I argue that in recent years, the therapeutic ethos and the ideal of authenticity have become aligned with distinctively neo-liberal notions of personal responsibility and self-reliance. This situation has radically exacerbated the threat to political community that Charles Taylor saw in the ‘ethics of authenticity’. I begin by tracing the history of the therapeutic ethos and its early (Rieff, Lasch, MacIntyre) and late (Furedi) critics. I then discuss Charles Taylor’s argument that the culture of self-fulfillment generated (...) by the therapeutic ethos harbors an important moral ideal, namely, the ethic of authenticity. Pace Taylor, I argue that authenticity has now become thoroughly instrumentalized in the service of the guiding political rationality of neo-liberalism. I make this case through a discussion of its uptake in managerial techniques and practices and also in popular culture. (shrink)

My essay argues that neoliberal forms of government emerged through the shifting political trajectory of the therapeutic ethos in the postwar period in Anglo-American societies. In the postwar era, the therapeutic ethos attracted the attention of conservative cultural critics who described it as a destructive force on communal obligation. Initially, the therapeutic ethos appeared to align naturally with New Left ideas of democratization in the workplace and private sphere. However, I argue that the New (...) Right was subsequently able to sever the therapeutic ethos from its alignment with social democratization by imbuing it with an alternative set of meanings centered on the ideas of market freedom and the entrepreneur. The result was the construction of the new, neoliberal forms of power, which, I argue, take the form of the management of subjectivity. Finally, I outline the two major social pathologies of the neoliberal era, namely, the consequences of its contractualized notion of citizenship and the explosion of social inequality, both of which are traceable to the influence of therapeutic notions of the self. (shrink)

For decades, Anderson has been pressing critical theorists and literary scholars to acknowledge the inescapably normative dimensions of their work. Through careful attention to rhetorical styles, she has persuasively argued that epistemological positions and social theories are tethered to “characterological” judgments—to implicit endorsements of ethos. Meanwhile, critical discourse has warmed to the claims of lived experience (the “turn to ethics,” the interest in “affect”), but the “ethical” has remained a negative movement, either as the critique of social and discursive (...) structures or as clearing space for the “other”—and “affect” has been construed as the pleasure and self-care that enable resistance to the pressure of these structures. The questions that galvanize ethical criticism (What is wrong with the way things are?) and theories of affect (How can I survive?) continue to evade the deeper one that Anderson sees as basic to any theorizing: How should I live?The lesson of Anderson's The Way We Argue Now is that ethics without ethos is shallow. In Psyche and Ethos, the lesson is that psychology without morality is benumbed. Though Anderson is characteristically judicious in her reconstruction of the arguments she opposes, there are several rhetorical targets in these lectures. The first is contemporary cognitive science, which pictures moral thinking as either the “belated” rationalization of decisions really made by “automatic” psychological processes or as a mechanism for eliminating “cognitive dissonance.” Anderson shows how these pictures assume an abstracted, “punctual” model of moral experience; their “deflationary” zeal ironically depends on an untenable ideal of moral voluntarism that is then speciously “debunked.” By contrast, novels are able to explore the temporal dimension of moral consciousness, especially through their representation of what she calls “moral rumination,” a concept further developed in her recent contribution to Character: Three Inquiries in Literary Studies. Anderson shows, moreover, that narrative fictions like The Winter's Tale, Middlemarch, and The Beast in the Jungle understand “belatedness” not as evidence for the superficiality of morality but as a distinct mode of moral recognition that can unfold only across time.Anderson worries that the new “eudaimonic” literary criticism, which explores “enabling moods,” unwittingly perpetuates the moral confusion of empirical psychology and “privileg[es] psychological over moral desiderata,” even as certain “psychological states” are “presented as morally desirable.” This contradiction is another iteration of one she has been confronting throughout her career: the strange incapacity of critical discourse either to recognize or to avow the normative claims—the elaboration of an ethos as good or valuable—with which it is nonetheless saturated. Still, the contradiction has been a defining feature of modern “therapeutic culture” (a formulation she employs): the neutral, functionalist descriptions of empirical psychology ostensibly bracket morality, yet some descriptions are inevitably coded as “better” or “worse,” and they are consistently harnessed to fully moral evaluations. It is rare to hear a literary theorist of Anderson's provenance reanimate, if indirectly, the criticism that Philip Rieff, Christopher Lasch, and Jackson Lears directed toward “therapeutic culture,” which has largely been forgotten or vulgarized by right-wing pundits. In essence, however, her plea is similar to theirs: she wants us to acknowledge that the moral life is integral to the “healthy” life; and she wants critics to stop dismissing it as epiphenomenal to either psychology or politics. She sees the novel, and the humanities more broadly, as the preeminent cultural vehicles for “clarifying” the moral life. (shrink)

