The foundations of psychoanalysis in the German idealist concepts of the reflexive human self have been the subject of detailed investigations devoted to the intertwined processes of introspection,...

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written (...) by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

Diagnostic errors are more frequently a result of the clinician's failure to combine medical knowledge adequately than of data inaccuracy. Diagnostic reasoning studies are valuable to understand and improve diagnostic reasoning. However, most diagnostic reasoning studies are characterized by some limitations which make these studies seem more simple than diagnostic reasoning in real life situations actually is. These limitations are connected both to the failure to acknowledge components of knowledge used in clinical practice as well (...) as to acknowledge the physician-patient relationship's influence on clinical knowledge and on the reasoning process itself. In addition the modes of reasoning described in these studies frequently is oversimplified. In this paper three simplistic and competing models of diagnostic reasoning are analyzed and criticized, followed by an evaluation of two alternative models proposing a combined view. (shrink)

The following topics are considered: - 1) Computer-based medical consultation: good doctors have the capacity to make right guesses. - 2) Elementary diagnostic logic: illness as a boolean combination of signs or symptoms, diagnosis as a deductive process. - 3) Clinical decision under uncertainty: partial and/or elusive evidence, overlapping types. - 4) Local heuristic strategies: (1) statistical methods, (2) probabilistic (bayesian) methods, (3) fuzzy methods and Mycin-type expert systems. - 5) General heuristic strategies: representing medical knowledge (rules, nets, frames), (...) simulating expert behavior. - 6) Diagnostic inference and pattern recognition: natural species vs. expert judgement. (shrink)

In order to train healthcare professionals in the announcement of serious medical diagnoses, we propose the de-sign of a section of a website that aims to enable caregivers to better control this professional activity that they dread. These diagnoses materialize through language interactions between doctors and patients that are emotion-ally charged. The analysis of these announcement interviews involves access to interactions that are as close as possible to those that take place in real work situations through role-playing. We will show (...) that the design of the website based on the architectural dimension (functional structure of the activity), the relational dimension (roles, co-constructed communication contract) and the communicational dimension (mobilized language processes) allows to identify this sensitive professional activity in its characteristic aspects. Based on a study commissioned by the Ligue contre le cancer, we will show how and in what way the identified dimensions have formative potential and we will highlight their contribution to improving the understanding of the activity and developing training materi-als. (shrink)

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as (...) clinical research (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. (shrink)

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

My article, “Whole-brain death and integration: Realigning the ontological concept with clinical diagnostic tests”.

