour of figures in Plato’s dialogue Timaeus. The loss of beginning present in this phenomenon was appropriate to both features of chôra and the effects of typical analyses of philosophy of deconstruction. Bergren’s analyses focused on accentuating gender of chôra, which, according to this author, had been neglected hitherto in discussions. She collated chôra descriptions with characteristics of women in myths, early Greek epic and philosophy and she arrived at a conclusion that chôra has features of a single woman and a married one at the same time. And yet Theodorou’s studies showed that in the Homeric epics chôra is not treated as an idea but is related with single things and events. The other part of the comments (represented by Andrew Benjamin and K. Michael Hays’ utterances) concerns Eisenman’s attitude to tradition which was treated as a variety of iteration understood philosophically. Benjamin commenced his considerations at the point of closeness between a definition of tradition and a concept of chôra understood as perpetuation (placement). A problematic issue was for him Eisenman’s complex relation to tradition based on its contest and affirmation at the same time. Overcoming the simple subordination to tradition – according to Benjamin – was based on awareness of the role of repetition in culture not known before. Hays made an attempt to explain the pleasure and torment of repetition with the support of Sigmund Freud and Roland Barthes’ concepts. According to Hays repetitions are attempts of a single being to a certain primal state perceived as free of any tension. In a similar way Rosalind Krauss explained a motif of a grate present in Modernistic art and also exceptionally frequent in Eisenman’s work. -/- Annex Architecture is still writing Balzac novels. Peter Eisenman and literature -/- Architecture’s approach to writing, script or literature, present within Peter Eisenman’s work, is an exceptional phenomenon, furthermore a complex one. The article considers four possible relations. The first one relates to Eisenman’s characteristics as a person extremely gifted with the ability to wordplay, which very ‘play’ reveals skills to create architectural images. In the second approach the attention has been paid to Eisenman’s interests – in the first period of his oeuvre – in linguistic works by Noam Chomsky and his transformational-generative grammar. The third kind of relations applied to overcoming the need for autonomy of architecture (and of modernist aesthetics at the same time) and renew interests in questions of meaning in architecture. The fourth sort of relations occurred when Eisenman started to create reflections of historic or literary narrations in architecture – ‘stone stories’ and architectural fictions of their kind. -/- Bernard Tschumi -/- From perversion to deconstruction In Bernard Tschumi’s writings from the 1970s and 1980s we can find a transposition of important threads of post-structuralist ideas deriving from Georges Bataille, Roland Barthes and Jacques Derrida’s works. The analysis of the architect’s writings also shows roots in Phillippe Sollers, Michel Foucault and Denis Hollier’s works. The analysis of borrowed elements from the beginnings of Tschumi’s theoretical activity may be helpful in explaining the contents of his later writings motre inspired by philosophy of deconstruction. The set of his earliest views was inspired by Marxism, Neo Marxism and French Structuralism, mainly by the writings of Henri Levebre and Guy Debord. From the thought of Levebre Tschumi took interest for city as not only a question of urbanistics but also a political issue. From Debord’s concepts he borrowed a conviction about the role of situational violation for changes in the society structure. Some of these beliefs were preserved in his own concepts of architecture as an event. From this period derived also his will to change conservative elements of social structure not by means of political revolution but of theoretical and creative activity. Tschumi acknowledged that the effective way of the proceedings towards achieving his aims would be accepting the role of both a critical intellectualist and architecture expert who would not hide away his left-wing orientation. The speculations defined by the architect as ‘revolting analyses’ were about to characterise contradictions which tear the society apart, penetrate architecture and constitute the basis of culture. Spreading away of the conscience of false assumptions hidden away in various disciplines could have weakened cohesion of a conservative society and influence the will to change among the elites. This way the beginnings of political revolution were rooted in philosophy of architecture. In 1977 Tschumi published his text entitled The Pleasure of Architecture inspired by Roland Barthes’s The Pleasure of the Text, it also included some concepts derived from Georges Bataille and Jacques Derrida. First of all the author used Barthes’s concept which made an assumption that literary activity is pervaded by the spirit of resistance towards social rules, and Tschudi transferred this remark onto architecture. From the ideas of Bataille, acquainted via Holier’s work, he derived his belief that two concepts of space, a conceptual one (defined as Pyramid) and a sensual one (defined as Labirynth), not losing their distinct features, they join in the concept of experienced space which exceeds contradictions. The exceeding itself was defined as the basic rule of architecture and it was referred to situations in which architecture not only negates social needs, but also disavows its own tradition. Crossing the borders applies not only to political issues or permanent rules of the very discipline but also interfering with other fields (especially literature and film). The fact that architecture is associated with organising events turned Tschumi’s attention to questions of violence that result from upsetting architectural order of a given building by its users and the one hand, and on the other from forcing the users to specific acts imposed by this very order. The analysis of the concepts used by Tschumi in his early writings indicates that they are close to definitions that would occur in his reflection in the following years influenced by philosophy of deconstruction. -/- Approaching deconstruction Tschumi in his theories developed in the 1980s presumed that the current social world had undergone a deep process of decay, and the reaction against which ought to be based on ordering-up actions, and also preserving the main outline of disintegration of the whole and its elements in the state of conflict. The statements concerning the nature of the contemporary to Tschumi social relations were applied by him to the world of architecture, this led him to coming up with designing strategies that took into consideration the destabilised character of conditions in which works of architecture were created. New ways of conduct invented by Tschumi drew their inspiration from literature and research on literature, psychoanalysis, structural linguistics, structuralism and post structuralism, and eventually also deconstruction philosophy. The proposed methods were opposed by their author both to functionalism continuity trends and postmodern architecture. Tschumi’s proposals contradicted any forms of conservatism or traditionalism in political sphere as well as in reference to tendencies in architecture. They were not simple contradictions of social or architectural rules, they intrude them from the inside, weaken or escalate the already existing incongruities, they move the boundaries between the areas. Revolutionary illusions about the possibility of radical changes were replaced with strategies which completed, tainted or test former rules in the series of formal games of permutation and combination. Quite different from avant-garde formalism Tschumi’s games were not about maintaining the autonomy of a given area, but on the contrary – polluting it with other areas’ influences. Tschumi enjoyed demonstrating illusions of architecture concerning simple relations between form and function, or between form and meaning. Making use of Freud, Lacan and Foucault’s research he introduced a category of “madness” into architecture allowing an observation that the recognised norms are nothing but merely ones of many possible principles of behaviour, and their recognised status resulted from unjustified hindering innovativeness which is crucial for architecture. To reborn architecture’s capability of changing Tschumi also made use of Barthes’s discoveries concerning rules of narration and works by writers who applied in their writing knowledge on linguistics. Making a work’s author unclear by various mechanical transformations of its elements was however apparent only, and formal rigours imposed on the process of designing liberated possibilities difficult to obtain in more traditional creative action. Another mode of acting introduced by Tschumi was combining his work of elements deriving from outside architecture; joining space records with notation of motion and events accompanying architectural objects among others. These architectural and extra-architectural elements were not unified, on the contrary their heterogenous and conflictual character was stressed. This is how shock, anxiety and instability, typical for live in great metropolises, infiltrated architecture. Taking some ideas of deconstruction philosophy as a pattern Tschumi also took into critical consideration in his essays traditional in architecture oppositions between form and figuration, or theory