Qu’est-ce qu’une sensation pour un médecin hippocratique? Cette question est traitée ici à partir d’une recherche sur le rôle que les traités chirurgicaux et le Pronostic accordent aux sensations du malade d’une part, du praticien d’autre part, dans l’élaboration du jugement médical, selon ses deux moments principaux que sont l’estimation d’un pronostic et le choix d’une conduite thérapeutique. L’hypothèse mise en œuvre est celle de la réflexivité de la médecine hippocratique : la représentation que les médecins se faisaient de l’élaboration (...) du jugement médical à partir des signes sensibles doit être conforme aux théories médicales de la sensation et du jugement. Si cette hypothèse est valide, la pratique clinique hippocratique doit refléter les conceptions médicales de la sensation et du jugement, et peut donc en témoigner. Cette étude confirme cette hypothèse et établit que le jugement résulte, pour les médecins hippocratiques, d’un mélange des sensations. Ces dernières sont comprises comme des processus physiologiques dont les vecteurs de diffusion sont, selon notamment certains textes anatomiques, les vaisseaux. Aucun texte hippocratique, pas même Maladie sacrée, ne localise un siège de la sensation ou du jugement. Les conseils adressés aux médecins pour viser l’exactitude dans un jugement toujours singulier (Ancienne médecine, 9) relèvent d’un régime des sensations (« l’économie autour du malade » d’Épidémies VI) analogue au régime des aliments et des exercices que les médecins prescrivent à ceux qui les consultent. Par‑delà leurs différences doctrinales, une certaine unité des traités qui forment le noyau de la Collection hippocratique est ainsi confirmée. Cette unité est d’abord celle de la théorie du mélange compris comme crase, qui joue dans la conception du jugement médical à partir des sensations un rôle éminent. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces (...) the concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

The recent literature has seriously challenged, and in my view defeated, the traditional representationalist interpretation of Descartes. One contributor to it, John Yolton, has recently extended its arguments to argue that the traditional representationalist interpretation of Locke must be relinquished as well, that Locke, following the Cartesian path of Arnauld, held a semiotic theory of ideas which “de-ontologized” them and construed them as signs or cues in the direct perception of physical objects. The Cartesian support for this view, especially in (...) La Dioptrique, has been questioned by R.F. McRae, who argues that “if Locke accepts Descartes' theory of vision, then Descartes' conception of sensations as signs provides no support for the direct realist interpretation of Locke.” My aim here is not to resolve the representationalism issue, but to show the irrelevance to it of the kinds of questions the Yolton-McRae exchange raises concerning sense perception. I shall try to show that there stems from Descartes a single account of those questions the essentials of which are embedded in theories falling on both sides of the representationalism issue. That single account involves a theory of judgment and vision, especially of distance, which in the case of Malebranche and Berkeley, even involves the same confusions. (shrink)

Descartes analysed the mind into various faculties or powers, including pure intellect, imagination, senses, and will. This article focuses on his account of the sensory power, in relation to its Aristotelian background. Descartes accepted from the Aristotelians that the senses serve to preserve the body by detecting benefits and harms. He rejected the scholastic Aristotelian sensory ontology of resembling species, or ‘forms without matter’. For the visual sense, Descartes offered a mechanistic ontology and a partially mechanized account of sensory processes, (...) including some previously ascribed to judgement. He did this in the context of his theory of brain signs that prompt sensations. The article contends that Descartes’s use of the sign-relation was modelled on standard discussions of non-resembling signs in commentaries on Aristotle’s De interpretatione. It follows three uses of the sign-relation: brain states that cause colour sensations; brain states that cause experiences of spatialized contents, such as shapes; and brain states that realize a ‘natural geometry’. It argues that Descartes’s natural geometry does not involve mental operations but physiological mechanisms that co-vary with the distance to seen objects. While retaining the language of sensory powers, Descartes offered a partial mechanization of those powers. (shrink)

Purpose This paper presents an ethnographic study of gamete donation in Latvia. The aim of the study is to describe and analyse the practice of applying responsibility in gamete donation cases from the perspective of anthropology and ethics. Methods We performed thirty semi-structured interviews with laypeople and five focus group discussions among adolescents. The third source of data was media analysis: 57 articles discussing assisted reproduction in Latvian electronic popular media as well as internet discussions among ART participants. The data (...) were processed using Atlas.ti. Results The data showed that the situation of ART responsibility is formulated through defining one’s relationship to the gametes, to the nation and the relationship between parent and child. Conclusions The practice of gamete donation does not create new responsibilities but uses already existing relations in a situation marked by new knowledge. Relationships among ART users, donors and physicians often result in an imbalance of responsibility sharing. The framework of relational ethics is one possible way to change the practice of balancing and sharing responsibility in ART applications. (shrink)

PurposeThis paper presents an ethnographic study of gamete donation in Latvia. The aim of the study is to describe and analyse the practice of applying responsibility in gamete donation cases from the perspective of anthropology and ethics.MethodsWe performed thirty semi-structured interviews with laypeople and five focus group discussions among adolescents. The third source of data was media analysis: 57 articles discussing assisted reproduction in Latvian electronic popular media as well as internet discussions among ART participants. The data were processed using (...) Atlas.ti.ResultsThe data showed that the situation of ART responsibility is formulated through defining one’s relationship to the gametes, to the nation and the relationship between parent and child.ConclusionsThe practice of gamete donation does not create new responsibilities but uses already existing relations in a situation marked by new knowledge. Relationships among ART users, donors and physicians often result in an imbalance of responsibility sharing. The framework of relational ethics is one possible way to change the practice of balancing and sharing responsibility in ART applications. (shrink)

Mental health problems start early in life. However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients. In this study, we interviewed 12 young people who entered mental health care reluctantly at the initiative of others before the age of 18. Their journeys through mental health care (...) varied significantly despite sharing the same starting point. Our analyses resulted in a model of three trajectories. We describe relational and structural facilitators and obstacles within each trajectory and have formulated narratives highlighting core experiences differentiating them. Trajectory 1 was characterized by a rapid loss of hope, leading the adolescents to conclude that mental health care was not worth the investment. Trajectory 2 was characterized by a lingering hope that never materialized into a constructive therapeutic process despite prevailing efforts by both therapists and adolescents. Trajectory 3 was characterized by genuine meetings, allowing the therapist to transform from an unsafe stranger into a safe, competent, and benevolent adult. We discuss how our results have implications for understanding agency displayed by adolescent clients in therapy, therapist flexibility and authenticity, service organization, and attributional processes influencing clinical judgment and therapeutic processes when adolescent psychotherapy has a difficult starting point. (shrink)