“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large and medicine in particular; it has important implications for the process of diagnostics. Because genetic diagnostics produces knowledge about genetic disease and predisposition to disease, it is essentially influenced by these innovations in the disease concept. In this paper, I argue that genetic diagnostics presents new ethical challenges not because the diagnostic process or method in genetic diagnostics is ethically (...) different in kind from traditional medical diagnostics, but because it relies on a neo-ontological concept of disease in a context of genetic reductionism. Geneticization has not produced a radically new concept of disease, however, but has introduced innovations into the classical ontological concept of disease. When this new concept of disease is held in tandem with genetic reductionism, we are led to the absurd conclusion that disease is the very essence of the human being. I argue that neither the neo-ontological concept of disease nor genetic reductionism is necessary for a proper understanding of genetic diagnostics. (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the HistoryPeter Zachar, PhD (bio)Le moigne narrates a history of the development of psychiatric ratings scales as hybrids between psychological tests and diagnostic categories. In his telling, psychological tests seek to quantify population-based traits on which every person has a position and which tend to be conceptualized as being stable. Personality traits are often conceptualized as dispositions. Diagnostic (...) categories represent not trait-like properties of populations but episodic states consisting of clusters of symptoms experienced by individuals with disorders. Ratings, scales, he notes, are hybrids between the two. They are used to quantify psychiatric symptom clusters so that change over time can be measured. Le Moigne argues that these distinctions were initially suggested during the development of measures that could assess outcomes in psychopharmacological treatment studies.With respect to depression, Le Moigne writes that in the 1970s and 1980s something akin to depressive personality was reconceptualized as a temperament. A key move, somewhat reflective of Kraepelin’s notion of a depressive temperament, was to view a dysthymic temperament as both a predisposing factor and an attenuated form of depression. Thus, an episodic state commandeered the predisposing–dispositional role that was assigned to stable personality traits.This conceptual shift allowed test-like ratings scales to be seen as useful for quantifying not just stable traits, but salient features of episodic states that are potentially subject to change in response to interventions. To put it another way, in the development of a psychological test, one goal is to have high test-retest reliability (i.e., stability of measurement). With rating scales used to measure change, one wants the scores to not be as stable; ideally the scores on the later assessments will be lower. According to Le Moigne, when dysthymia was subsequently placed on axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (as a syndrome) and segregated from personality disorders which were placed on axis II, personality traits were evicted from the conceptualization of depressive disorders.One perennial feature of psychiatry and psychology is that even if an older idea is superseded [End Page 253] in the view of some thinkers, it can still attract adherents. Indeed, interest in understanding a relationship between personality and attenuated states did not fully disappear. For example, based on research in genetics, the schizophrenia spectrum concept included not only schizophrenia, but also milder conditions such that were conceptualized as personality disorders; that is, schizotypal personality disorder and paranoid personality disorder (Kety, Rosenthal, Wender, & Schulsinger, 1971).During the development of the DSM-IV, some people wanted to add depressive personality disorder to the manual (Phillips, Hirschfeld, Shea, & Gunderson, 1995). It seems to have become a territorial dispute between mood disorder specialists and personality disorder specialists The mood disorders specialists challenged the personality disorder specialists to differentiate depressive personality disorder from early onset, chronic dysthymia. They were able to do so by using criteria such as critical, blaming, and derogatory toward self. After the mood disorders work group proposed incorporating some of those criteria into a revised criteria set for dysthymia, the two sets overlapped. The result was the old criteria for dysthymia were printed in DSM-IV and criteria for depressive personality disorder and the revised criteria for dysthymia were both placed in the appendix.In the DSM-5, Axis II was eliminated and personality disorders were placed alongside all the syndromic symptom clusters at the same level. Even so, interest in attenuated presentations as personality-related lingered still. During the development of the DSM-5 there was some thought to using diagnostic spectra as a meta-structure for organizing the manual (Andrews et al., 2009). One idea was to move some personality disorders into a best fitting spectrum, akin to attenuated forms. This did occur with schizotypal personality disorder which is both in the DSM-5 chapter on schizophrenia and in the chapter on personality disorder. In the schizophrenia chapter it is positioned as the earliest emerging disorder on the spectrum. There was also some interest in grouping avoidant personality disorder with the anxiety disorders, but the evidence supporting such a change was not available.These issues may... (shrink)

This paper aims to draw attention to an important but underappreciated aspect of the instrumental value of freedom: its diagnostic value. This is the value freedom has insofar as it makes it possible for us to discover ourselves and improve ourselves in our capacity to make value judgements. Diagnostic value, I argue, has an important role to play in explaining the value we attach to freedom. Accordingly, this paper is aimed at elucidating this concept, examining its relevance to (...) our lives, and defending an account of how to measure the diagnostic value of opportunities and sets of opportunities. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders classifies “anorexia nervosa” as a mental disorder, yet individuals with anorexia often characterize it as an identity. The author describes the identity of being an anorectic and compares it with what it takes to have anorexia in the diagnostic sense. This furthers the existing scholarship on anorexia and identity, most notably by revealing a disconnect between being an anorectic and having anorexia: Some individuals inhabit the identity of being an anorectic (...) but do not have anorexia because they do not have a significantly low body weight. The author explores whether expanding the diagnostic criteria for anorexia would be beneficial for anorectics by examining the implications of classifying the identitive phenomenon of being an anorectic in terms of a medical concept of mental disorder. In the short term, the answer depends on whether being an anorectic calls for interventions that require a diagnosis. Either way, it would be beneficial to develop nonmedical frameworks for understanding anorexia that facilitate interventions that do not require a diagnosis. Understanding being an anorectic as an identity lays the scaffolding for a nonmedical way of conceptualizing anorexia that illuminates innovative approaches to assisting anorectics. (shrink)

Background: Causal reasoning as a way to make a diagnosis seems convincing. Modern medicine depends on the search for causes of disease and it seems fair to assert that such knowledge is employed in diagnosis. Causal reasoning as it has been presented neglects to some extent the conception of multifactorial disease causes. Goal: The purpose of this paper is to analyze aspects of causation relevant for discussing causal reasoning in a diagnostic context.

