Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

In this article, I side with those who argue that the debate about the definition of “disease” should be reoriented from the question “what is disease” to the question of what it should be. However, I ground my argument on the rejection of the naturalist approach to define disease and the adoption of a normativist approach, according to which the concept of disease is normative and value-laden. Based on this normativist approach, I defend two main theses: (1) that conceptual analysis (...) is not the right method to define disease and that conceptual engineering should be the preferred method and (2) that the method of conceptual engineering should be implemented following the principles of Alexandrova’s account of social objectivity in the context of the definition of disease. (shrink)

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I (...) will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization. (shrink)

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists and focus on the criticisms that (...) led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition. (shrink)

BackgroundGeneral practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic.MethodsSemi-structured interviews with Dutch general practitioners working in the Netherlands were (...) conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding.ResultsFifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision.ConclusionsLack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. (shrink)

The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly . This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team’s decision to (...) resort to surrogate consent may help the care team during the inclusion process and enable the patient’s family circle to be better informed about providing surrogate consent. (shrink)

In this paper, we want to take a critical stance towards Tsou’s recent proposal that a neuro-oriented version of the homeostatic property cluster kind model (MPCK) should be an ideal for the DSM. Our strategy will be to discuss the creation of the Social Pragmatic Communication Disorder (SPCD) in DSM-5 to show the limits of MPCK as an ideal for the next DSM deliberations over a set of diagnoses revisions. We argue that an ideal model for the DSM should address (...) the issues of deep uncertainties and pragmatic considerations to be useful in this context. (shrink)

Anne-Marie Gagné-Julien et Pierre-Olivier Méthot Durant les deux dernières décennies, plusieurs questions classiques de la philosophie de la médecine et de la psychiatrie ont connu un renouvellement. Des angles de recherche jusqu’alors peu explorés font désormais l’objet de vifs débats, et les questions traditionnelles ont été réinterprétées à la lumière de ces nouveaux développements. En examinant ces récents thèmes grâce aux contributions de chercheur.e.s francophones, ce dossier vise à nourrir la progression de cette « nouvelle » philosophie de (...) la médecine et de la psychiatrie, à apporter un éclairage inédit sur certains de ses domaines et de ses objets encore méconnus de même que sur ses courants et ses problématiques émergents, et ainsi à faire avancer des débats classiques sous des angles nouveaux. (shrink)

ABSTRACT:One recent body of work has concerned medicalization and how it can create epistemic injustice. It focuses on medicalization as a hermeneutical process that shapes the conceptual framework(s) we use to refer to some conditions/experiences. In parallel, some scholars with lived experience of madness have started to explore the epistemic harms suffered by the Mad community. Building on this, I argue that the process of medicalization in psychiatry affects the Mad community in a specific way that has been overlooked in (...) the literature on medicalization and epistemic injustice. That is, medicalization can create what is called "contributory injustice." This form of injustice occurs when marginalized communities have been able to create alternative hermeneutical resources, but these resources are dismissed or discredited by the dominant group. I argue that the emerging field of Mad Studies is a victim of this type of injustice when Mad experiences are unilaterally medicalized. (shrink)

La création récente du diagnostic de trouble dysphorique prémenstruel (TDPM) dans le DSM-5 a été contestée sous de multiples angles. Les principales critiques mettent en avant les lacunes en faveur de la validité du TDPM, ainsi que le risque de pathologisation et de stigmatisation des changements physiques et comportementaux vécus par les femmes pendant leur phase prémenstruelle. Pour éclairer cette controverse, j’emprunte certains outils du cadre conceptuel des injustices épistémiques (IE) développé par Miranda Fricker. Plus précisément, je vais me baser (...) sur de récents travaux qui ont tenté d’appliquer ce cadre aux processus de catégorisation en médecine et en psychiatrie. Cela me permettra de mettre au jour un angle mort du débat actuel sur le TDPM, soit les perspectives des personnes touchées par ces symptômes. Ces points de vue ont été généralement négligés, mais le cadre des IE nous permet de recentrer le débat sur les intérêts et les besoins des personnes affectées par les processus de catégorisation psychiatrique. (shrink)

In the debate over the definition of ‘mental health,’ three different approaches are generally distinguished: the normativist approach, the hybrid approach and the naturalistic approach. This paper qualifies this classification by clarifying the sense in which Christopher Boorse defends a naturalistic approachvis-à-visthe central concepts of psychiatry. This paper also clarifies in what way Boorse is opposed to the normativist approach advocated by some authors of the anti-psychiatric movement, such as Szasz.