“Artworks are not being but a process of becoming” —Theodor W. Adorno, Aesthetic Theory In the everyday use of the concept, saying that something is grotesque rarely implies anything other than saying that something is a bit outside of the normal structure of language or meaning – that something is a peculiarity. But in its historical use the concept has often had more far reaching connotations. In different phases of history the grotesque has manifested its forms as a means of (...) subversive resistance against society’s prevailing notions of form and power. What aids this impact and distinguishes two of its basic stylistic features is the grotesque’s dissolution of form and its hyperbole. Such grotesqueries, however, soon solidify into new forms, new structures of meaning, hierarchy and practice, and in this sense the history of the grotesque is, on one hand, a continual opposition and transgression of the prevailing notions of art as well as of God and humanity, while on the other hand it offers continual resistance to its own solidifying process. As such the grotesque will not and cannot be contained in form without it losing the very thing that makes it grotesque. Even though it is somewhat easy to point out certain stylistic features of the grotesque, the sum of those features tell us very little about what is at play within it. Definitions concerned with the grotesque’s content rather than its form faces similar difficulties. Throughout history, expressions relating to the grotesque have been used in defense of a whole host of different social and cultural discourse including, for instance, Catholicism (See Erhard Schön’s Der Teufel mit der Sackpfeife , 1536), Protestantism (See Lucas Cranach’s Der Papstesel , 1523), a material folk culture (see Mikhail Bakhtin’s Rabelais and his World , 1984) and an idealistic romantic structure of meaning (see Wolfgang Kayser’s The Grotesque in Art and Literature , 1957). Thus though the grotesque cannot be reduced to the expression of certain forms or meanings, in order to examine what the grotesque is about one has to try to see how it’s relationship to flow and process and how, by maintaining this relationship, it attempts to avoid solidifying into form and meaning. The process of the grotesque alluded to here revolves around a play between periphery and center, the marginalized and the dominant. Most often this is expressed as a direct negation of the center of power. In the medieval grotesque tradition of the carnival, for example, it is expressed by its emphasis on the nether regions of the body as the center of creation of meaning. Spirit does not come from above, but from the belly, buttocks and genitals, and there is, expressed in this manner, a mockery of the predominant Christian notion of truth and meaning. Such inversions of the sites of meaning most often explicitly express an increased interest in materiality instead of ideal content which comes to the fore through the play between periphery and center. Even in early grotesque Renaissance art (for example in the works of Raphael) the depiction of the mythological or ideal reveals an exploration of the possibilities of the material. The works of art thus explore their own boundaries rather than act as vessels of the divine and in this way the grotesque explores the limits of form and materiality. This in turn brings to the fore a metaphysical dimension in the workings of the grotesque: It is an immanent exploration of its own boundaries. Materiality and metaphysics are joined together, because it is through the awareness of itself as a structuring (dis)order that it places itself in opposition to the prevailing notions of form and power. This way the grotesque expresses an awareness of the division of sign and reality and a search for this reality. It implicitly expresses the awareness that meaning is not something God-given and static, but fluctuating and man-made. In modern explorations of the history of the grotesque it is commonly seen as a form of realism that manifests a shift from the ideal towards the material, freeing art from representing some hidden higher order and instead making the work of art the very site of creation and meaning. Going even further, the grotesque actively opposes the notions of the ideal by marking a shift from an ahistorical view of the world towards the historical. However, this also makes clear why the grotesque has a tendency to solidify into new static forms of meaning, for by establishing itself as a subversive counterforce there is an idea of transgression and emancipation. That is why the grotesque often historicizes and relativizes only to repeat the mistakes of that which it negates: putting itself in the king’s chair. The exploration of the material seems to create new forms and notions of the ideal. The representation of an otherness outside the prevailing notions of meaning and truth becomes a positive manifestation of this otherness as truth itself. Thus the historical “truths” of the grotesque are superseded by history itself. When the expressions of the grotesque solidify into static form and meaning, they become mere objects like anything else in the world. Instead of being this elusive thing of process and flow, it becomes tangible to the existing hierarchy of power as well as history itself. In this way the grotesque can be expunged, included or simply revealed as yet another false notion of truth, which is precisely what has happened with the grotesque throughout the course of history. If from the beginning the expression of the grotesque has not already been in the service of some structure of meaning and truth, it has quickly been included or has quickly included itself in such a structure. But by doing so it rejects its own basis: the tension between periphery and center is replaced by the attempt to create a new center, a new structure of meaning and truth. The doubleness, ambiguity and flow of the grotesque are then rejected by the grotesque itself. THE NON-FORM OF FORM In the critical thinking of Theodor W. Adorno (1903-69) the problem of art, caught between a reductive and prevalent notion of truth and meaning and a peripheral and alienated otherness, is reexamined and reformulated. For Adorno, the instrumental rationality of Enlightenment itself reverts into a new form of mythology which is every bit as static and exclusive as the hierarchies of religion it supersedes. All is excluded that is non-identical to the instrumental mastery of the objects of the world, "For the Enlightenment, anything which cannot be resolved into numbers, and ultimately into one, is illusion; modern positivism consigns it to poetry." 1 As such the non-identical has been banished from the realm of thought and action, and banished specifically to the realm of art. But the realm of art is not able to provide a decent home for it because even modern art is not something entirely autonomous. While it is excluded from the notions of truth and meaning provided by instrumental rationality, it still originates from society. Just like instrumental rationality art is about mastery, structuring and exclusion. Therefore, the problem for art is that it cannot directly provide a space for the non-identical because its mode of operation is similar to that of instrumental rationality. Even worse, art has very few possibilities to free itself from this. If it becomes l’art pour l’art it is at the same time reduced to the very thing instrumental rationality claims it to be: a subjective judgment of taste.expressionism also stands as an example of this. Conversely, art cannot work within the framework of the identity-thinking of society, because any notion of freedom or emancipation would reproduce the exclusive practices of instrumental rationality. For example: Explicit socialist literature may establish itself in opposition to instrumental rationality while at the same time reproducing it. Its language may seem different, but in reality it merely provides a different set of reductive schematics for human life and experience. The problem for the art of the grotesque was, as I mentioned earlier, that far too often it was merely a symbolic manifestation of a notion of otherness—not otherness itself. Because of this the subversive character of the grotesque ends up shaping and containing otherness instead of providing a space for it. According to Adorno the only way to avoid this is to radicalize the grotesque. In order to avoid solidifying into form the work of art has to be an object which cannot be contained in thought or form—a non-form of form. The work of art has to work in a way that it strives for autonomy but without entirely leaving a discernible reality. In other words, it has to pull in two directions at once. Thus the work of art is a paradox. It is autonomous in the sense that it closes itself off from everything outside of the work of art, trying to shy away from the contaminating influence of the identity thinking of instrumental rationality. At the same time though the work of art is heteronomous in the sense that it originates from a specific historical context and is bound to be what society is not. Autonomy and heteronomy are inseparably intertwined. Unable to display otherness itself, but still trying to be a refuge for it, there is only one option for art: It has to turn against itself and destroy its own logic of form, thereby demonstrating how any representation of otherness is impossible. Art becomes a lamentation of the victims of the identity thinking of instrumental rationality and shows the traces of the otherness that is unable to appear. Adorno’s pessimistic theory of art and history stages art as a negative dialectical process where the work of art closes itself off and rejects everything outside, while the individual elements in the work of art destroys its very own logic of form from within: Artworks synthetize ununifiable, nonidentical elements that grind away at each other; they truly seek the identity of the identical and nonidentical processually because even their unity is only an element and not the magical formula of the whole […]. The resistance to them of otherness, on which they are nevertheless dependent compels them to articulate their own formal language, to leave not the smallest unformed particle as remnant. This reciprocity constitutes art’s dynamic; it is an irresolvable antithesis that is never brought to rest in the state of being. 2 Relative to a traditional understanding of the grotesque, Adorno radicalizes the tension between center and periphery, autonomy and heteronomy. In the traditional understanding of the grotesque, as we find it for example in the writings of Mikhail Bakhtin, the grotesque establishes the display of otherness as a new center of meaning and truth. However Adorno rejects such notions and argues instead for a modernism of the grotesque in which both center and periphery are included in a negative dialectical process and continually synthesizing and destabilizing each other’s positions. A modernism of the grotesque works on the inside of the sign or the artwork, continually outlining and questioning the boundaries between materiality and form. This moves the focus away from the relation between the sign or work of art as a conceptual manifestation on one side and the object it refers to on the other side. Instead it implicitly points to the amorphous mass from which the signs and thereby meaning have been carved, the remnants that have been left behind. Modernism of the grotesque does not imply that it is emancipatory or that it reconciles man with nature, and does not represent a new position or a new ideology. It merely remembers and insists on the double nature of man and art: to write or paint yourself or an artwork whole by inscribing meaning in life or by applying form on a canvas is at the same time both creation and destruction. The very signs we use to center meaning in our lives carry its own alienation in them. Meaning surfaces only when process and flow comes to a halt—solidifying, but at the same time excluding parts that do not fit into that particular structure of meaning. NOTHING DONE AND NOTHING UNDONE It has always been difficult for art historians to find a suitable category for the works of the Danish artist Leif Lage (b. 1933). In his paintings the sensitive figuration seems so fragile that it is on the verge of turning into abstraction. Or conversely: the figurative emerges cautiously and hesitantly out of abstraction. As an art critic once wrote, he can almost paint things away. 3 Working in some undefinable space between abstraction and figuration, the Lage’s works shy away from the realm of words, and as a result few critics have been able to write anything meaningful about his works. In fact even fewer have been able to write more than one or two pages. The Danish author and art critic Leif Hjernøe is one of those few, but even he starts off by saying how impossible it is to write about Lage, confessing that his works exist both as process and in a field of in-between which words cannot reach. He writes: Always you find yourself in a place where nothing is done and nothing left undone, and where the elements of the work of art rest in a continuous motion. Always there is the open wound, where infection rather than surgical intervention is considered as an opportunity. And the conflict between matter and antimatter makes all diagnoses uncertain and allows conditions of uncertainty to spread in a place of raw presence. 