This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature that illustrate the problem of the (...) vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators. (shrink)

Kairos has been a key concept in medicine for millennia and is frequently understood as “the right time” in relation to treatment. In this study we scrutinize kairos in the context of diagnostics. This has become highly topical as technological developments have caused diagnostics to be performed ever earlier in the disease development. Detecting risk factors, precursors, and predictors of disease (in biomarkers, pre-disease, and pre-pre-disease) has resulted in too early diagnoses, i.e., overdiagnoses. Nonetheless, despite vast advances in science and (...) technology, diagnoses also come too late. Accordingly, timing diagnostics right is crucial. In this article we start with giving a brief overview of the etymology and general use of the concepts of kairos and diagnosis. Then we delimit kairos in diagnostics by analysing “too early” and “too late” diagnosis and by scrutinizing various phases of diagnostics. This leads us to define kairos of diagnostics as the time when there is potential for sufficient information for making a diagnosis that is most helpful for the person. It allows us to conclude that kairos is as important in diagnostics as in therapeutics. (shrink)

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary criteria (...) actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; (...) and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

A philosophical question divides the field of addiction research. Can a psychological disorder count as an addiction absent a common underlying physical basis (neurological or genetic) for every case of the disorder in the category? Or is it appropriate to categorize a disorder as an addiction if the symptoms of and diagnostic criteria for it are sufficiently similar to those of other disorders also classified as addictions—regardless of whether there is some underlying physical basis common to each case of (...) the disorder? The question concerns the scope and validity of the scientific concept of addiction and, more broadly, what is required for a psychological concept to count as scientific. The case of pathological gambling (PG) raises this question nicely. ‘‘Should pathological gambling be considered an addiction?’’ asks Howard Shaffer (2003, 176). He specifies the question further (2003, 177–178): ‘‘When clinicians and scientists identify a behavior pattern as an addiction, even if they can identify it reliably according to DSM criteria, how do they know that it is indeed an addiction?’’ He warns that, as it stands, ‘‘the concept of addiction represents a troublesome tautology’’ (2003, 178): a subject S is addicted if and only if S engages in repetitive behavior with negative consequences against S’s better judgment. The problem with this concept is that it provides no way to distinguish behavior that cannot be controlled from behavior that is merely in fact not controlled. This ‘‘lay’’ concept is of little scientific value, Shaffer (2003, 179) argues, saying that ‘‘for addiction to emerge as a viable scientific construct . . . investigators need to establish a ‘gold standard’ against which the presence or absence of the disorder can be judged.’’ PG has no such gold standard, says Shaffer. What would such a gold standard be? Shaffer suggests ‘‘neurogenetic or biobehavioral attributes’’ (ibid.).. (shrink)

Recent work in cognitive psychology and experimental semantics indicates that people do not categorize natural kinds solely by virtue of their purported scientific essence. Two attempts have been made to explain away the data by appealing to the idea that participants in these studies are reasoning diagnostically. I will argue that an appeal to diagnostic reasoning will likely not help to explain away the data.