and practice. By combining various inspirations he eventually worked out an idea of architectural event, which he understood as a series of actions contesting its own field, redefining its sources, principles and elements. An event, understood in this way, was not so much producing works as rather creating conditions of their production and at the same time designing the society different from a hierarchic one. -/- Park of deconstruction Among numerous philosophical strategies of deconstruction most frequently used was questioning the practice of strong opposition of two reasons. In many cases Bernard Tschumi’s writings just consider functioning of the conflict juxtaposition of the ideas of structure and ornament or theory and practice in history of architecture. Violation of traditional relations between terms of this kind, both old and modern, raised Jacques Derrida’s objections, when he was induced for the first time to co-operate with architects’ milieu. During this long lasting thought exchange the philosopher eventually acknowledged Bernard Tschumi’s arguments for reasoning the encroachment of architecture’s fundamental rules. Deconstruction applied in architecture was not a simple transposition or analogy of practices that had been applied by philosophy of deconstruction. We may even say that considering architectural terms became an important formula of deconstruction. Architecture understood in philosophical way became something beyond the practice and theory of its own discipline, a sort of metaphysics of both philosophy and architecture. The deliberate encroachment of simplicity of dividing architecture into theory and practice, for the first time became a clear aim for Tschumi in his drawings and texts entitled The Manhattan Transcripts. The contents of this series of works was a record of characteristic features of this New York district in such a way that not only objects were the subject of the record but also relations between objects, people and events. The record was about to take into consideration a conflict character of elements of this representation and at the same time to avoid applying to them the rule of mimetism. The record became a form of reflection over the very record by an increased control over the ways of representation. Architecture which was considered in the The Manhattan Transcripts was not directed to fulfill the needs of inhabitation or production, it was rather related with hitherto usually marginalised liminal situations: building ostentatiously big monuments, religious cult, war etc. Architecture operating in these relations focused also the attention on the included in it continuous tendency to overpass its own restrictions, the role of violence as its not recognised factor, or the meaning of excess and shock in its operation. Architecture moving from reason towards madness became even more visible in the design of Parisian Parc de la Villette, whose pavilions were defined as folies (in French it means both small park buildings and follies). The park was supposed to be on the one hand a reflection of traditional society disintegration while on the other it questioned basic rules of producing a work of architecture. The traditional rules of designing, based on ordering up, were replaced with the strategies of dysfunction and dissociation. In Tschumi’s opinion methods of this kind may be equivalent of what Derrida named différance. Instead of aiming at mergence, any diversity, plays or variations were strengthen. Tschumi’s texts, in which he explained his attitude, were completed by Derrida’s extent statement entitled Point de folie – Maintenant l’architecture. Derrida’s article is the most significant of all his statements on architecture as a form of thinking and activity. According to the philosopher, architecture should divide space (in French defined as espacement), what enables both thinking and action – it arranges the space of an event. Tschumi’s buildings, defined as folies, in an essential way destabilise any created order, and at the same time they refresh it. Derrida’s statement suggests that architecture may become both metaphor of an order merging a language or a society but also of inner forces which deconstruct and reconstruct it. Therefore architecture is at the same time a construction, a deconstruction and a reconstruction. Parc de la Villette stands out in this system with its attempt to step beyond the scheme of an easy repetition and its heading for chances of achieving more radical otherness. -/- Conclusion Destruction as construction. Paradoxes of deconstruction in architecture -/- Scepticism about persistence and common importance of fundamental values of human culture evinced in philosophers and writers’ works as early as in Greek antiquity, nevertheless it was not expressed so strongly as in the second half of the 20th century. Especially in Heidegger’s work Being and Time (although originated in 1927, still influential in all later philosophy) the following states were characterised: the state of losing the ground (Abgrund), of being out of sight (Unheimlichkeit) and of being out of dwelling (Un-zuhause-sein) – as the basis of self-confidence of conscious being there (Dasein). The entire criticism of philosophy of home and dwelling draws the inspiration from this early writing of the German philosopher, it combines crisis of basic terms of metaphysics with social conditions which are dictated by living in large metropolis. The crisis of both metaphysical foundation and home appears to be similar to the situation of weakening the relations between a man and his dwelling in extensively expanding cities. Whereas philosophy, as well as many disciplines of social sciences, have diagnosed for a long time the destabilisation of fundamental ideas of Western culture and crucial changes in the ways of dwelling, architecture itself occurred to be “the last fortress of metaphysics” (J. Derrida). Among contemporary architects, Peter Eisenman and Bernard Tschumi were the ones who engaged most decidedly in the issues of critical analysis of architecture foundation and its social role. Both the architects noticed new formulas of contemporary social and individual existence, tremendously different from the entire history, and at the same time they affirmed lack of adequacy of architecture concepts to new situations. Both Eisenman and Tschumi used to describe the existing architecture as a tool for consolidation of highly integrated and hierarchised societies, and also as a discipline extremely uncoincidental with the current character of social life based on ideas of freedom and diversity. The means to transform architecture and make a factor of further social changes out of it, was a concept that accentuated revealing the inner contradictions of this discipline, and considering them in designing strategies. Eisenman’s activity, in regard of what has just been noticed, was focused on questioning the basic rules of traditionally comprehended architecture, especially the rule of purpose. The American architect noticed that the concept of architecture as fulfilment the need of location, hides away the fact that the location has to be constantly reconsidered, and hence it is overtaken by change (dislocation). Therefore new concept of architecture propounded architectural activity to translocate the concept of location – more than before – but also to change its status perpetually. Such comprehended architecture should claim, as its main purpose, the constant revision of this purpose and create itself anew permanently. Even Eisenman’s earliest designs of houses nos. I-IV broke with such values as the sense of safety, closeness and familiarity, and just on the contrary they accentuated senses of strangeness, homelessness and loss of confidence. The contradictions within architecture noticed by Tschumi referred to combination of intellectual and sensual values in architecture, when their non-appropriation was defeated by an additional condition, namely the way of experience based on pleasure of excess, marked by insanity. The features of folly were especially visible in his designs of gardens, where the order of planning was mixed with sensual experience introduced by particular elements (both the ones created by nature, and the buildings defined as folies). Parc de la Villette designed by the French architect in Paris put in question not only the common understanding of purpose in architecture but also the ideas of order and integrity, as its plan was based on the combination of independent layers with records of grids of points, various lines and planes. The architecture that collides inadequate elements with each other was supposed to be a kind of an event with no beginning and no end. The architecture treated as an event became a form of a space weakened articulation that maintains its diversity and lack of accordance of the elements building it up. The analyses of Eisenman and Tschumi’s theoretical writings indicate how much the aims of architecture have actually changed; instead of supporting social persistence, the architecture is rather intensifying contradictions, and instead of providing people with the sense of safety, it sublimes danger. From simple acts of defamiliarisation, increasing the distance to itself and enhancing the role of theory, through discomfort, anxiety, not feeling someone at home, weirdness, excess, shock and violence, architecture reached the edge of stability and uncertainty, only to make an attempt at penetrating what is impossible and unutterable, and recording what cannot become the subject of any records. -/- . (shrink)