Contemporary educational goals place increasing emphasis on conferring recognition and building self-esteem for people deemed to be marginalised and vulnerable. Such goals coalesce with the language, symbols and practices of therapy inscribed within a broader 'therapeutic ethos'. The paper relates these trends to broader cultural demoralisation about people's potential for human agency and evaluates their effects on educational debates. A therapeutic ethos in education appears benign and empowering. Yet, the paper argues that it produces a diminished (...) view of people and low expectations about people's capacity for resilience and autonomy. One effect is to encourage an alignment between the values and activities of education and welfare. This both legitimises and extends institutional and government influence over people's psychological and emotional states. The paper explores these trends and evaluates their implications for educational ideas about human agency. (shrink)

This article takes a historical look at abortion in Norway, especially the parliamentary debates and the legislation on selective abortion. By using metaphor theory and discourse analysis we disclose that mental health issues came into practice as a legitimate cause for selective abortion for women in Norway from the 1960s and recur in more recent debates about important amendments in 1996 and 2003. In order to abort, women must simultaneously adopt a psychological means of self-representation. The history of the discourse (...) on selective abortion in Norway thus illustrates the often ambiguous relationship between reproductive policy and ‘psy’. The analysis also shows that a therapeutic discourse today creates a framework of meaning for all political parties in Norway in the questions regarding abortion, including the Christian Democratic Party traditionally committed to religious motifs. This particular part of the history of abortion in Norway suggests that the psy-sciences and a therapeutic outlook on the self and society came into being in Norway from the 1960s, marking a defining moral shift from the previous religious and moral reasoning to a therapeutic ethos. (shrink)

For over fifty years, scholars have argued that a therapeutic ethos has begun to change how people think about themselves and others. There is also a growing concern that the therapeutic ethos has influenced educational theory and practice, perhaps to their detriment. This review article discusses three books, The Dangerous Rise of Therapeutic Education (by Kathryn Ecclestone and Dennis Hayes), Aristotle, Emotions, and Education (by Kristján Kristjánsson), and The Therapy of Education (by Paul Smeyers, Richard (...) Smith and Paul Standish), that point to the problematic assumptions and outcomes of therapeutic educational practices. The authors of the three books, however, disagree about whether a focus on emotions or therapy in education is necessarily an unwelcome intrusion into education. (shrink)

For over fifty years, scholars have argued that a therapeutic ethos has begun to change how people think about themselves and others. There is also a growing concern that the therapeutic ethos has influenced educational theory and practice, perhaps to their detriment. This review article discusses three books, The Dangerous Rise of Therapeutic Education (by Kathryn Ecclestone and Dennis Hayes), Aristotle, Emotions, and Education (by Kristján Kristjánsson), and The Therapy of Education (by Paul Smeyers, Richard (...) Smith and Paul Standish), that point to the problematic assumptions and outcomes of therapeutic educational practices. The authors of the three books, however, disagree about whether a focus on emotions or therapy in education is necessarily an unwelcome intrusion into education. (shrink)

What is the spirit that animates collective action? What is the ethos of democracy? _Worldly Ethics _offers a powerful and original response to these questions, arguing that associative democratic politics, in which citizens join together and struggle to shape shared conditions, requires a world-centered ethos. This distinctive ethos, Ella Myers shows, involves care for "worldly things," which are the common and contentious objects of concern around which democratic actors mobilize. In articulating the meaning of worldly ethics, she (...) reveals the limits of previous modes of ethics, including Michel Foucault's therapeutic model, based on a "care of the self," and Emmanuel Levinas's charitable model, based on care for the Other. Myers contends that these approaches occlude the worldly character of political life and are therefore unlikely to inspire and support collective democratic activity. The alternative ethics she proposes is informed by Hannah Arendt's notion of _amor mundi_, or love of the world, and it focuses on the ways democratic actors align around issues, goals, or things in the world, practicing collaborative care for them. Myers sees worldly ethics as a resource that can inspire and motivate ordinary citizens to participate in democratic politics, and the book highlights civic organizations that already embody its principles. (shrink)