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, the (...) concept of ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge. (shrink)

It has been argued extensively that diagnostic services are a general good, but that it is offered in excess. So what is the problem? Is not “too much of a good thing wonderful”, to paraphrase Mae West? This article explores such a possibility in the field of radiological services where it is argued that more than 40% of the examinations are excessive. The question of whether radiological examinations are excessive cries for a definition of diagnostic futility. However, no (...) such definition is found in the literature. As a response, this article addresses the issue of diagnostic futility in five steps. First, it investigates whether the concept of therapeutic futility can be adapted to diagnostics. A closer analysis of the concept of therapeutic futility reveals that this will not do the trick. Second, the article scrutinizes whether there are sources for clarifying diagnostic futility in the extensive debate on excessive radiological examination. Investigating the debate’s terms and definitions reveals a disparate terminology and no clear concepts. On the contrary, the study uncovers that quite different and incompatible issues are at stake. Third, the article examines a procedural approach, which is widely used for settling controversies over utility by focusing on the role of the professionals. On scrutiny however, a procedural approach will not solve the problem in diagnostics. Fourth, a value analysis reveals how we have to decide on the negative value of excessive examinations before we can measure excess. The final and constructive part presents a definition of diagnostic futility drawing upon the lessons from the previous analytical steps. Altogether, too much radiological examination is not a good thing. This is simply because radiological examinations are not unanimously good. Excessive radiological examinations can be defined, but not by one simple general and value-neutral definition. We have to settle with contextually framed value-related definitions. Such definitions will state how bad “too much of a good thing” is and make it possible to assess how much of the bad thing there is. Hence we have to know how bad it is before we can tell how much of it there is in the world. (shrink)

The present paper will summarise the methodology, the scientific outcomes, and the potential for generalisation of the model of a project that studied cohabitation between human inhabitants and liminal species (in the present case, corvids) in Tartu, Estonia, from October 2021 to July 2023, with a comparative field study in Paris, France. It will present the context and goals of using a semiotic model to map interspecific cohabitation, expose what kind of data can be used to feed the model in (...) a relevant way and how it was done in the case of this project. This paper will present how the model diagnosed issues in cohabitation, both from material nuisances and cultural aspects, insisting on the concept of “hostile minority” that emerged from the study. It will discuss the importance of problem-solving in interspecific cohabitation, what the model suggested regarding this aspect, how this tool can be generalised to a large variety of cases and why it should be used this way. (shrink)

ABSTRACT. — This article examines the concept of adaptive preference as it has appeared in feminist political philosophy since the 2000’s. This concept refers to preferences shaped in compliance with an oppressive environment and that jeopardizes one’s well-being. In the first part, the two most influential conceptions of adaptive preference will be discussed : the ones provided by the philosophers Martha Nussbaum and Serene Khader. Afterwards, I will assess these conceptions in the light of recent work by feminist anthropologists Saba (...) Mahmood and Lila Abu-Lughod, in which they revaluate the political project of feminist philosophy underlying adaptive preferences. -/- RÉSUMÉ. — Cet article porte sur le concept de préférence adaptative tel qu’il est apparu en philosophie féministe politique et anglophone depuis les années 2000. Ce concept désigne les préférences formées conformément à un milieu oppressif et qui vont à l’encontre du bien-être. Dans un premier temps, il sera question des deux théorisations les plus influentes à l’heure actuelle: celles développées par les philosophes Martha Nussbaum et Serene Khader. Ensuite, j’évaluerai ces positions à l’aune des récents travaux des anthropologues fémi- nistes Saba Mahmood et Lila Abu-Lughod, dans lesquels elles remettent en question le projet politique de la philosophie féministe sous-jacent aux préfé- rences adaptatives. (shrink)

Les diagnostics prodigieux sur lesquels Galien a construit sa renommée révèlent une conception très verticale de la relation de soin, qui laisse peu de place à l’interrogatoire. Cet état de fait a souvent été rapporté à un souci d’afficher sa virtuosité dans le contexte compétitif de la pratique médicale impériale. Cet article reprend et précise les analyses existantes sur le sujet en montrant que des considérations théoriques et thérapeutiques, complémentaires mais plus fondamentales, doivent aussi être prises en compte. La clinique (...) galénique se laisse ainsi analyser sur trois niveaux, comme performance publique, comme procédé théorique, puis comme activité pratique dépendant des aptitudes et dispositions de chaque malade. (shrink)