The real estate industry is characterized by a high degree of financial intensity and is more significant in certain areas. The relative enterprises require certain financial ability and large shareholders’ controlling power to support their survivals and competitiveness. However, due to the multiple adverse impacts of current state policies on banks and private capital, the problem of capital restraints of real estate has become increasingly serious. From a corporate governance perspective, this paper studies the interactions among financial constraints, (...) ownership concentration and corporate performance under different shareholding states: by analyzing the quantitative characteristics of equity structure and searching for the appropriate range of the largest shareholder holding ratio, which has considered both the financial sustainability and characteristics. It is found that raising the ownership concentration could enhance supervision effect rather than encroachment, effectively ease the financial constraints and improve the performance of enterprises, both of which are significant under high ownership concentration. Financial constraints play a significant intermediary effect in absolute holdings and have obvious regulatory effects in decentralized equity. Also, the mechanisms of ownership concentration are reflected in the strengthening of corporate supervision, reduced agency costs, improved operating efficiency, and increased investment attractiveness. The adjusted behavior adds to the responsibility awareness rather than free-ride psychology, forming a dynamic game on financial decisions. Their financial sustainability in areas would provide a nationwide reference for governance reform and managerial behavior. (shrink)

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

Receiving a diagnosis of cancer can be devastating. Cancer continues to be one of the most feared diagnoses, and experiencing pain is a major fear for people diagnosed with cancer. Cancer pain is complex in aetiology and can be acute or chronic and can be caused by various compression, ischaemic, neuropathic or inflammatory processes. Many people with cancer will experience excruciating pain, which is often underreported and undertreated. The reasons for this are complex and include various factors including fears and (...) beliefs held by patients. Cognitive factors are important modulators of pain and the appraisals, meanings and beliefs that people have in relation to illness, cancer, and pain, have implications in regard to help-seeking behaviours and the coping strategies people adopt. Cancer pain can impact a range of psycho-social factors across its course. Cancer pain relates to higher rates of psychological distress, anxiety and low mood, and the perception of pain intensity is, in turn, influenced by psychological factors. Cancer pain can negatively affect psychological health, and psycho-social factors can affect the pain experience. It has been suggested that people with a life-limiting illness experience ‘total pain’, and this can encompass psychological, social, practical, spiritual domains. Research demonstrates that cancer is predominantly an illness affecting older people, yet there is a higher risk of under-treated pain in this age group and there is a paucity of research into the subjective experiences of older people managing their cancer pain. Many older people are required to self-manage cancer pain at home as outpatients, due to drivers to keep people out of inpatient care, such as the high healthcare costs of inpatient treatment, and patients wanting to manage their illness, and die, at home. Our own research into this area found that the self-management of cancer pain involves a sequential and temporal process, which centres on perceptions of control. We describe how the older people in our study experienced a perceived loss of control, followed by a sense of gaining control over pain through various experience of certain internal and external factors. The assessment and treatment of physical pain should be done in combination with assessment and treatment of psycho-social and spiritual pain, and interventions for cancer pain need to focus on increasing positive affect and reducing helplessness. No person should suffer with poorly controlled pain and we argue for the need for further research in this area to ensure adequate treatment for all.Clinical Implications: Assessment and treatment of physical pain in people with cancer needs to be conducted in combination with assessment and treatment of psycho-social issues and spiritual pain. Psychological and behavioural approaches have strong evidence supporting their efficacy for reducing cancer pain. Interventions should target helplessness and focus on increasing positive affect through positive psychological states including fighting spirit and resilience. Person-centred interventions that focus on helping people with the search for meaning may help those with cancer pain derive positive benefits. (shrink)