4 The art works against the diagnosis and the certainty. Words are being eaten up by what is outside the realm of words: tension, process and doubleness. An approach to an understanding of the work of Lage could be to follow his connection to Samuel Beckett (1906-89). One can note, therefore, that Lage has illustrated several of the Danish translations of Beckett’s works. Though one is an author and the other a painter both seek a place where figuration, where the word, erodes. For both this entails an attempt to question and examine and so move in behind the façade of the surface in an exploration of that something or nothing that may be behind representation. At the same time even in the vanishing point of figuration or words, the meaningless words or the disjointed lines still stand as signs of human activity—signs of movement in emptiness. With very few exceptions Lage’s artworks revolve around one motif: Man—most often “en face.” But unlike traditional portraitures Lage’s people are found within. The artworks do not sense the reality of appearances, but rather the existential dimensions within man. As a seismograph they are sensitive to the utmost subjectivity in order to display an objective, sensuous depiction of the very problem of subjectivity. Instead of a static façade of a man, Lage’s “en face” shows the process-character of man. The people in Lage’s paintings are always in process—in the midst of becoming or dissolving. I will take a closer look in the following at the ways in which Lage establishes this sense of being in constant process, of being in-between modes or categories. THE DOUBLENESS OF THE STROKE Lage’s etchings attract attention in particular for the tension conveyed there between the material and the form. The material physically opposes the violence of the needle. But instead of embracing the violence of the needle and the victory over matter—instead of making the artistic creation and figuration express a heroic mastery of the background it is made out of—Lage uses the stroke to express the very tension between stroke and material, figuration and background. In the drypoint etching Untitled from 1983, which illustrated the Danish translation of Beckett’s Ill Seen, Ill Said , the needle tears up the material in long rough lines: Together, the primarily horizontal and vertical lines form a face. Thus the force needed to etch a line in the metal-plate draws attention to itself: It is there in the absence of curves and nuances. Man emerges on the metal-plate after great exertion and in a very simplistic form. This way Lage enhances the nature of the material, as the material’s resistance is not something to overcome. On the contrary the figuration is smitten by its very resistance and as such expresses the violence of its own becoming. Even more pronounced is the fact that the lines do not just show the violence of creation—it actively erases figuration in the same process that creates it. For example the mouth consists of 8-10 horizontal strokes, of which some seem to be connected to each other as if the mouth has been quickly scratched out. The mouth speaks of the inability to speak. In the same way, the eyes are black holes due to a large amount of criss-cross cuts, which together form a dark middle. Those lines, at the same time, form the eyes of the figuration and scratch out the eyes of the figuration. The extroverted aspects of the face—connected to speech and sight—are portrayed as introverted as well. Just as the etchings down into the metal-plate makes something appear. Leif Lage, Untitled , 1983 (etching) The figuration of the etching is connected to creation. It expresses that something is wrought into existence out of nothing by sheer artistic force. However, this force is at the same time presented as a violence of creation, which makes it impossible for form to truly emerge. Herein lies one of the basic principles of Lage’s art, namely that art cannot be that nothing or something behind the realm of words or signs. Without form, art would lose its ability to express anything at all. Form is a necessity if art is to avoid becoming as devoid of expression as the reality is that we cannot reach behind the appearance of things. On the other hand, art cannot raise itself above its own material in joyous celebration of the beauty of form. This would use the material in the manner of an instrument and thus would suppress the otherness it attempts to rescue. When art becomes mere form, any traces of otherness will have dissolved. Then art would be a question of technique, in no way different from the instrumental rationality of society. Therefore art works in a particular space between form and non-form. As Hjernøe says of the works of Lage, it is in the center of the event, in the in-between where things neither are nor are not, "And everything takes place just before it changes character. As the blood just before it coagulates, as the milk just before it separates, as fried egg just before it turns white […]." 5 The precise emphasis on the in-between of Lage’s art points in particular to the work of art as both outside of and in time. The work of art is a singular point in time, but at the same time it is continually in process. In the borderland between form and non-form, between creation and destruction, it shimmers like a fata morgana . The work is done but at the same time undone. It is only there as a cry in response to the inability to come into being. Akin to the etching is the drawing, but while both, of course, use the stroke or line as their main instrument, the paper does not resist the line in the same sense as the metal-plate of the etching. As a result in Lage’s drawings the stroke frolics in a space with almost no tension at all. There is nothing there to keep the pencil stroke at bay, but at the same time this means that there is nothing there to keep it together. One of the more expressive examples of this is found in an untitled drawing from Tegninger og Text ( Drawings and Text ) from 1999. The drawing consists of one unbroken pencil stroke. It is as if the stroke is confused—it darts around on the paper making doodles on the way or gathers itself in more straight lines in the center of the paper. It is in this manner that the semblance of a body is established. A couple of small circles serve as eyes and are the reason that the rest can be read as both face and body instead of pure abstraction. In fact the unbroken stroke serves as both abstraction and figuration as on the one hand it is the stroke that seemingly outlines the shape of a figure, while on the other hand the unbroken stroke dissolves any truly recognizable figuration by continuously, without end or aim, overflowing the boundaries of the figure. Seen again here is a doubleness to the stroke and the act of creation. In the etching it was all about the tension between the resistance of the material which created the doubleness. Here it is the opposite. It is the lack of tension. The stroke is free to do anything, but has no aim: without some kind of resistance, there is nothing to hold figuration together. It threatens to dissolve into nothingness. Conversely, the drawing can also be seen as a process of becoming. Like a form of automatic writing, the pencil darts around until it finds a point of densification. But even in such an interpretation of the drawing, the figuration appears artificial—it points to itself as the result of the artistic act of creation. The stroke is primarily stroke and only secondarily figuration. With its wild movement it calls attention to itself as stroke. Thus the figuration never becomes something in its own right. It points to the basic principle of creation: Someone has drawn me, I am the result of artistic endeavors, and therefore I am not for myself but always overflowing the boundaries that contain me. It is the stroke that in the very same movement creates figuration and dissolves it. Leif Lage, Untitled , 1999 (drawing) THE LIGHTNESS OF COLOR, THE DENSITY OF PAPER Often the watercolor is used as a precursor for larger paintings, because it has an immediacy in which one can quickly paint the main lines of a composition. However, Lage’s watercolors are not temporary points in a process leading to another final painting. They are not sketches, later to be filled with details in another material. For him watercolor is an end in itself. This also implies that he doesn’t try to work against the paper’s absorption of the water color and its tendency to absorb detail. On the contrary, he examines the possibilities inherent in this blurring of the line and absorption of color. As in the previous examples, there are of course recognizable shapes in Lage’s water colors. But these shapes are rarely separable from color, line or even paper. In other words: the figurative and the abstract more or less become one. One of the reasons for this is that Lage often works on wetted paper which means that the paper hungrily absorbs color into its fabric instead of it being on top of the paper. The paper becomes line because it is the absorption of the color which, together with the brush stroke itself, separates the colors from each other. The line is also color and the color is also line, because there is no separation between the different colors other than the colors themselves. At times this results in almost complete abstraction. In such cases Lage add lines with a pencil as if he wants to hold some sort of figuration together. At other times it is the other way around: the strokes of the pencil are a being dissolved by the water color blurring out the figuration. Untitled 1 from 1999 displays various tones of green. The contour of the colors appears unusually rough. Most of all it is reminiscent of a shoreline which has found its form through the work of thousands of years between water and land. Pockets of resistance surface as islands not yet drowned in color—as paper or color not yet consumed by the dominant color. The shape of the colors does not seem created by the hand of the artist, but rather by the inner workings of the watercolor: color against color over time has resulted in this very image, as if it is all a part of a natural process of change and decay. Despite the fact that there are no strong differences in color there seems to be a struggle taking place in the watercolor. For example, inexplicable holes in the dark color, which cover most of the right side of the watercolor, appear as if the underlying color is eating away the dark color, or that the dark color is in the process of covering up the underlying color. The small pockets of resistance demonstrate a process and development that, almost as a happy accident, evokes a couple of small eyes and a large mouth. Behind the colors a few slanted lines can be discerned, but the hand of the artist has long ago disappeared behind the life of the colors. Thus the watercolor seems to be held at precisely the point in time where figuration randomly appears. The small eyes and wide mouth seemingly express the realization of the figuration’s temporality. It is just a moment in time, soon to be consumed again in the life of the colors. The nature, the background it stems from and is part of, moves on undeterred, continuing its everlasting process of creation and decay. In this sense, the watercolor provides an experience of how neither artist nor man is able to transcend the materiality they consist of. The colors of man, the materials man consists of are “becoming” and “progress” but