This study applied cognitive diagnostic models to assess students’ learning progressions in energy. A Q-matrix was proposed based on existing literature about learning progressions of energy in the physical science domain and the Trends in International Mathematics and Science Study assessment framework. The Q-matrix was validated by expert review and real data analysis. Then, the deterministic inputs, noisy ‘and’ gate model with hierarchical relations was applied to data from three jurisdictions that had stable, defined science curricula. The results suggested (...) that the hypothesized learning progression was consistent with the observed progression in understanding the energy concept. We also found similarities in students’ attribute mastery across the three jurisdictions. In addition, we examined the instructional sensitivity of the selected item. We discuss several curriculum-related issues and student misconceptions that may affect students’ learning progressions and mastery patterns in different regions of the world. (shrink)

It is only by fixing on agreed meanings of terms in biomedical terminologies that we will be in a position to achieve that accumulation and integration of knowledge that is indispensable to progress at the frontiers of biomedicine. Standardly, the goal of fixing meanings is seen as being realized through the alignment of terms on what are called ‘concepts’. Part I addresses three versions of the concept-based approach – by Cimino, by Wüster, and by Campbell and associates – and (...) surveys some of the problems to which they give rise, all of which have to do with a failure to anchor the terms in terminologies to corresponding referents in reality. Part II outlines a new, realist solution to this anchorage problem, which sees terminology construction as being motivated by the goal of alignment not on concepts but on the universals (kinds, types) in reality and thereby also on the corresponding instances (individuals, tokens). We outline the realist approach, and show how on its basis we can provide a benchmark of correctness for terminologies which will at the same time allow a new type of integration of terminologies and electronic health records. We conclude by outlining ways in which the framework thus defined might be exploited for purposes of diagnostic decision-support. (shrink)

The aim of this essay is to consider both Schmitt’s polemical and his analytical claims in dealing with a concept which is central to his theory and yet strangely overlooked by the secondary literature: the concept of friendship. The essay proceeds in three steps; first it makes some textual claims about the meaning and role of friendship in Schmitt’s writings; secondly its puts forward an interpretation of the significance of friendship in Schmitt’s political thought; finally, it tries to disentangle polemics (...) from diagnostics in Schmitt’s discourse and draws some tentative conclusions. (shrink)

The aim of this essay is to consider both Schmitt’s polemical and his analytical claims in dealing with a concept which is central to his theory and yet strangely overlooked by the secondary literature: the concept of friendship. The essay proceeds in three steps; first it makes some textual claims about the meaning and role of friendship in Schmitt’s writings; secondly its puts forward an interpretation of the significance of friendship in Schmitt’s political thought; finally, it tries to disentangle polemics (...) from diagnostics in Schmitt’s discourse and draws some tentative conclusions. (shrink)

Dr Taylor's book analyses the disease concept as it developed in medical history and seeks to clarify it with the help of concepts largely derived from logical class theories. A solution is proposed to the problem of how to distinguish between the class of 'patients' and the class of 'healthy persons' which corresponds to the actual diagnostic practices of doctors. The earliest theories of disease postulated concrete entities which exist independently of the body. The notion of disease entity (...) has lost its original ontological connotations and instead its important feature has become the possession of a unitary and self-contained character. Dr Taylor describes the modern theories as essentially 'reactive' in character, that is the symptoms of a disease are the bodily reactions to the 'noxae'. After seeing the subject in its historical content, Dr Taylor goes on to discuss in detail the notion of the classification of diseases, making extensive use of modern views on the logic of classes. (shrink)

The target article focuses exclusively on System 2 and on reasoning rationality: the ability to reach valid conclusions from available information, as in the Wason task. The decision-theoretic concept of coherence rationality requires beliefs to be consistent, even when they are assessed one at a time. Judgment heuristics belong to System 1, and help explain the incoherence of intuitive beliefs.