Deep brain stimulation of the subthalamic nucleus is an effective treatment for the motor symptoms of movement disorders including Parkinson's Disease. Despite its therapeutic benefits, STN-DBS has been associated with adverse effects on mood and cognition. Specifically, apathy, which is defined as a loss of motivation, has been reported to emerge or to worsen following STN-DBS. However, it is often challenging to disentangle the effects of STN-DBSper sefrom concurrent reduction of dopamine replacement therapy, from underlying PD pathology or from (...) disease progression. To this end, pre-clinical models allow for the dissociation of each of these factors, and to establish neural substrates underlying the emergence of motivational symptoms following STN-DBS. Here, we performed a systematic analysis of rodent studies assessing the effects of STN-DBS on reward seeking, reward motivation and reward consumption across a variety of behavioral paradigms. We find that STN-DBS decreases reward seeking in the majority of experiments, and we outline how design of the behavioral task and DBS parameters can influence experimental outcomes. While an early hypothesis posited that DBS acts as a “functional lesion,” an analysis of lesions and inhibition of the STN revealed no consistent pattern on reward-related behavior. Thus, we discuss alternative mechanisms that could contribute to the amotivational effects of STN-DBS. We also argue that optogenetic-assisted circuit dissection could yield important insight into the effects of the STN on motivated behavior in health and disease. Understanding the mechanisms underlying the effects of STN-DBS on motivated behavior-will be critical for optimizing the clinical application of STN-DBS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychological CourageDaniel Putman (bio)AbstractBeginning with Aristotle philosophers have analyzed physical courage and moral courage in great detail. However, philosophy has never addressed the type of courage involved in facing the fears generated by our habits and emotions. This essay introduces the concept of psychological courage and argues that it deserves to be recognized in ethics as a form of courage. I examine three broad areas of psychological problems: (...) destructive habits; irrational anxieties; and psychological servitude in which one individual emotionally controls another. Psychological courage is the strength to confront and work through these problems. Such courage involves facing our deep-seated fear of psychological instability. I conclude that the development of psychological courage is essential to the well-being of many people.Keywordscourage, Aristotle, habits, dependency, rashness, cowardice, anxiety disorders, patienceThe virtue of courage exhibits different forms in human life. Types of courage can be broadly differentiated in terms of the fear which must be faced and the goal to be attained. Two forms of courage have been discussed at some length in the history of ethics. “Physical courage” is characterized by overcoming a fear of death or physical harm. The goals to be achieved by its exercise are traditionally defined by society or by the requirements of survival. The paradigmatic example is Aristotle’s (1987) brave soldier who faces death to defend his city (1115a25–35). Another example would be bravely defending self and family against a threat from nature such as a flood or dangerous carnivore. The second form, “moral courage,” also has some allusions in Aristotle (1115a12–13; 1115b1–2), but Plato’s portrayal of Socrates is in many ways the archetype for moral courage in Western philosophy. While Socrates is also said to have displayed physical courage in defending Athens, it is his fearlessness in defending a deeply held greater moral good against society which has inspired untold numbers of Plato’s readers, from the Stoics to today’s students. 1 In moral courage the major fear is loss of ethical integrity or authenticity, but moral courage is also tied to dealing with social disapproval (Martin 1986, ch. 4; Walton 1986). The person confronting her peer group over a racist joke displays moral courage. In acting courageously the individual maintains moral integrity while at the same time overcoming the fear of being rejected by friends. Other examples abound: the whistle-blower facing ostracism from colleagues for calling attention to injustice in the workplace, or the Quaker or Buddhist protesting against a manufacturer of armaments. Examples of physical and moral courage often overlap. Gandhi (as well as Socrates) exhibited moral courage while facing death, and a soldier in battle may have to deal with peer rejection of his heroic actions. However, the distinction, while imprecise, does speak usefully to quite different forms of courageous experience. [End Page 1]In this paper I want to introduce a third form of courage almost never discussed in the literature. Best called “psychological courage,” it is a form of the virtue which millions of human beings have to possess and exercise on a regular basis. The fear to be faced is not usually that of physical harm, nor is it fear of social ostracism. Nor is loss of moral integrity a major concern. The fear centers around a loss of psychological stability. I speak of the courage it takes to face our irrational fears and anxieties, those passions which, in Spinoza’s terms, hold us in bondage. These can range from habits and compulsions to phobias. Aristotle would have classified many of these under lack of temperance. A drinking habit or an irrational fear of open spaces reflects a lack of proper balance regarding the pleasures of life. But facing and working through these habits or anxieties can involve courage for several reasons. First, to admit the problem is to face the possibility of being stigmatized by society. In this sense psychological courage has some similarities to moral courage. Second, a great deal of pain, physical and psychological, can be involved in confronting the anxiety or changing the habit, and the individual knows this beforehand. Third, and most significant to this form of courage, the stability... (shrink)

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption (...) can significantly modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