Between Sickness and Health is about illness rather than disease, and recovery rather than cure. The book argues that illness is an experience, represented by the feeling that 'I am not myself'. From the book's phenomenological point of view, feelings of illness cannot be 'unreal' or 'fake', whatever their biological basis, nor need they be categorised as 'physical', 'psychosomatic' or 'psychiatric'. The book challenges the disease-centred ethos of medicine and medical education. It demonstrates that a clearer conception of illness, (...) as distinct from disease, is therapeutic. The feeling that 'I am once again myself' can return, in some degree, whatever state the body is in. Resilience becomes more available when it is seen as a set of personal skills that can be developed, rather than as an inborn trait. Possibilities of wellness are enhanced by recognising that medical and other therapies can either support or impede recovery, as can human relationships and the socio-political environment. The book's many clinical examples are drawn from the author's broad experience as a neurologist, rehabilitation physician and systemic family therapist. Between Sickness and Health will be useful for students, practitioners and academics, and also for anyone who has been or might one day be ill. (shrink)

Interest in the Buddhist concept of mindfulness has burgeoned over the last few decades as a result of its application as a therapeutic strategy in mind-body medicine, psychotherapy, psychiatry, education, leadership and management, and a wide range of other theoretical and practical domains. Although many commentators welcome this extension of the range and application of mindfulness—drawing parallels between ancient contemplative traditions and modern secular interpretations—there has been very little analysis of either the philosophical underpinnings of this phenomenon or of (...) its implications for education. This article examines the new interpretations of mindfulness in the following areas—meaning and definition, ethical foundations and spiritual ethos—in an attempt to gain a clearer understanding of what is involved in the process of reconstructing the concept of mindfulness. In conclusion, some implications for learning and education are examined in the light of these recent re-interpretations of mindfulness principles and practices. A central thesis throughout is that—although there are many educational benefits of mindfulness in the areas of moral, affective and spiritual education—such potential gains require the maintenance of organic connections between contemporary practices and their foundations in secular Buddhism. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional challenges. `Wise (...) Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Daoism, Practice, and Politics:From Nourishing Life to Ecological PraxisEric S. Nelson (bio)I. Daoism's Multiple ModelsManhua Li, Yumi Suzuki, and Lisa Indraccola have offered evocative insights, questions, and alternatives in their contributions concerning the arguments of Daoism and Environmental Philosophy: Nourishing Life (Nelson 2021). The present brief response and sketch of the book will not address every point in their essays, but I will strive to reply, directly and indirectly, (...) to their primary concerns.First, it should be noted that I take a pluralistic conception of 'Daoisms' as my point of departure. This is necessary since Daoist studies have been hampered by overly ahistorical and one-sided definitions that prioritize one philosophical or religious moment (such as skepticism or mysticism) in historically complex and varied transmissions that encompass a multiplicity of texts and perspectives. Due to the fact of the plurality of incompatible kinds of Daoism in Chinese antiquity and in subsequent history, my text considers a range of early Daoist and Daoist-related perspectives in the context of their potential consequences for environmental philosophy, ethics, and politics. Consequently, my approach is primarily philosophical without limiting any text to being exclusively philosophical, religious, or rigidly committed to one perspective, which would be untrue to the sources themselves.Second, examining distinctive tendencies (modifying Graham 1989 and Liu 1994) in the Daodejing 道德經, the Zhuangzi 莊子, and related texts enables us to articulate distinctive and conflicting ecological, ethical, and political paradigms. In place of constructing a mythologizing ideological construction of 'Chinese culture' and Daoism as intrinsically 'Green', a familiar essentializing tendency that has provoked skepticism regarding the very possibility of Daoist environmental philosophy, my book provides a different 'critical Daoist' strategy. This alternative entails that Daoist exemplars can be deployed as therapeutic models in the present, while at [End Page 792] the same time confronting their ideological codifications and uses. Early Daoist sources have roamed on long intercultural journeys. The Daodejing and the Zhuangzi have provided elements for European thinking about civilization, technology, and nature from Martin Buber and Martin Heidegger (Nelson 2017) to Peter Sloterdijk's 'Euro-Taoism' (Sloterdijk 1989) to contemporary progressive Green movements (Joshi 2022) and even ecofascism (Lubarda 2020). Similarly, in the current Chinese context, Green Daoism has both critical and authoritarian ideological functions in visions of 'ecological civilization' (shengtai wenming 生態文明) (Schönfeld and Chen 2019) and fears of a 'green leviathan'. Accordingly, it is not accidental that my anarchistic and participatory democratic interpretation of one key thread, which I call 'ziranist' and clarify below, in early Daoist and Wei-Jin mysterious-learning (xuanxue 玄學) discourses, has led to the most intense discussions and controversies about this book. These include the contributions by Li, Suzuki, and Indraccola that propose questions and alternative possibilities concerning agency and responsiveness, authority and self-determination, freedom and fate, and adaptation and intervention, as well as purposive techniques and anti-purposive uselessness.Third, this hermeneutical strategy points toward the tertiary aspect of our preliminary definition of Daoism. It does not primarily name