Bien que Hegel ne propose pas de solution satisfaisante au problème de l'injustice sociale, il est important d'analyser ce problème, car il définit les limites de la société civile. Dans ce court article, je veux montrer que l'injustice sociale est caractérisée par l'insatisfaction, qui produit une classe de hors-caste, car elle n'a ni biens, ni droits. De plus, il y a faille et problème, car Hegel conçoit la société civile à partir d'une axiologie de l'harmonisation et de l'intégration que démentent (...) les processus économiques. En revanche, la perspicacité du diagnostic hégélien démontre bien que l'absence d'intégration et de reconnaissance sociale est un mal aussi grand que la privation matérielle.Although Hegel offers no solution to the problem of social injustice, it is important to analyse this problem, for it defines the limits of civil society. In this short paper, I shall try to show that social injustice is characterized by the dissatisfaction that produces a class of outcaste people who have no goods, nor rights. Furthermore, there is a shortcoming and a problem in Hegel's conception of civil society: it is based on an axiology of harmonization and integration, which is contradicted by economic processes. However, the perspicacious hegelian diagnosis shows clearly that the absence of integration and social recognition is as great an evil as material deprivation. (shrink)

The dominant conception of delusion in psychiatry (in textbooks, research papers, diagnostic manuals, etc.) is predominantly epistemic. Delusions are almost always characterized in terms of their epistemic defects, i.e., defects with respect to evidence, reasoning, judgment, etc. However, there is an individualistic bias in the epistemic conception; the alleged epistemic defects and abnormalities in delusions relate to individualistic epistemic processes rather than social epistemic processes. We endorse the social epistemological turn in recent philosophical epistemology, and claim that a corresponding (...) turn is needed in the study of delusions. It is a turn from the (purely) individualistic conception, which characterizes delusions only by individualistic epistemic defects and abnormalities, to the (partially) social epistemic conception, which characterizes delusions by individualistic as well as social epistemic defects and abnormalities. This paper is intended as an initial step toward such a social epistemological turn. In particular, we will develop a new model of the development of delusions according to which testimonial abnormalities, including testimonial isolation and testimonial discount, are a causal factor in the development of delusions. (shrink)

Carey argues that the aspects of categorization that are diagnostic of deep conceptual structure and, by extension, narrow conceptual content, must be distinguished from those aspects that are incidental to categorization tasks. For natural kind concepts, discriminating between these two types of processes is complicated by the role of explanatory stance and the causal history of features in determining category structure.

Over the past few decades, cognitive science has identified several forms of reasoning that make essential use of conceptual knowledge. Despite significant theoretical and empirical progress, there is still no unified framework for understanding how concepts are used in reasoning. This paper argues that the theory of conceptual spaces is capable of filling this gap. Our strategy is to demonstrate how various inference mechanisms which clearly rely on conceptual information—including similarity, typicality, and diagnosticity-based reasoning—can be modeled using principles derived (...) from conceptual spaces. Our first topic analyzes the role of expectations in inductive reasoning and their relation to the structure of our concepts. We examine the relationship between using generic expressions in natural language and common-sense reasoning as a second topic. We propose that the strength of a generic can be described by distances between properties and prototypes in conceptual spaces. Our third topic is category-based induction. We demonstrate that the theory of conceptual spaces can serve as a comprehensive model for this type of reasoning. The final topic is analogy. We review some proposals in this area, present a taxonomy of analogical relations, and show how to model them in terms of distances in conceptual spaces. We also briefly discuss the implications of the model for reasoning with concepts in artificial systems. (shrink)

In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The "tightrope walking" attitude refers to the psychiatrist's ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The "holistic experience" includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation (...) of the atmospheric quality of the intersubjective space. The "co-construction of symptoms" regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the "evolving typification" we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors' most recent clinical experiences. (shrink)

This paper proposes an ethical reflection on personalized medicine and more precisely on the diagnostic technology underlying it, including nanochips. Our approach is inspired by a combination of two philosophical frames of reference: first, John Dewey’s distinction between intuitive valuation and reflexive evaluation, second, John Rawls’ reflective equilibrium. We aim at what we call a ‘reflexive equilibrium’, a mutual adjustment between on the one hand, the intuitive beliefs scientists have about the ethics of the technologies they work on (‘valuations’ (...) in Dewey’s vocabulary) and, on the other hand, the reflexive ethical assessment of these technologies (‘evaluations’). Our goal, in this paper, is to provide the first step of this process through a philosophical analysis of some valuations on individualized medicine. In order to apprehend the ethical values shaping the development of biochips, we present and analyze qualitative interviews with scientists involved in the conception and the development of biochips involving nanotechnologies. We then propose a critical assessment of the role of ethics in these scientific practices. Last, we suggest two distinct and complementary ways to solve some of the issues brought to light by the interviews, without aiming at any dogmatic or “ready-made” answer. The first of these perspectives gives a central role to the capability individuals could achieve through personalized medicine; the second approach analyses the ethical disruptions entailed by personalized medicine with a special focus on care. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis (...) and treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)