also “decay” and “disappearance”. The artist’s pencil strokes have been eaten up long ago, and the figuration is living on borrowed time. Human or artistic activity is about creating form, transcending mere matter by shaping and applying meaning to it. But Untitled 1 shows the doubleness of such creation: the transience and fragility of human life. Should the figuration come into being, should it rise and transcend the material, which binds it to its temporal existence, it would become nothing because its very existence is conditioned by the life and work of the colors. In the same sense man cannot escape his own temporality. He too, for better or worse, must accept a life in the volatility of sensation. Leif Lage, Untitled 1 , 1999 (watercolor) In most of Lage’s watercolors there seem to be a stronger artistic control than in Untitled 1 . Most often both the arrangement of colors and the technique in which they are painted express the hand of the artist. An example of this is Untitled 2 from 1999. While figuration in Untitled 1 seemed to appear as a happy accident, the figuration is much more “created” in Untitled 2 . Here the most important parts of the figuration, the eyes, the mouth and part of the skull, are colored black and painted on top of the background’s play of colors. The background primarily consists of blue and yellow tones. Only parts of the paper are covered in color, however, which yet again stresses the act of painting: There is a surface which is being filled by color by an artist. The blue tones are concentrated in the figuration, while the yellow tones surround it. All this means that the figuration stands out more clearly in this watercolor. This is also underlined by the fact that the blue and dark tones cover part of the yellow tones as spots here and there. Thus it is not a background which is in the process of consuming figuration, but rather the emerging figuration which blots out the background. Such an understanding is even suggested by how the mouth and eyes are placed in the larger blue color field. The eyes and mouth are in the center of the watercolor, while the blue color field is placed from center out towards the left side. This gives the impression of a face turned slightly to the right and slightly upwards, which again makes the mouth appear to emerge from the paper. It also helps that the mouth cuts the center axis of the watercolor. In other words, the arrangement of the blue and black colors create some depth and perspective which gives the illusion of a figuration, seen partially in profile, emerging from the background. Seen in profile, the eyes and mouth seem extroverted—they almost seem as if they are put on top of the face. But at the same time they are painted as black holes, sucking in the gaze of the onlooker. The watercolor is even more challenging if one follows what may be the faint outline of the skull, which, on the right side of the watercolor, no longer works together with the blue color, but rather alone postulates the outline of the skull. If not the blue color field, but this line, is the outline of the skull, then all of a sudden the face is not in profile but “en face”—staring directly towards the onlooker. Outline and color seemingly work against each other and establish two different expressions. Without the slightly upward tilted expression of the profile, the eyes and mouth do not seem to emerge from the paper. On the contrary, seen “en face,” the eyes and mouth are really gaping pits of darkness. In this sense Untitled 2 is at the same time surface and depth of perspective. The line gives form but at the same time it dissolves the form created by the colors, and vice versa. Leif Lage, Untitled 2 , 1999 (watercolor) As the last example of Lage’s artistic method, I have chosen another untitled work (as indeed nearly all of Lage’s artworks are)—this time from 2000. This is perhaps one of the most figurative watercolors Lage has created, though that doesn’t tell us too much. The painting depicts a human face in blue and green tones on a yellow toned background. The colors create a clear demarcation between the figure and the background, which compensate for the watercolor’s lack of outline. Beneath the face darker tones imply the beginning of the torso, and nuances of color even hint at something which could be a collar. The hair is in even darker tones and its structure is emphasized using pencil strokes on top of the water color. One eye is marked by a brown spot with a darker spot in the middle, while the other eye is added by pencil. The mouth is a round, red dot. In Untitled from 2000 the work between abstraction and figuration is much less pronounced than in the previous examples cited here. Nonetheless the watercolor has a delicacy to it which almost makes the figuration disappear, even as it appears. This has something to do with the fact that all the individual brush strokes have dissolved. The only outlines are those created by the clash of colors. Even the red mouth seems to be more paint than mouth—unable to be formed truly as anything other than a speck of color with some small semblance to a mouth. In contrast to the other watercolors, there is no movement, no progress or decay, just a vibrating standstill. The figure is not emerging or disappearing but embedded in and as surface, and as such it makes the figure seem stuck in its condition rather than freed by the act of giving form: mouth open as a wound. Pencil strokes add detail and life to the hair as an attempt to help the figure emerge. But all this does is create two levels in the watercolor: The pencil strokes are put on top of the figuration rather than being part of it. Thus they end up highlighting the endless distance between the movement and form-giving of the pencil strokes and the static and stuck figure behind these strokes. Leif Lage, Untitled , 2000 (watercolor) MAN AND THE VIEW OF THE ONLOOKER Lage’s works seem at the same time to be an examination of tensions between form and material in art and a display of an image of man full of the same tensions. This is because the people who are emerging in Lage’s images are not just in his works, They are his works. This means that man is not something emerging from a background but is part of this background and vice versa. The art of Lage inscribes man in its surroundings and background. Man is not the ruler of nature. Man does not rise above matter; there is no truly transcendent position for man to occupy in the art of Lage. Instead man is a part of the very matter, it, at the same time, tries to distance itself from in order to distinguish itself from its surroundings. Man emerges in an attempt not to be line, stroke, color. In an attempt to free itself of matter. Should it succeed in this, however, it would turn into nothing. On the other hand, if man fully accepted itself as mere matter it would disappear in it—in instincts, urges and lack of reflection. The appearance of man is thus subject to a state of being in-between. Only in the tension between material and its negation can the outlines of man be traced. However this also means that in the art of Lage man is never something in itself but always in process—on the way to its freedom and its loss. However, Lage’s art is not just about showing the tensions inherent in man but also about showing such tension on the verge of breaking point. In the moment before everything is done, or when nothing yet has been done, the delicate tension between form and material has been stretched to its utmost in such a way that man’s character of process emerges and is contained on the paper or canvas. Therefore, Lage’s art contain traces of human life. Not only is it an autonomous unity of tensions where man is stretched out between its singularity and the surroundings it is a part of. It is also this pulsation between figuration and material which brings about the traces of human endeavor and activity. Even when man almost seems to have disappeared into the material, strokes and lines are still there as a reminder of human activity and potential creative power—as a reminder that hope is still possible and that man is still there. The view of the onlooker seeks out forms and meaning. It seeks outlines and edges. But first and foremost it is the eyes in Lage’s works of art that allow the onlooker to decode the figuration at play. This creates a distinctive relationship between the onlooker and the artwork. The onlooker tries to wrest the enigma from the artwork, tries to reduce it to solid, meaningful form. But the very same moment that hints at such a possibility sees the view of the onlooker confronted with a gaze of its own. The eyes of the figure in the work of art are most often dark pits, as if they were an illustration of the violence committed against the eyes of the onlookers and their search for meaning. Or as if they were a dark reflection of the onlooker’s failed attempts to delineate the traces of life in the artwork to a solid meaningful form. Therefore, the gaze of the figuration speaks not only of its own powerlessness but also of the powerlessness of the onlooker. When the view or sight has trouble finding solid meaningful forms, it has something to do with the fact that the precondition for sight, light, no longer stems from something transcendent. In Lage’s art there is nothing outside the works of art, nothing outside of human life, and as such nothing to shed light on the works of art or human life and reveal solid meaningful forms. All light comes from within. In a western context, light as a medium for sight is central to the understanding of meaning. People speak of the clarity of thought, while knowledge is tied together with enlightenment, and so forth. But the light no longer originates from a divine point of view. It originates from man, who has created himself in the image of God. The problem with this is that light always covers up its own base. Light illuminates something but at the same time it hides itself. 6 While it was previously God who was unknowable, now it is man. It is also problematic that sight and the medium of sight stem from the same place. Following this thought one can posit two final problems. Firstly, the immediacy and presence established by light by making forms and objects accessible to sight is fake. Light is not some independent entity which present things in a neutral manner for the onlooker. It is inextricably tied together with the gaze’s desire after meaning. In other words: Light perverts the appearance of things because it doesn’t originate from some objective entity which allows them to appear as they are. Instead light is based upon and originates from the subject and its conquering gaze, seeking out meaning and form constantly. Secondly, the joining of sight and light makes introspection within human life impossible. Everything can be illuminated by its use value for the subject but only as long as it is separated from the subject, as long as it is an object. But the subject itself cannot be illuminated. Lage’s art tears down such a dividing line between subject and matter, but it does so without reestablishing a divine position from where the light emanates. Therefore, the light in Lage’s art may not illuminate very well. It may not have the certainty presented by modern science or the religions of yesterday. But it does show what such light tries to hide, namely, the subject as it is in its material reality—inscribed in time and death, which are the basic conditions of materiality, but at the same time also full of life in its joy and will to create. For the onlooker the meeting of the gaze in Lage’s works of art is thus also a destruction of the view of the onlooker. The ability to see is challenged in a radical way. Those outlines will not solidify into static form, as if the light was too dim to see. Just as in Lage’s figurations, the view of the onlooker turns to black: turns towards the onlooker in recognition and becoming—or disappearance. NOTES Max Horkheimer and Theodor W. Adorno. Dialectic of Enlightenment . (Palo Alto: Stanford University Press, 2002): 4-5. Theodor W. Adorno. Aesthetic Theory . (London & New York, 2002): 176. Carsten Bach-Nielsen. “Mere glæde end gru.” Kristeligt Dagblad . September 24, 2002. Leif Hjernøe. “Den yderliggående inderlighed.” LEIF LAGE—Retrospektiv udstilling 1983 . (Copenhagen: Brøndum, 1983): 18. Ibid. Maurice Blanchot. The Infinite Conversation . (Minneapolis: University of Minnesota Press, 1993): 162-163. (shrink)