a philosophical theory or a religious worldview. It concerns shifting, overlapping, and diverging ensembles of discourse and practice. This is not the vague ahistorical idea of 'a way of life' but rather refers to how philosophy is enacted through a specific configuration of—to adopt early Greek expressions—logos as dis-course (e.g., argumentation, hermeneutics, logic, rhetoric), ethos (e.g., comportment, orientation, a way of dwelling), and praxis (practices of the self, with others, and with things and nature). Thus, the Laozi 老子 and Zhuangzi collections can be analyzed textually and conceptually as having multiple threads (drawing on a variety of authors and sources) that form constellations in the received texts with better and worse historical, practical, and conceptual readings. My interpretive strategy in this discussion, which does not exclude other approaches, is that these texts express forms of practical instead of merely speculative philosophy. They are suggestive of an ethos of relational freedom, irreducible to rules and techniques, which dismantles hypostatized experiential and linguistic fixations, including moralistic fixations, in order to freely encounter the myriad things and enact and practice the dao in one's own singular way.'Critical Daoism', therefore, serves as a pluralistic, diagnostic, and practical designation... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bridge From Analysis to Action:Psychodynamic Analyses of Religion and Michael S. Hogue's American ImmanenceAJ Turner (bio)I. IntroductionThe purpose of this essay is to work constructively with Michael S. Hogue's groundbreaking American Immanence: Democracy for an Uncertain World to demonstrate how psychodynamic analyses of religion are essential theoretical allies in the fight for resilient democracy. The "revolution in mind"1 that psychodynamic approaches contribute, especially in their analyses of religion, (...) both complements and complicates socio-political theory as a whole. In the improvisational spirit of "yes-and," the goal here is not to identify and decry the failures and shortcomings of Hogue's theopolitical vision but rather to inspire the recovery of a sibling discourse—a kind of "rebirth of a forgotten alternative"2—that also draws deeply from the American immanental tradition in order to add psychodynamic depth to Hogue's timely and important analysis. Psychodynamic theories of religion shed light on how symbolic identifications, including and especially ultimate concerns, structure personal and collective experience. By engaging religion and theology sympathetically, constructively, and creatively, theorists such as Rollo May, Gordon Allport, Karen Horney, Erich Fromm, and Ernest Becker departed from the skepticism, reductionism, and dismissal that characterized psychoanalytic analyses of religion in the wake of Freud.3 Each of these figures, and especially Becker whose work will be a focus in this essay, are noteworthy interlocutors for extending Hogue's theopolitical theorizing of resilient democracy, particularly in how they drew unique inspiration from the American immanental tradition [End Page 44] in their social analyses. In this respect, they provide a more robust theorization of the psychosocial conditions of the associational ethos needed to connect Hogue's conception of resilient democracy with forms of agonistic organization and democratic activism. Briefly stated, psychodynamic approaches are a helpful bridge for connecting these proposals to strategies of organization, their impediments, and collective action.In this way, both psychodynamic analyses of religion and Hogue's theopolitical innovation insist that no revolutionary political change is possible, and certainly not of the kind or scale needed to counter our wickedly entangled global crises, without a deep engagement with theological imaginaries. They differ, however, in their theoretical aims. Whereas Hogue compellingly argues for the political upshot of a theology deriving from the American immanental tradition, psychodynamic analysts of religion focus on the function of ultimate concerns in individual and collective life. In other words, American Immanence rests on a methodology of analyzing the philosophical and theological assumptions that have contributed to our climate crises and then presenting clear and compelling articulation of an alternative paradigm meant to open up new ways of being. In contrast psychodynamic analyses leverage conceptual clarity of psychic reality for the fundamentally therapeutic aim of transformation. At their best, both approaches share what could be called an etiological orientation to ontological questions in order to provide liberative alternatives through rational understanding and clarification, but the terrain, and thus the problems they hope to mitigate in their analyses are focused differently. Extending the visual metaphor, they are different lenses highlighting different areas of the same landscape. Furthermore, it must be said that neither are sufficient in themselves, but the psychodynamic theorists of religion to be highlighted in this essay share deeply with Hogue's heading in American Immanence.II. A Problematic AssumptionIn emphasizing and attempting to explain4 the role of non-rational processes in the both individual and social processes of perception and organization of experience, psychodynamic theories confound a widely held and problematic assumption that the triumph of rational analysis is the hallmark for building the society to which we should aspire. Political theory in general, [End Page 45] especially as it has taken its cues from a rationalist legacy about the inherently liberating force of Reason, has been weighted toward an assumption that its task of exposing the mystifications of power would suffice in inspiring more "rational" and therefore necessarily equitable social organization. This speaks to the longstanding socio-political interest in "consciousness raising" tactics, which are often meant to dispel "false consciousness." It even comes across in the emphases of Deweyan pragmatists on education. Psychologists of all stripes point out that this approach... (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT (...) in Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