continent. 2.2 (2012): 60–63 Translated by Rodrigo Maltez Novaes. From the forthcoming book Post-History , Minneapolis: Univocal Publishing, 2013. It is not necessary to have a keen ear in order to find out that the steps we take towards the future sound hollow. But it is necessary to have concentrated hearing if one wishes to find out which type of vacuity resonates with our progress. There are several types of vacuity, and ours must be compared to others, if the aim (...) is to understand it. The incomparable is incomprehensible. If we affirm that our situation is incomparable, we give up the effort to grasp it. The comparison that imposes itself is to the vacuity of the Baroque. There are innumerable traces in the present that evoke the Baroque. We bear the mark of the same somber rationalism (logics, informatics, cybernetics), and of the same magic and fanatic irrationalism (mass media, phantastic ideologies). But there is a decisive difference. Humanity advanced over a stage during the Baroque. All of its gestures, even the most sincere, were marked by theatricality. The vacuity that resonated under its feet was of the void under the stage. Baroque man represented. 1 For example he represented faith in waging religious wars. Baroque vacuity was the consequence of a medieval loss of faith in dogmas . Our vacuity is different. We do not represent anything. Our world is not a stage. We are not actors, and if we act, it is not to represent a drama, but to divert the audience's attention and our own from the subjects that really matter. We act like criminals that try to hide their tracks. We pretend. Our progress is a farce. The vacuity under our feet is not Baroque. We have not lost our faith in dogmas: we have lost faith in ourselves . We are as counter-reformists as was the Baroque (we want to cover up the recent revolution with warm cloths), but for different reasons. Although comparable with the Baroque, in certain aspects, our situation is in fact incomparable to any other. That is because an incomparable, unheard of, never before seen event happened recently, which emptied the ground we tread. Auschwitz . Other posterior events; Hiroshima, the Gulags, are nothing but variations of the first. Therefore every attempt to grasp the present leads to the following questions: how was Auschwitz possible? How can we live after this? Such questions relate not only to the ones directly or indirectly responsible, and not only to those who were directly or indirectly hit by it: they relate to everyone who takes part in our culture. Because what is so incomparable, unheard of, never before seen and therefore incomprehensible in Auschwitz, is that it was there that Western culture revealed one of its inherent virtualities. Auschwitz is a characteristic realization of our culture. It is neither the product of a particular Western ideology, nor of specific “advanced” industrial techniques. It springs directly from the depths of culture and of its concepts and values. The possibility to realize Auschwitzes is implicit within our culture from the very start: the Western “project” already harbored it, although as a remote possibility. Auschwitz lies within the initial program of the West, which progressively realizes all of its virtualities as history unfolds. That is why the question that Auschwitz poses before us is not: how did it happen? It serves no purpose to “explain” Auschwitz. The fundamental question is: how was it possible? Because what is being questioned is not the extermination camp, but the West. Thus one other question: how to live within a culture henceforth unmasked? Everything that happened afterwards resonates with such a question, with such vacuity. Every economic, social, political, technical, scientific, artistic, philosophic event is corroded by such an undigested question. The distance that separates us from the event does not mitigate the abyss, it erodes it even deeper. Because the distance progressively dissolves the aura of the horror that envelops the event, and it progressively opens up a vision of the scene. It progressively reveals that there all of our categories, all of our “models”, suffered an irreparable shipwreck. Auschwitz was a revolutionary event, in the sense that it overthrew our culture. Insofar as we seek ways to cover up such revolution with trips to the moon or with genetic manipulations, we are counter-revolutionaries: we are inverting the course of history in order to cover up the past. The unspoken in Auschwitz is not the mass murder, it is not the crime . It is the ultimate reification of people into amorphous objects, into ashes. The Western tendency towards objectification was finally realized and it was done so in the shape of an apparatus . The SS were functionaries of an extermination apparatus, and their victims functioned in function of their own annihilation. The extermination camp's program, once it started functioning, developed in an automatic fashion, autonomous from the decisions of the initial programmers, even if, as it effectively did, it contributed to the defeat of the programmers. The SS and the Jews functioned one in function of the other like cogwheels. The models for such functionality were provided by the highest of Western values: the SS behaved like “heroes” and the Jews like “martyrs”. This is an apparatus that functions at a borderline situation: objective even beyond death. What has just been said is intolerable. We cannot accept it and so we mobilize arguments against it. Good arguments. The SS behaved like criminals: they removed the gold teeth from the cadavers. The Jews behaved like victims: they rose up in the Warsaw ghetto. Such arguments are true, but they do not reach the nucleus, the “ eidos ” of the phenomenon: they do not grasp it. Although there was “normal” behavior: (theft, murder, revolt, heroism), there was also “abnormal” behavior: functionality during a borderline situation. And this is what counts. There, for the first time in the history of humanity, an apparatus was put into operation that was programmed with the most advanced techniques available, which realized the objectification of man, together with the functional collaboration of man. The previous horrors committed by Western society against other societies and against itself (and there are many) were crimes . They were violations of Western models of behavior: anti-Christian, anti-human, irrational. So that it is possible to condemn them and continue to be Western, even if the horror is so colossal, such as the enslavement of Africans. However, it is not possible to condemn Auschwitz and continue to adhere consciously to the West. Auschwitz is not a violation of Western models of behavior, it is, on the contrary, the result of the application of such models. Our culture allowed its mystifying mask to fall and must be rejected in toto if we admit that the purpose of every culture is to allow for the convivial existence of men that recognize each other mutually as subjects. However: it is not possible to reject one's own culture. It is the ground we tread . Those who seek to reject their own culture (as Nietzsche did in rejecting Judeo-Christianity), fall victim to madness. Those who reject their culture's models, are incapable of grasping the world in which they live. Cultural models are traps to catch the world. Those who seek to substitute their own models for other's (for example by shouting “Hare Krishna”) will find that such exotic models have already been caught by the very models to be substituted. There is no exit: we are condemned to use our models and to serve such models, even after they have been unmasked, if we wish to continue living. The only alternative would be to commit suicide. That is: we must continue our economic, political, scientific, artistic, philosophic activities despite Auschwitz. We must continue progressing despite everything . That is why there are those who recommend that we should seek to forget what happened, that we should repress the event. They sustain that enough has already been said and written about the subject and that it is time to “overcome” it. But such an ostrich strategy reveals itself disastrous. Because the result is that Auschwitz transfers itself from Poland of the 1940s to the post-industrial society of the future. What characterizes the extermination camp is precisely that it is not an event that can be “overcome”, because it is the first realization of an inherent virtuality within the Western project, which will repeat itself in other formats unless we become totally conscious of it. The advantage (if this is an appropriate term) that Auschwitz offers us, is to give us a concrete example of the West’s tendency towards the apparatus. For the first time in our history it is possible for us to experience concretely the utopia inherent in our culture. For the first time in our history we have the experience that utopia, no matter in what form, towards which we progress, is the extermination camp. Everywhere we can observe, as of now, the emergence of variations on the theme “Auschwitz”. Everywhere apparatus spring, just like mushrooms after a Nazi rain, from the ground that has become rotten. Certainly: such new apparatus are not externally similar to the Nazi extermination camps. Their labels are different, as are the ideologies that pretend to inspire them. Even the apparatus that admittedly envision extermination, such as the Gulags, the ones of a future nuclear war, or the ones that functioned in Vietnam, claim to be different from Auschwitz. Others claim to be “friends of mankind”, such as the scientific, technical and administrative apparatus. But such labels and such ideologies are deceptive and serve only to cover up the essence of apparatus. They are all just like Auschwitz, black boxes that function with complex inner-workings in order to realize a program. They all function according to an inertia that is inherent to them and such functionality escapes , from a certain point, the control of their initial programmers. In a final analysis such apparatuses function, all of them, towards the annihilation of all their functionaries, including their programmers. Exactly because they objectify and dehumanize man. Thus Western culture reveals itself as a project that seeks to transform itself into an apparatus. What characterizes the West is its capacity for an objectifying transcendence. Such transcendence allows for the transformation of all phenomena, including the human phenomenon, into an object of knowledge and manipulation. The space for such transcendence opened up thanks to Judeo-Christianity and resulted, in the course of our history, in science, technique and recently, in Auschwitz. The ultimate objectification of the Jews into ashes is the ultimate victory of the spirit of the West. It is social technique taken to the extreme. Certainly: the transformation of men into ashes is primitive, incipient social technique that progressively refines itself. It will be followed by less brutal objectifications, such as the robotization of society. But it does not matter which form it will assume: it will always be an objectifying manipulation of mankind. Although the apparatus of the immediate future are not necessarily incineration ovens, all will be, and not only the nuclear ones, apparatus for the annihilation of man. The Western program contains several virtualities, not only apparatus. Numerous virtualities have not yet been realized. In this sense the “history of the West” has not ended yet, the Western game continues. But all not-yet realized virtualities are infected by apparatus. That is why it has become currently impossible to engage ourselves in the “ progress of culture .” As it would be to engage ourselves in our own annihilation. We have lost our faith in our culture, in the ground we tread. That is: we have lost faith in ourselves. It is this hollow vibration that follows our steps towards the future. What remains is for us to analyze the event “Auschwitz” in all its details in order to discover the fundamental project that realized itself there for the first time, so that we may nurture the hope to project ourselves out of that project. Out of the history of the West. This is the “post- historical” climate in which we are condemned to live from hereon. NOTES 1. In Portuguese representar (to represent) also means “to act” or “to play a role.&rdquo. (shrink)