The article examines the essence and relationship of aesthetic experience and aesthetic judgment. It is argued that philosophical aesthetics deals with constants that are fundamental to aesthetic experience. Such constants are phenomena and characteristics that have a fundamental ontological status in the aesthetic sphere. It was found that the ontological characteristic of aesthetic experience is that it is not reducible to “pure” rationality, that is, it is not something that is “adapted” to complete and final comprehension by the mind (...) alone. Therefore, a complete “absorption” of aesthetic experience by a certain semantic structure is impossible: such experience always goes beyond any discursive boundaries and simultaneously opens them. In addition, aesthetic experience serves as one of the means of a person’s “contact” with the world and society. Forming on the material of sensations, aesthetic experience extends from the most general ideas about the universe to the inner life of a person. The analysis also showed that the formulation of an aesthetic judgment is based on the concepts of the perfect and the imperfect. In turn, the mastery of such concepts is carried out in the process of correlating a certain aesthetic fact with the existing value scale. That is why aesthetic judgments have signs of normativity. They also create the basis for a common worldview and attitude, lay the foundation for mutual understanding between people of a certain culture. The study showed that the process of aesthetic assessment is a constant correlation of the existing state of affairs with something ideal, this is a permanent “demand” for perfection, as well as a tireless search for an opportunity to fulfill this “demand”. At the same time, ethical experience is dissociated from “pure” pragmatics, which personifies vital necessity, because the aesthetic sphere is always associated with a certain “redundancy” in human existence. Also, the results obtained in the course of the study suggested that philosophical aesthetics, which takes into account and investigates the specificity of the phenomenon of corporeality, as well as such phenomena of human existence as affective sensitivity and sensitive rationality, is able to overcome the limitation of “an-esthetic” naturalism in aesthetics. (shrink)