This paper seeks to circumscribe the concepts, sources, and limits of Nietzsche’s early ethical thought through a reconstruction of his ethical "symptomatology." In the 1870s, Nietzsche stressed that the Greeks understood the true nature of the political phenomenon, and that this could correct fundamental errors that were responsible for the illness of German culture. His definition of the Greek ethos radically challenges modern democratic politics through a reassertion of aristocratic, heroic, and agonistic values. But because Nietzsche did not systematically (...) describe his early ethics, a reconstruction is necessary. His metaphor of the philosopher as a “physician of culture” is a guide for this reconstruction. Using concepts of wellness and illness, Nietzsche identified different symptoms and possible remedies, and hoped to cure German culture through a therapeutic transvaluation of modernity. To reconstruct this symptomatology I turn to The Greek State, Homer’s Contest, and The Birth of Tragedy. First, I define the notions of “agon” and “eris” that are central to his reading of Greek ethics. I then describe four ethical symptoms and their remedies. I conclude with interpretative hypotheses that address issues that were left unanswered by Nietzsche. This symptomatology shows that his reading of Greek ethics functions as a radical—albeit fragmentary—normative critique of his time, and of our democratic age. (shrink)

Die vorliegende Abhandlung rekonstruiert Nietzsches Auseinandersetzung mit dem Stroizismus und bietet erstmals eine umfassende Analyse seiner argumentativen Strategien. Zugleich eröffnet sie einen weiten kulturhistorischen Horizont: durch zahlreiche Belgstellen zu stoishen Konzepten in Werken Ciceros und Senecas und durch Seitenbliche auf Positionen Kant und Schopenhauers. Einserseits übt Nietzsche Kritik an der maskenhaft-unauthentischen Attitüde eines stoischen Heroismus, am Verlust emotionaler Erlebnisintensität und intellektueller Sensibilität durch eine Erstarrung in stoischer Ataraxia sowie Postulat eines 'naturgemäßen Lebens', das er auf einen lantenen Willen zur Macht (...) hin transparent macht. Anderseits verbindet Nietzsche das stoische Ethos der Selbstdisziplin sogar mit seinem Konzept des 'freien Geistes' und betont seine Bedutung als Mowens der Kulturentwicklung und als Therapeutikum gegen die Décadence.This essay reconstructs Nietzsche's discussion of stoicism and for the first time presents a comprehensive analysis of his argumentation strategies. Numerous quotations from stoic concepts in the work of Cicero and Seneca and references to Kant and Schopenhauer provide us with a broad picture of the European cultural history. One the one hand, Nietzsche criticizes the lack of authenticity in the attitude of stoic heroism, as well as the loss of emotional intensity and intellectual sensitivity through petrification in stoic ataraxia, and he shows in which respect the stoic claim to 'natural life' is influenced by a latent 'will to power'. On the other hand, Nietzsche combines the stoic ethos of self-discipline even with his idea of the 'free spirit' and emphasizes its importance as a catalyst for cultural development and as a therapeutic measure against decadence. (shrink)