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent (...) changes in the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- . (shrink)

This book brings cutting edge neuroscience and psychology into dialogue with philosophical reflection to illuminate the loss of control experienced by addicts, and thereby cast light on ordinary agency and the way in which it sometimes goes wrong.

The possibility of changing the past by means of time-travel appears to depend on the possibility of distinguishing the past as it is ‘before’ and ‘after’ the time-travel. So far, all the metaphysical models that have been proposed to account for the possibility of past-changing time-travels operate this distinction by conceiving of time as multi-dimensional, and thus by significantly inflating our metaphysics of time. The aim of this article is to argue that there is an intuitive sense in which past-changing (...) time-travels are metaphysically possible also in one-dimensional time. (shrink)

In spite of these efforts in the 1920s and 1930s to initiate ongoing research on contraception, the subject of birth control remained a problem of concern primarily to the social activist rather than to the research scientist or practicing physician.80 In the 1930s, as has been shown, American scientists turned to the study of other aspects of reproductive physiology, while American physicians, anxious to eliminate the moral and medical dangers of contraception, only reluctantly accepted birth control as falling (...) within their professional domain.As a result, the problem of cheap, effective, and safe contraception was not solved by these earliest attempts. Consideration of the subject was initiated afresh by private philanthropy after World War II, sparked by a new wave of interest in population studies.81 Summarizing such efforts to support research in the reproductive sciences, a recent Ford Foundation study has noted: “To initiate and sustain serious research in the reproductive sciences has required for more than half a century concerted effort by interested individuals and private organizations, mainly from outside the mainstreams of the biomedical research community.”82The early laboratory research on chemical contraception described in this paper was but one important outcome of the concerted effort made by reformers in the 1920s to eliminate a variety of social problems thought to derive from excessive fertility. Scientific arguments and expertise were employed to advocate reform as well as to define the appropriate solution to such social problems. Scientists were recruited as advocates for the movement, but they were also employed as researchers in laboratory investigations sponsored by these same reformers.Sponsors of these early laboratory studies noted the difficulty of obtaining first-class investigators.83 The routine analyses necessary for such research, as well as the traditional scientific aversion to applied problems, provide only a partial explanation for this response. The real difficulty lay in recruiting investigators to a field that had previously been taboo. Once opened up — first as socially relevant, and finally as scientifically sound — there was much interest in this area, and the appeal to researchers of the scientific issues surrounding fertility and reproduction soon surpassed that of the reforming value of birth control.A survey of the kinds of experimental investigations sponsored by birth control advocates indicates the range of physiological problems explored by contraceptive research. The most definitive work was done on the efficacy and safety of spermicides, but the potential of other contraceptive methods was also examined. Investigators attempted to develop spermatoxins that would effectively immunize women against sperm, and they also tried to elucidate the mechanism of hormonal control of reproduction. In fact, speculations about the possible hormonal manipulation of fertility were expressed at the Seventh International Birth Control Conference held in Zurich in 1930.84In the 1920s, clinical studies were undertaken to assess the effectiveness of the various birth control methods. Laboratory investigators complemented this work by screening spermicides for safety and testing for their ability to kill sperm. There were a variety of birth control preparations on the market, but no one really knew whether these were effective or even safe.85 Although the physiology of other major organ systems was well advanced, the scientific study of reproductive physiology and contraceptive technology was clearly in its infancy in this period. Routine analyses simply could not be conducted, because the fundamental research establishing baselines had not yet been done. Scientists used this fact to redirect attention to basic research on reproduction.Laboratory research on contraception indicated important unexplored areas for physiological investigation. Social activists, who had encouraged prominent scientists to become interested in both the social value and the genetic implications of birth control, found these investigators revising the goals of their research. The biologists had formed their own network and had begun to seek out funding, reformulating the justification for sponsorship of further investigations. The eugenic motivations underlying these studies, which had initially made them theoretically attractive to biologists, were gradually eroded. Concern with “human evolution” ceded its place to interest in physiological mechanisms. Crew and others began to note that the use of biological theory to justify essentially political decisions had serious limitations. Biologists had become uncomfortable with those very arguments which had originally captured their interest. Recognition of the potential political abuse wrought by applying scientific principles to society was expressed by Crew just one year after the Zurich meeting. Referring to previous assessments of the role of sex in reproduction, he generalized: “In the past the biologist has justified feudalism, Manchester Liberalism, socialism and every other type of social organization and political programme by reference to selected biological phenomena.”86 By 1932 Crew had also begun to question the biological logic of regulated breeding, and had made it clear to his American sponsor that there was no simple correspondence between the practice of birth control and the genetic improvement of the human race.87Biologists further began to recognize, however, that although the hopeful genetic solution to human problems was probably an illusion, contraception still remained one tangible means to alleviate, human misery. Some laboratory scientists, like Crew, acknowledged the applicability of their own particular skills to this problem. For a few brief years, social needs and scientific goals were mutually supportive and closely intertwined. But as laboratory researchers gained interest in the study of reproduction and established their own priorities in this field, they temporarily withdrew from the arena of debate over birth control as an important mechanism for social reform.With the rise of Hitler, the genetic arguments for birth control rapidly lost their appeal. But by that time the scientific problem of how to achieve effective contraception had entered the professional consciousness. Both physicians and scientists began to be aware of birth control as a subject within their domain of expertise, although outside the principal focus of their research. Scientific discussion of birth control permanently altered from a question of justification to a problem of method: How could one achieve reliable and safe contraception? This had been Sanger's and Dickinson's goal from the beginning. Laboratory scientists had indeed been persuaded to undertake this work; this research had in turn affected biologists' perceptions of the whole field of reproductive physiology, encouraging further study of reproductive mechanisms. The promise of new knowledge provided for continued funding of this research, despite the caution by scientists that the social benefits would not be as immediate or as far-reaching as advocates and they themselves had first argued.The activities of birth control activists and their supporting agencies, and the financial backing of private contributors and foundations, notably the Rockefeller philanthropies, provided an important new stimulus to the development of research on the biology of reproduction in the late 1920s and early 1930s. Biologists were able to claim an enlarged realm of issues for scientific study through their activities as advocates and as investigators for the birth control movement. At the same time, they promised as-yet-undiscovered possibilities for regulating human reproduction once its physiology was understood. The knowledge and control that they promised lay in understanding the whole reproductive cycle — not merely in evaluating the toxic effects of presumptive spermicides.Chemical spermicides never summoned the interest of scientists as the contraceptive pill was to do, yet that research did reinforce the widespread perceptions of scientific research as essential to social reform. Spermicide investigations focused research efforts in reproductive biology by challenging traditional taboos, defining problems for further study, and providing laboratory investigators the opportunity to assert the social and scientific value of their own skills. Crew echoed this attitude as he observed in 1934:Man has turned from the adventurous conquest of his environment to the conquest of himself. To-day is the day of biological invention, eagerly used for the control of the undesirable and the unwanted. Sex and reproduction are no longer hedged around by myth and taboo; they are no longer accepted as mysteries that defy understanding. They are matters inviting examination and explanation; they are regarded as expressions of physico-chemical forces, the nature of which is to be displayed. It is accepted that when knowledge is sufficient, control will be absolute, and, though knowledge is not yet sufficient, readers... must be persuaded to the view that this will not always be so.88The synergism between reproductive biology and social needs has been temporary and sporadic, but recurring, since the 1920s. Scientific research programs have clearly been influenced by issues raised by public debate. Nevertheless, reproductive biologists have continued to assert their own professional goals. For the most part, they have rejected problems without inherent scientific interest and have spurned applied research except as it has had a direct bearing on current research themes. This attitude, apparent among American and British investigators in the 1930s, created the intellectual context for the invention and acceptance of the technically sophisticated oral contraceptive pill. It did not foster the production and improvement of the simple, safe, effective, and cheap vaginal contraceptive desired by early birth control advocates. (shrink)