This is a major work by Ian Maclean exploring the foundations of learning in the Renaissance. Logic, Signs and Nature offers a profoundly learned, compelling and original account of the range of what was thinkable and knowable by learned medics of the period c.1530-1630. This is a study of great significance to the history of medicine, as well as the history of European ideas in general.

The clinical trial is the major investigational tool of clinical medicine. Two recent reports highlight the fact that the most often quoted mechanisms for the protection of research subjects, viz., research ethics board review and eligibility criteria, are insufficient to achieve this end. In this paper, we argue that the prime mechanism for the protection of persons in clinical trials should be the clinical judgement of the physician-investigator. The clinical investigator has a duty to protect subjects from both harm and (...) undue risk. It is argued that the clinical investigator has a duty to screen for, and exclude, potential research subjects who may be unduly vulnerable to the risks of a particular clinical trial. In order to fulfill this obligation, the investigator should personally screen each potential research subject at the time of accrual. In larger trials in which this is not feasible, this task could be delegated to another appropriately qualified health care professional, with the principal investigator retaining personal responsibility. To reinforce and make explicit this legal and moral duty, we propose that the investigator sign a statement, appended to each subject's consent form, to attest that this duty has been responsibly discharged. (shrink)

Risk is the probability that within a certain time some expected negative event will take place. In medicine risk can be related to a decision or to some intrinsic factors which are associated with the probability of the occurrence of a disease. Decisions can be necessary in the individual life with respect to the question of visiting a physician or performing a certain diagnostic or therapeutic procedure. The introduction of new pharmaceutical or technical products into medical use are another set (...) of decisions which can generate certain risks. Intrinsic or inherent risk factors are a set of variables or signs and symptoms which indicate the presence of a certain probability that some disease or event, e.g., arteriosclerosis or sudden infant death syndrome, may occur. Risk is always related to judgement. In a decision process cost, effectiveness and profit can be used to estimate the magnitude of the risk to be taken. In a similar way the problems in connection with an inherent risk are primarily related to the recognition of the magnitude of risk and to the possibility of prophylactic measures.In our own area of research, the sudden infant death syndrome (SIDS) is an event where only risk factors can be observed. We point at two facts in this context: Highly complex patterns of symptoms like behaviour can better be classified by intuitive Gestalt perception. A medical procedure like induction of labour can itself become a risk factor. (shrink)

Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. With special reference to (...) a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand. (shrink)

At the core of medicine is the idea to help fellow human beings by improving or even restoring their health. Let us call this the auxiliary stance of medicine—the motivation of medical intervention by reference to a moral obligation to guide our peers in their attempt to live a healthy and productive life. In parallel, the auxiliary stance is also central to public health, with a focus on prevention and health promotion. Taken together, we can view medicine and public health (...) as the two main human auxiliary endeavors to protect individuals and populations from health risks and help them to heal when sick. (shrink)

Frege believes that the real power to determine the sentence to show the logic of interest to "true." And with the word "truth" of redundancy on the same, he believes the lack of everyday language and the ability to determine the appropriate symbol. However, Frege, it seems that he invented the concept of text assigned to a special force to determine the sign: determine the bar. This paper attempts to demonstrate, although Frege until the final stage of his academic career (...) to determine the bar still insist to retain its logic into the language system, but the concepts and words in this design does not meet him on the relationship between logic and fuzzy real insight. A key step in the argument, we will by means of Husserl on the "faith of variation" to clarify the doctrine of "judge" and "determined" by Frege between the neglected difference. On this basis, we finally prompted a brief on the logic of Frege and true insight into the relationship between the interpretation of ambiguous direction. (shrink)

Errors of judgment regarding pain sensations are not possible. Christopher Hill, in his paper ‘Introspective Awareness of Sensations’, argues that we do sometimes commit ‘errors of judgment’ and he draws on an example that involves the perception of pain to illustrate his point. I analyze Hill’s example and draw on other examples of pain sensations to show how errors of judgment are not possible. I argue that pain sensations appear to be causally shaped and in some cases (...) generated solely by beliefs, expectations and dispositional states. Changes in beliefs, expectations and dispositional states appear to change the sensation that is generated. If pain sensations are generated in the way that I suggest, then the fact that some of the influences that causally shape and generate a pain sensation are constantly subject to change means that there may be little ‘truth’ that can be objectively established regarding a belief about a pain sensation. If there is little ‘truth’ that can be objectively established about a pain sensation, it will be inaccurate to label an instance of pain avowal as an ‘error of judgment’, or to speak about judgments concerning pain in terms of truth or error more generally. (shrink)