Angus Fletcher pitches his book to general readers. Though it consists of literary criticism, it is designed as a psychological self-help manual-literature as therapy. Fletcher's thera­peutic program is presented as an alternative to the kind of literary Darwinism that iden­tifies human nature as the basis for literature. He acknowledges the existence of human nature but aims at transcending it by promoting an Aquarian ethos of harmony and un­derstanding. He has some gifts of style, but the dominant voice in his (...) stylistic blend is that of the shill hawking a patent medicine. He presents himself as a modern sage who reveals an ancient but long-lost technique for using literature to boost happiness and well-being. Each of his 25 chapters identifies a distinct literary technique and uses popularized neuro­science to describe its supposedly beneficial psychological effects. Fletcher’s chains of rea­soning are habitually tenuous, and his exposition is littered with factual errors that betray ignorance of the books, genres, and periods he discusses. Despite its shortcomings, Fletch­er’s book has received encomiums from prestigious researchers, including the psychologist Martin Seligman and the neuroscientist Antonio Damasio. In evaluating Fletcher’s rhetor­ical style, analytic categories, Aquarian ethos, historical self-narrative, pattern of reasoning, and literary scholarship, this review essay reaches a more negative judgment about the value of his book. As an alternative to Fletcher’s book, I recommend a few evolutionary literary works for general readers. (shrink)

RE-ISSUED WITH INDEX 'Therapy may be mad,' declares Rob Weatherill in this outspoken volume. Therapy here means particularly psychotherapy and counselling, but should be also taken to signify the universal logic of the post-modern therapeutic culture of well-being, happiness and enjoyment. More and more people want to believe in therapy who have lost belief in anything else. Counselling and therapy increasingly inform all human interaction. The dominant ethos is a holistic one. This book aims to refute, primarily through (...) the prism of modern psychoanalysis and key theorists like Baudrillard, Levinas, Lyotard, Paz, Steiner, Reiff as well as Žižek, the fashion for a return to a pre-Cartesian ideal of harmony and integration. On the contrary, there is something monstrous, something excessive, that Freud termed the death drive, at the heart of the Real upon which ordinary reality, so to speak, rests. Enlightenment thought, in which we in the West in particular are caught, is entirely incapable of going beyond the ideal humanist version of man – our last great illusion. (shrink)

An ethical epoché is required to leave the terrain of a self-evident morality and question its origin. In particular, four fundamental motifs of the ethical dimension are identified: pathos, to be thematised as an alternative to the persistent activist unilateralism; response, which always involves body and soul; diastasis with its stumbles and subtractions; and finally coaffection, in which the social dimension of experience is announced. Ethical behaviour feeds on the magma of pathos, which in turn would be blind and directionless (...) without any ethos. (shrink)

This paper develops and defends a new account of therapeutic trust, its nature and its constitutive norms. Central to the view advanced is a distinction between two kinds of therapeutic trust – default therapeutic trust and overriding therapeutic trust – each which derives from a distinct kind of trusting competence. The new view is shown to have advantages over extant accounts of therapeutic trust, and its relation to standard (non-therapeutic) trust, as defended by Hieronymi, (...) Frost-Arnold, and Jones. (shrink)

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, (...) 94 articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

This article utilizes recent Western approaches to the ethical inquiry into human activities of forgetting, especially the approach represented by Ricoeur’s work on memory and forgetting and their ethical functioning. The three areas of Ricoeur’s investigation includes the therapeutic/pathological area; pragmatic area, which deals with the issue of individual and group’s self-identity in relation to time and otherness; and the more explicitly ethical area. These three divisions are useful to start with, but Ricoeur’s work shows some narrowness in neglect (...) of positive, productive and healthy forgetting, which has been deemed significant by the Zhuangzi. This paper is the first of the author’s serial writings to apply Ricoeur’s three areas of forgetting to investigate the forgetfulness of the Zhuangzi, and examines therapeutic forgetting and its ethical dimension only. (shrink)

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a (...) conversation with a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

: "Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent.