In this chapter we consider the tension between how pain researchers today typically define pains and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, providing evidence that during (...) large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

In this paper, I outline the ways that reification as a pathology of what I call “cybernetic society” shapes the fundamental structures of the self and our shared social reality. Whereas the classical theory of reification was a diagnostic attempt to understand the failure of class consciousness, I believe we must push this thesis further to show how is fundamentally an ontological and not a merely cognitive or epistemic concern. By this I mean that it is a pathology of (...) consciousness as well as social praxis and, as such, infects the ontological substrates of social reality. In effect, reification is a collective rather than merely subjective phenomenon. I explore this dialectic between our subjective and social dimensions of being to show how reification actively shapes self and world. I end with a discussion of how this theory of reification as an ontological concept can be used to overcome it via what I term “ontological coherence,” or the capacity of the self to reflect dialectically on the shapes of sociality that one inhabits, opening it up to evaluative reflection and critique. (shrink)

Mon objectif dans cet article est de mieux cerner les contours d’une conception institutionnelle de la corruption. Je tenterai de contribuer à ce programme de recherches sur la corruption institutionnelle d’une double façon. Premièrement, j’essaierai de clarifier le concept de « corruption institutionnelle » en mettant en lumière quatre de ses principales caractéristiques et certains de ses avantages. Deuxièmement, je tenterai d’exposer trois problèmes auxquels sont confrontés ses partisans : les problèmes de la portée, du faux-diagnostic et de l’essentialisme. (...) Malgré la sympathie que j’ai pour cette approche, j’espère montrer qu’elle recèle certains points problématiques. Je tenterai essentiellement de montrer que les « institutionnalistes » risquent de faire de la corruption un concept normativement surchargé. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 295-298 [Access article in PDF] A Dialectical Conception of Autism Giovanni Stanghellini Some Reasons for the Philosophical Turn in the Psychopathology of Schizophrenia There are many ways to become a schizphrenic. Each individual has her own schizophrenia, coherent with her life history, her problems and alternatives deriving from them (Binswanger 1960). What clinical psychiatry calls "schizophrenia" is not a unitary illness but a (...) common final state—a "syndrome" in the etymological sense, that is, a condition to which different psychopathological pathways may lead. Schizophrenic symptoms, like Schneiderian first-rank symptoms (delusions, hallucinations, experiences of passivity), are nothing but a rather uniform type of reaction. First-rank Schneiderian symptoms may be interpreted as attempts to explain disturbing basic experiences of change in self, body, and world perception (Klosterkoetter 1988) or as the epiphenomena of complex interactions between sensory disorders (aberrations in the perception of self, body, and world), conceptualisation disorders (impairments in the constitution of meanings and intentions), and attitudinal disorders (eccentric structure of values and beliefs) (Stanghellini 2000a). Since the schizophrenic syndrome, as defined by current diagnostic manuals, lacks any authentic core phenomena, and so-called schizophrenic symptoms are not specific (Berner and Kufferle 1982), the clinical diagnosis of schizophrenia finally becomes a diagnosis by exclusion (Maj 1998). This conceptual weakness is obviously unacceptable (not only for old dissenters from operational diagnostic criteria) and is kindling a velvet revolution in nosological studies and a renaissance of philosophically oriented psychopathological research (Parnas and Zahavi 2000). Autism: The Loss of Vital Contact with Reality Eugène Minkowski was a forerunner in the field of philosophical psychopathology: "The psychiatrist and the metaphysician become one in their common research concerning what is human and human experience" (Minkowski 1947). Indeed, his doctoral thesis on autism (Minkowski 1926) was dedicated to his teachers, the psychiatrist E. Bleuler and the philosopher H. Bergson, and his conceptualisation of autism is an ideal example of the link between philosophical perspectives and psychopathological research. The term "autism" was introduced by Bleuler (1911) to describe detachment from outer reality and immersion in inner life. Bleuler's concept of autism relied on Freud's (1905) notion of autoerotism and on associationistic psychology. According to Bleuler, autism was a consequence of the [End Page 295] splitting of psychic functions: a defense mechanism serving to avoid conflicts between desires and reality testing, promoting the shift to inner fantasy life and entailing social withdrawal, emotional indifference, inappropriate behaviors, and idiosyncratic values and beliefs.Minkowski, who was influenced by Bergson and phenomenology, departed from Bleuler's conceptualisation and defined autism as "loss of vital contact with reality" (Minkowski 1926, 1927). For Minkowski, autism is not a symptom, but a global phenomenon investing the whole person. Autism is a way of being whose essential feature is a pragmatic deficit: Autistic activity consists in the reduced capacity to interact with the external world. Autistic thought is characterized by its lack of communicative action. The pragmatic deviance of autistic language is a good example: The autistic person is not interested in communicating her inner world to the others; language is not a means of communication which serves mutual understanding, a cooperative process whose aim is interlacing one's own world with that of others. The autistic person's use of language is much like a soliloquy, the monologue of the solitary thinker more focused on ex-pression—the outward portrayal of immanent contents of consciousness—than on dialogue—the exchange of meanings between speaker and listener. Moreover, each meaning is presented in its manifold profiles or adumbrations and the task of selecting the context-relevant meaning is left to the listener.The pragmatic weakening of the autistic person, according to Minkowski, is not simply a social or occupational dysfunction (APA 1994), that is, a renunciation or refusal to act according to social expectations and standards. It involves the loss of vital contact with reality. The meaning Minkowski attributes to the term "vital" is essential for understanding his philosophical approach to defining the schizophrenic condition. Minkowski assumes that contact with reality is vital when it is established through action (and language... (shrink)