Bodily movement has a deeper meaning than modern sport science might recognize. It can have religious undertones, and in modern societies, it is sometimes related to the building of national identity. In the study, two cases of bodily practice are compared. Norwegian ski has a relation to friluftsliv (outdoor activities) and is highly significant for modern Norwegian identity. Indian yoga is related to the traditional ayurveda medicine and to Hindu spirituality, and obtained an important place in the process of anti-colonial (...) nationalism. The aim is to demonstrate how Norwegian skiing and Indian yoga as national body and movement cultures in different ways, show a complex connection between ‘ancient roots’ and modern transformations of cultural identity. Gliding on skis, sitting, and breathing in yoga make up the basis on which people have built identities of their collective ‘we’. (shrink)

Lawyers write, blog and are otherwise producers of words; they structure public life through legal discourse and integrate all issues that reinforce legal reasoning. Even if one is inclined not to justify the power of their words in the context of a democratic theory, one is hardly able to challenge its public acceptance. But semiotic analyses harden the question whether these emperors wear nothing but robes. That attitude intensifies where medicine becomes increasingly relevant for legal discourse, as becomes clear where (...) for instance US political viewpoints bring bioethical issues to the Courts. One major theme in today’s medicine pertains to identity in its psychological, philosophical and social dimensions. Identity thus becomes a groundbreaking semiotic issue in law and medicine; both discourses are particular important to the otherness of the other. A US criminal law case interests here (Harrington v. State of Iowa, 2003; cited as: 659N.W.2d 509). The case is decided with “information about what the person has stored in his brain”. A chain of signs is involved: from “brain-function” to “brain-storage” via “brain-scan” to “brain-fingerprint”, for which the case became famous. A long series of signs and meanings belong here to intertwined discourses. Central is a particular sign in each discourse: “brain” means brain scan, and “fingerprint” means law! The two display trading mechanisms, which determine the otherness of the other and the self! The chain of signs in the Harrington case shows inter-disciplinarity in law and inter-discursivity among law and medicine. The trading itself underlines the semiotic dimensions in cyberspace, in particular the semiotics of the virtual (Hayles, Kurzweil) and their effects on legal discourse. (shrink)

Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)

In this paper I address three problems posed by modern medical technology regarding comatose dying patients. The first is that physicians sometimes hide behind the tests for whole-brain death rather than make the necessary human decision. The second is that the tests themselves betray a metaphysical judgment about death that may be ontologically faulty. The third is that discretion used by physicians and patients and/or family in deciding to cease treatment when the whole-brain death criteria may not be met (...) are sometimes open to challenge. In each of these problems I find that the operative concept of death relates to life itself. This point is expanded by examining the uses of the word death in our language and culture. From these I formulate an initial ontology of death. In it, death is described through a relationship with life, rather than as an absence of life, of consciousness, awareness, or sensation. This ontology then leads to a proposal for an ethics of discretion about the discontinuation of treatment for comatose patients. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew (...) Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

The aim of the paper is to examine the possible relationships between the different dimensions of aesthetics on the one hand, and medical practice and medical ethics on the other hand. Firstly, I consider whether the aesthetic perception of the human body is relevant for medical practice. Secondly, a possible analogy between the artistic process and medical action is examined. The third section concerns the comparison between medical ethical judgements and aesthetic judgement of taste. It is concluded that the mutual (...) relevance between the aesthetic sphere, moral judgement and medical practice can be understood only if we recognize these spheres as distinct. (shrink)

Philosopy of medicine focuses inter alia on metaphysics and epistemology that are instantiated in biomedicine as physicalism (or materialism) and empiricism. The Golubchuck case reveals how the clinicans failed to recognize the relation between medical science and medical ethics and made biomedical decsions devoid of medical ethics. That is, they failed to make medical judgments that by defintion include a normative ethical component.

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)

There are good reasons for wanting to adopt an intentionalist account of experiences generally, an account according to which having an experience is a matter of representing the world as being some way or other—according to which, that is, such mental episodes have intrinsic, conceptual, representational content. Such an approach promises, for example, to provide a satisfying conception of experiences’ subjectivity, their phenomenal character, and their crucial role in constituting reasons for our judgements about the world. It promises this, moreover, (...) without incurring the difficulties that face the adverbialist and the friends of such items as qualia and “private objects”. Still, even many of those who have been persuaded of that much are inclined to make an exception of the bodily sensations, since pains and the rest have traditionally been taken to be peculiarly “blank”—instances of brute, non-conceptual feeling. In this study, I reject that tradition and argue that sensation experiences are indeed representational, and hence not in that respect exceptional. The idea that they are nevertheless distinctive in other ways vis-à-vis ordinary perceptual experiences has led intentionalists such as John McDowell to adopt an account of their content that is both mentalist and radically subjectivist: an account, in other words, that takes the items represented by such experiences to be mental and constitutively dependent on their being represented. To my mind, such subjectivism is both viciously circular—like the parallel view of colours—and at odds with the admirably intentionalist aspirations of these views. Hence I turn to consider objectivist versions of intentionalism, views that assimilate sensations to somatosensory perceptual experiences such as those that inform us of, for example, the position of our own limbs. Admittedly, these views not only risk losing the “interiority” of sensations, but I argue that they also cannot be combined with mentalism and that this generates considerable difficulties—difficulties that have either been ignored or underestimated by those working with less demanding conceptions of content. Nonetheless, I make a number of preliminary moves to show how such difficulties might be dealt with, and how the objectivist can register even the distinctively “inner” character of sensations—by, amongst other things, focussing on the peculiarities of somatosensory content. So the prospects for intentionalism about sensations are, I argue, good. (shrink)

Medicine involves specific practical expertise as well as more general context-independent medical knowledge. This raises the question, what is the nature of the expertise involved? Is there a model of clinical judgement or understanding that can accommodate both elements? This paper begins with a summary of a published account of the kinds of situation-specific skill found in anaesthesia. It authors claim that such skills are often neglected because of a prejudice in favour of the ‘technical rationality’ exemplified in evidence-based medicine (...) but they do not themselves offer a general account of the relation of practical expertise and general medical knowledge. The philosopher Hubert Dreyfus provides one model of the relation of general knowledge to situation-specific skilled coping. He claims that the former logically depends on the latter and provides two arguments, which I articulate in the second section, for this. But he mars those arguments by building in the further assumption that such situation-specific responses must be understood as concept-free and thus mindless. That assumption is held in place by three arguments all of which I criticize in the next section to give a unified account of clinical judgement as both practical and conceptually structured and thus justified in the face of a prejudice in favour of ‘technical rationality’. (shrink)

The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three (...) elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. (shrink)