Monothematic delusions involve a single theme, and often occur in the absence of a more general delusional belief system. They are cognitively atypical insofar as they are said to be held in the absence of evidence, are resistant to correction, and have bizarre contents. Empiricism about delusions has it that anomalous experience is causally implicated in their formation, whilst rationalism has it that delusions result from top down malfunctions from which anomalous experiences can follow. Within empiricism, two approaches to the (...) nature of the abnormality/abnormalities involved have been touted by philosophers and psychologists. One-factor approaches have it that monothematic delusions are a normal response to anomalous experiences whilst two-factor approaches seek to identify a clinically abnormal pattern of reasoning in addition to anomalous experience to explain the resultant delusion. In this paper we defend a one-factor approach. We begin by making clear what we mean by atypical, abnormal, and factor. We then identify the phenomenon of interest and overview one and two-factor empiricism about its formation. We critically evaluate the cases for various second factors, and find them all wanting. In light of this we turn to our one-factor account, identifying two ways in which ‘normal response’ may be understood, and how this bears on the discussion of one-factor theories up until this point. We then conjecture that what is at stake is a certain view about the epistemic responsibility of subjects with delusions, and the role of experience, in the context of familiar psychodynamic features. After responding to two objections, we conclude that the onus is on two-factor theorists to show that the one-factor account is inadequate. Until then, the one-factor account ought to be understood as the default position for explaining monothematic delusion formation and retention. We don’t rule out the possibility that, for particular subjects with delusions there may be a second factor at work causally implicated in their delusory beliefs but, until the case for the inadequacy of the single factor is made, the second factor is redundant and fails to pick out the minimum necessary for a monothematic delusion to be present. (shrink)