In this paper, I outline the ways that reification as a pathology of what I call “cybernetic society” shapes the fundamental structures of the self and our shared social reality. Whereas the classical theory of reification was a diagnostic attempt to understand the failure of class consciousness, I believe we must push this thesis further to show how it is fundamentally an ontological and not a merely cognitive or epistemic concern. By this I mean that it is a pathology (...) of consciousness as well as social praxis and, as such, infects the ontological substrates of social reality. In effect, reification is a collective rather than merely subjective phenomenon. I explore this dialectic between our subjective and social dimensions of being to show how reification actively shapes both self and world. I end with a discussion of how this theory of reification as an ontological concept can be used to overcome it via what I term “ontological coherence,” or the capacity of the self to refect dialectically on the shapes of sociality that one inhabits, opening it up to evaluative refection and critique. (shrink)

This commentary challenges Professor Lennard Nordenfelt's thesis that Cicero's The Tusculan Disputations has presented us with "the first Diagnostic Manual of Mental Disorders". In this short response I argue that by making his "peculiar" claim Nordenfelt is mistaken about the thrust of the stoic project and Cicero's presentation of it, and mistaken about the stoic view of irrational responses.

The stated purpose of the Diagnostic and Statistical Manual of Mental Disorders is to classify mental disorders. However, no tenable operational definition of mental disorder is offered in the manual. This leaves the possibility open that the behaviors labeled as disordered in the DSM are not members of a valid category. Attempts to define mental illness fall into the category of essentialist or relativist based, respectively, on the acceptance or denial of the existence of a defining biological attribute that (...) all mental disorders possess. However, the disorders in the DSM cannot be accounted for by either of these approaches making it unlikely that they represent a single valid concept. Simultaneous inclusion of brain illnesses and normal behaviors in the DSM are a likely explanation for the disparate nature of DSM disorders. (shrink)

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of (...) disease. Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis. (shrink)