Natural languages come in two different modalities. The impact of modality on the grammatical structure and linguistic theory has been discussed at great length in the last 20 years. By contrast, the impact of modality on linguistic data elicitation and collection, corpus studies and experimental (psycholinguistic) studies is still underinvestigated (van Herreweghe/Vermeerbergen 2012; Orfanidou et al. 2015). In this paper, we address specific challenges that arise in judgement data elicitation and experimental studies of sign languages. These challenges are related to (...) the socio-linguistic status of the Deaf community and the larger variability across signers within the same community, to the social status of sign languages, to properties of ;he visual-gestural modality and its interface with gesture, to methodological aspects of handling sign language data, and to specific linguistic features of sign languages. While some of these challenges also pertain to (some varieties of) spoken languages, other challenges are more modality-specific. In addition, the special combination of the challenges discussed in this paper seems to be a specific facet empirical research on sign languages is faced with. In addition, we discuss the complementarity of theoretical approaches and experimental studies and show how the interaction of both approaches contributes to a better understanding of sign languages in particular and linguistic structures in general. (shrink)

Although the body has been the focus of much contemporary cultural theory, the models that are typically applied neglect the most salient characteristics of embodied existence—movement, affect, and sensation—in favor of concepts derived from linguistic theory. In _Parables for the Virtual_ Brian Massumi views the body and media such as television, film, and the Internet, as cultural formations that operate on multiple registers of sensation beyond the reach of the reading techniques founded on the standard rhetorical and semiotic models. Renewing (...) and assessing William James’s radical empiricism and Henri Bergson’s philosophy of perception through the filter of the post-war French philosophy of Deleuze, Guattari, and Foucault, Massumi links a cultural logic of variation to questions of movement, affect, and sensation. If such concepts are as fundamental as signs and significations, he argues, then a new set of theoretical issues appear, and with them potential new paths for the wedding of scientific and cultural theory. Replacing the traditional opposition of literal and figural with new distinctions between stasis and motion and between actual and virtual, _Parables for the Virtual _tackles related theoretical issues by applying them to cultural mediums as diverse as architecture, body art, the digital art of Stelarc, and Ronald Reagan’s acting career. The result is an intriguing combination of cultural theory, science, and philosophy that asserts itself in a crystalline and multi-faceted argument. _Parables for the Virtual_ will interest students and scholars of continental and Anglo-American philosophy, cultural studies, cognitive science, electronic art, digital culture, and chaos theory, as well as those concerned with the “science wars” and the relation between the humanities and the sciences in general. (shrink)

Rationality in medicine is frequently construed as hypotheticodeductive. This article argues that such a model gives a distorted view of the rational character of an enterprise that makes judgments about individual human well-being. Medicine as a science is a practical human science. Seen as such, its rational orientation is one that applies general knowledge to particular situations. It is argued that such an orientation is not deductive but interpretative. The Aristotelian concept of practical wisdom (‘phron sis’) is used as a (...) model of the rational orientation of clinical judgment. Keywords: clinical judgment, rationality, human sciences CiteULike Connotea Del.icio.us What's this? (shrink)

This essay sets out to explain how educational semiotics as a discipline can be used to reform medical education and assessment. This is in response to an ongoing paradigm shift in medical education and assessment that seeks to integrate more qualitative, ethical and professional aspects of medicine into curricula, and develop ways to assess them. This paper suggests that a method to drive this paradigm change might be found in the Peircean idea of suprasubjectivity. This semiotic concept is rooted in (...) the scholastic philosophy of John of St Thomas, but has been reintroduced to modern semiotics through the works of John Deely, Alin Olteanu and, most notably, Charles Sanders Peirce. I approach this task as both a medical educator and a semiotician. In this paper, I provide background information about medical education, paradigm shift s, and the concept of suprasubjectivity in relation to modern educational semiotic literature. I conclude by giving examples of what a suprasubjective approach to medical education and assessment might look like. I do this by drawing an equivalence between the notion of threshold concepts and suprasubjectivity, demonstrating the similarities between their positions. Fundamentally, medical education suffers from tensions of teaching trainee doctors the correct balance of biological science and situational ethics/judgement. In the transcendence of mind-dependent and mind-independent being the scholastic philosophy of John of St Thomas may be exactly the solution medicine needs to overcome this dichotomy. (shrink)

According to Hermann von Helmholtz, sensations are signs that external causes impress on our sense organs; those signs are then used by the mind to acquire knowledge of the reality. Helmholtz's work points out the difficulty of defining a notion of causality suitable for explaining the relation between sensations on the one hand and the physical world on the other. In fact, he states that: 1) Physical stimuli, understood as the causal origins of sensations, are unknowable in themselves; 2) There (...) is no empirical evidence for the kind of causality from which sensations originate; 3) A transcendental causality is nothing but the urge of the intellect to know everything. It is necessary to keep in mind that Helmholtz is a committed empiricist : therefore, he believes that all knowledge originates from sensations. He tries avoiding commitments with any kind of pre-established harmony between the two sides of the causal relation. That is to say, sensible perceptions give us information about the peculiarities of the external world, but the relation between sensations and the reality should be explained and should not be taken for granted. In this paper, I study Helmholtz's struggles with providing a suitable explanation of that relation; in doing so, I also make use of Emile Du Bois-Reymond's work concerning the limits of human understanding, and in particular the transcendent difficulty of grasping the origins of sensations. (shrink)

The problem of perception is one of specifying correct and consistent meanings for the concepts we use in talking about it. The most frequent mistake in the history of this concept has been to "reduce" perception either to sensation or to judgment. With this in mind, the author deals primarily with the period from Descartes to Kant, though ancient, medieval, and contemporary developments are also treated.--R. H. K.

A certain kind of externalism—"the view from nowhere"—lies at the heart of evidence-based medicine (EBM). As a consequence, the individual case glides out of focus. However, to judge to what extent external knowledge is applicable to an individual case, the clinician has to rely on some sort of knowledge of the case at hand. The article focuses on the tension between the externalism of EBM and the "internal evidence" one has to presuppose when making clinical judgments.

ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. These populations (...) cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

Social judgement theory is particularly well suited to the study of medical judgements. Medical judgements characteristically involve decision making under uncertainty with inevitable error and an abundance of fallible cues. In medicine, as in other areas, SJT research has found wide variation among decision makers in their judgements and in the weighting of clinical information. Strategies inferred from case vignettes differ from physicians' self-described strategies and from the weights suggested by experts. These observations parallel recent findings of unexplained variation in (...) diagnosis and management in clinical practice that have been the source of concern in the medical community. The lens model provides one of the few methods for quantitatively analysing physicians' judgements. Contrary to what one might expect from the variation in strategies on paper cases, several studies suggest that, in practice, physicians' diagnostic judgements are highly accurate. Cognitive feedback has been less successful as a practical teaching tool than originally hoped, but some aspects of this methodology show promise, particularly in conjunction with the increasing emphasis on statistical decision support. All things considered, SJT has provided insight into physicians' decisions and gives the medical research community important tools for studying judgements in actual practice. (shrink)