Social networking sites (SNS) are of increasing importance for adolescents’ social life. As adolescents are prone to display risky health behavior in the offline world, it is likely that they use their online profiles and communications to report on unhealthy behaviors, too. This may in turn enhance the perceived attractiveness of risky behavior within the adolescent cohort. Drawing on the insights of impression management theory, we argue in this article that adolescents use a variety of impression management tactics (...) in their SNS profiles and communications. Following this assumption, our empirical analysis of 5851 Facebook posts (profile texts, comments, photographs, etc.) shows that the users tend to associate risky health behaviors with positive attributes, such as accomplishment or sociability, to present themselves in an attractive way to their online peer audience. We argue that this raises two ethical issues relevant to health promotion: Adolescents’ health may be challenged by interaction on SNS, as their engagement in online impression management blanks out any health problems or critical assessments of risky health behavior. At the same time, the semi-public nature of the communication arena re-enforces the tendency to value unhealthy behavior as more attractive than in offline social interactions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Concepts and Theories of AddictionLennart Nordenfelt (bio)Keywordsaddiction, disease, will power, autonomy, holistic view of healthThe article "A Liberal Account of Addiction" is a good piece of analytic philosophy applied to psychiatry. It is well-informed both with regard to empirical matters and philosophical conceptualization. The arguments are often—but, as I will show, not always—quite convincing. The conclusions of the paper also have crucial consequences for practice, for the treatment (...) of patients, and for social policy.The authors argue that current scientific understandings of the problem of addiction are fundamentally flawed. They distinguish between two main positions in science: The Disease View and the Willpower View. According to the Disease View, drug-seeking behavior is the direct result of some physiological change in the drug seeker's brain. According to the Willpower View, the addict is no longer rational; he or she uses drugs as a result of a fundamentally non-voluntary process.The authors dismiss the Disease View in the following way. They first note that drug addicts are in many ways rational planners. The addicts may have to think a lot to find the best ways to find the heroin, cigarettes, or alcohol, and they normally act according to this planning. They are not in any simple sense "caused" to act in a particular way. Moreover, referring to recent neurological literature, the authors note that the changes caused by drug addiction—which have to do with activating reward pathways in the brain—are identical with the outcomes of many other human activities that we do not call addiction. "In fact, any pleasurable experience causes dopamine to be released within the brain, activating these reward pathways" (Foddy and Savulescu 2010, 4). These experiences can be the result of coffee drinking, sexual activity, and physical exercise. Thus, the physical changes in the brain are not effects peculiar to the pharmacology of the drugs; they are instead the effects of the pleasure that the subject has experienced.The argument against the Willpower View is lengthy and more involved. The proponent of the Willpower View must argue that there is some flaw in the subject's autonomy. The drug addict is in some sense unable to avoid taking the drug. The authors of the present article scrutinize this idea on the basis of distinguishing between different senses of autonomy: Substantive autonomy and procedural autonomy. They state that we must here be talking about procedural autonomy, namely, autonomy regarded as dependent only on our capacity to process information and make choices in accordance with our preferences. We cannot, as in the case of substantive autonomy, require that the preferences themselves be reasonable. [End Page 27] In such a case, many of our ordinary actions would be judged non-autonomous.The most reasonable Willpower accounts rely on the idea that addicted people in some sense lack self-control. The authors cite different interpretations of the concept of lacking self- control and they conclude that "none of these … theories can say that addicts are necessarily lacking in self-control unless they also make unreasonable normative or false factual claims about the nature of drug- or pleasure-oriented choices" (Foddy and Savulescu 2010, 10). For instance, according to one interpretation the subject does not endorse his own desire for drugs, but takes the drug anyway. According to another interpretation, the addict regrets taking the drug after having done so. Against such claims the authors claim that many addicts indeed endorse their desires for drugs and many addicts do not regret their addictive behavior.So what is the positive account proposed by the authors? They put forward what they call a Liberal View. It contains three claims about addiction: First, we do not know whether an addict values anything more than the satisfaction of his addictive desires; second, we do not know whether an addict behaves autonomously when he uses drugs; and third, addictive desires are just strong regular desires.According to the Liberal View, one has to accept that the addicts may have drug taking as their highest priority and that they do not have any reduced procedural autonomy. The authors say: "Once we abandon normative bias, we must accept... (shrink)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine (...) the evidence that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (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)

In this paper I address two important objections to the theory called ‘ Composition as Identity’ : the ‘wall-bricks-and-atoms problem’, and the claim that CAI entails mereological nihilism. I aim to argue that the best version of CAI capable of addressing both problems is the theory I will call ‘Atomic Composition as Identity’ which consists in taking the plural quantifier to range only over proper pluralities of mereological atoms and every non-atomic entity to be identical to the plurality of (...) atoms it fuses. I will proceed in three main steps. First, I will defend Sider’s Composition as identity. Oxford University Press, Oxford, pp 211–221, 2014) idea of weakening the comprehension principle for pluralities and I will show that :219–235, 2016a) it can ward off both the WaBrA problem and the threat of mereological nihilism. Second, I will argue that CAI-theorists should uphold an ‘atomic comprehension principle’ which, jointly with CAI, entails that there are only proper pluralities of mereological atoms. Finally, I will present a novel reading of the ‘one of’ relation that not only avoids the problems presented by Yi Composition as identity. Oxford University Press, Oxford, pp 169–191, 2014) and Calosi :429–443, 2016b, Am Philos Q 55:281–292, 2018) but can also help ACAI-theorists to make sense of the idea that a composite entity is both one and many. (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)

BackgroundAddictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased (...) risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status.MethodsAn online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017–2018.Result10 983 complete answers were collected. 7.1% of the participants had a sexual minority status. Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior.ConclusionAn awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study. (shrink)

This paper describes one possible origin point for fraudulent behavior within the American pharmaceutical industry. We argue that during the late nineteenth century therapeutic reformers sought to promote both laboratory science and increasingly systematized forms of clinical experiment as a new basis for therapeutic knowledge. This process was intertwined with a transformation in the ethical framework in which medical science took place, one in which monopoly status was replaced by clinical utility as the primary arbiter of pharmaceutical legitimacy. This (...) new framework fundamentally altered the set of epistemic virtues—a phrase we draw from the philosophical field of virtue epistemology—considered necessary to conduct reliable scientific inquiry regarding drugs. In doing so, it also made possible new forms of fraud in which newly emergent epistemic virtues were violated. To make this argument, we focus on the efforts of Francis E. Stewart and George S. Davis of Parke, Davis & Company. Therapeutic reformers within the pharmaceutical industry, such as Stewart and Davis, were an important part of the broader normative and epistemic transformation we describe in that they sought to promote laboratory science and systematized clinical trials toward the twin goals of improving pharmaceutical science and promoting their own commercial interests. Yet, as we suggest, Parke, Davis & Company also serves as an example of a company that violated the very norms that Stewart and Davis helped introduce. We thus seek to describe one possible origin point for the widespread fraudulent practices that now characterize the pharmaceutical industry. We also seek to describe an origin point for why we conceptualize such practices as fraudulent in the first place. (shrink)