This article analyzes efforts in Nicaragua to create ethical organizations and an ethical economy. Three societal ethea found in contemporary Nicaragua are examined: the ethos of revolution, the ethos of corruption, and the ethos of human development. The emerging ethos of human development provides the most hope for the nation's social and economic evolution. The practices of three successful economic development organizations explicitly aligned with the ethos of human development are described and evaluated: (1) a (...) microfinance foundation (FDL), (2) a federation of cooperatives (FENACOOP), and (3) a local branch of an international NGO (IO-Nicaragua). The article concludes with additional reflections on the meaning of ethical organizations and an ethical economy in the context of contemporary Nicaragua. (shrink)

Calls for the “translation” of research from bench to bedside are increasingly demanding. What is translation, and why does it matter? We sketch the recent history of outcome-oriented translational research in the United States, with a particular focus on the Roadmap Initiative of the National Institutes of Health (Bethesda, MD). Our main example of contemporary translational research is stem cell research, which has superseded genomics as the translational object of choice. We explore the nature of and obstacles to translational research (...) and assess the ethical and biomedical challenges of embracing a translational ethos. (shrink)

In The Ethos of a Late-Modern Citizen, Stephen K. White contends that Western democracies face novel challenges demanding our reexamination of the role of citizens. White argues that the intense focus in the past three decades on finding general principles of justice for diversity-rich societies needs to be complemented by an exploration of what sort of ethos would be needed to adequately sustain any such principles. Accessible, pithy, and erudite, The Ethos of a Late-Modern Citizen will appeal (...) to a wide audience. (shrink)

Although the therapeutic misconception (TM) has been well described over a period of approximately 20 years, there has been disagreement about its implications for informed consent to research. In this paper we review some of the history and debate over the ethical implications of TM but also bring a new perspective to those debates. Drawing upon our experience of working in the context of translational research for rare childhood diseases such as Duchenne muscular dystrophy, we consider the ethical and (...) legal implications of the TM for parental consent to research. In this situation, it is potentially the parent who is vulnerable to TM. In our analysis we not only consider the context of informed consent for research but also the wider environment in which the value of research is promoted, more broadly through the media but also more specifically through the communication strategies of patient organizations. All dissemination about developments in research for health runs the risk of portraying an overly optimistic view of the promise of biotechnological solutions and has the potential to encourage a ‘collective’ TM. In this paper we consider the challenge that TM presents to parents as well as explore the ethical and legal responsibilities of researchers to ensure an appropriately informed consent: compatible with a hopeful disposition of parents who consent for the their children whilst avoiding a blind and misleading optimism. (shrink)

Abstract:The discussion of the global economy and worldwide expansion of the capitalist and market economic system barely deals with the topic of public goods, although they are of paramount importance precisely in this international setting. Fortunately, the theory of public economics systematically developed the central concept of the public good with its far-reaching implications so that this knowledge can be applied also to global issues. In order to treat these often vaguely discussed issues, a typology of international relations is proposed. (...) These and other considerations prepare the way to ask the question about the implied ethos. Because a common and sustainable ethos for public goods in the global economy is of great relevance and high urgency, both religious and non-religious ethical traditions are called for making their necessary contributions to this foundation. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining (...) and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

Combined oral contraceptives have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are (...) approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The evolution (...) of the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic (...) responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology. (shrink)

The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not (...) quite as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

This article focuses on two very different thinkers from different periods of time, an early hedonist who belonged to Socrates’ circle and lived until the middle of the fourth century BCE and the late Stoic who ruled the Roman Empire in the second century CE. Despite all substantial divergences – for instance, on the value of pleasure – Aristippus the Elder and Marcus Aurelius shared an interest in presentism, broadly construed as a focus on the present and its primacy, and (...) engaged themselves in exercises regarding the experience of the present. Moreover, in developing their respective positions and the exercises they prescribed, we shall uncover and foreground their essentially therapeutic character. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of (...) class='Hi'>therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)