First, I want to thank PPP for the privilege of having my work read and commented on by esteemed colleagues. In this response, I briefly review some of the key issues that they have raised. These issues include 1) the usefulness of a definition of mental disorder for North American psychiatry, 2) the absence of a concrete criterion to address the demarcation problem, 3) the place and role of values in such a demarcation, and 4) the worries of over-inclusiveness, problematic (...) values and imposition of values.The first question that needs to be clarified is raised by Waterman's commentary : Is it really necessary to define mental disorder and mental health? Here I feel I should clarify a background assumption of... (shrink)

The anti-psychiatry movement of the 20th century has notably denounced the role of values and social norms in the shaping of psychiatric categories. Recent activist movements also recognize that psychiatry is value-laden, however, they do not fight for a value-free psychiatry. On the contrary, some activist movements of the 21st century advocate for self-advocacy in sciences of mental health in order to reach a more accurate understanding of psychiatric categories/mental distress. By aiming at such epistemic gain, they depart from the (...) anti-psychiatry movement. Through the analysis of the epistemic and political influence of two of these movements – Neurodiversity and the Mad Studies, we show how this new activism has taken a scientific turn compatible with current philosophical scientific frameworks, while still developing a critical approach on psychiatry. (shrink)

Objective: Basic temporal dysfunctions have been described in patients with schizophrenia, which may impact their ability to connect and synchronize with the outer world. The present study was conducted with the aim to distinguish between interval timing and synchronization difficulties and more generally the spatial-temporal organization disturbances for voluntary actions. A new sensorimotor synchronization task was developed to test these abilities. Method: Twenty-four chronic schizophrenia patients matched with 27 controls performed a spatial-tapping task in which finger taps were to be (...) produced in synchrony with a regular metronome to six visual targets presented around a virtual circle on a tactile screen. Isochronous (time intervals of 500 ms) and non-isochronous auditory sequences (alternated time intervals of 300/600 ms) were presented. The capacity to produce time intervals accurately versus the ability to synchronize own actions (tap) with external events (tone) were measured. Results: Patients with schizophrenia were able to produce the tapping patterns of both isochronous and non-isochronous auditory sequences as accurately as controls producing inter-response intervals close to the expected interval of 500 and 900 ms, respectively. However, the synchronization performances revealed significantly more positive asynchrony means (but similar variances) in the patient group than in the control group for both types of auditory sequences. Conclusion: The patterns of results suggest that patients with schizophrenia are able to perceive and produce both simple and complex sequences of time intervals but are impaired in the ability to synchronize their actions with external events. These findings suggest a specific deficit in predictive timing, which may be at the core of early symptoms previously described in schizophrenia. (shrink)

Commentator: Mark Purvis Commentator: Sheena McMain Commentator: Clare Connolly Commentator: Maggie Eisner Commentator: Shirley Brierley Commentator: Becky Ship.

Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation- specificity of many normal functions or cannot account for many situation-specific diseases. In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. (...) We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation- specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation- specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health. (shrink)

This article puts experience of both mildwifery students and beginner psychiatric nurses into perspective. It analyzes dynamics which contribute to build their relationship to the job. The inquiry, as Dewey defines it, is chosen as the analytic entry. Starting from health care professionals’ speech about subjectively significant situations, it emphasiz-es suggestions brought throughout the caring activity. They highlight three dimensions which are constituent of the relationship to the job. These are specifically brought out and discussed here : the relashionship with (...) the vulnerable other, the place of uncertainty in the caretakers’ activity and the building of a clinical sense. (shrink)

Background Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and (...) analysed thematically. Participants and research context Healthcare teachers ( n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers. (shrink)

Here we question the mechanisms underlying the emergence of the feeling of control that can be modulated even when the feeling of being the author of one’s own action is intact. With a haptic robot, participants made series of vertical pointing actions on a virtual surface, which was sometimes postponed by a small temporal delay (15 or 65 ms). Subjects then evaluated their subjective feeling of control. Results showed that after temporal distortions, the hand-trajectories were adapted effectively but that the (...) feeling of control decreased significantly. This was observed even in the case of subliminal distortions for which subjects did not consciously detect the presence of a distortion. Our findings suggest that both supraliminal and subliminal temporal distortions that occur within a healthy perceptual–motor system impact the conscious experience of the feeling of control of self-initiated motor actions. (shrink)

Le titre de ce livre surprend. Le mot Luxure, privé d’article, est-ce un nom propre? Celui d’un personnage? D’un concept? Et le sous-titre promet « une histoire », non pas entre telle et telle dates, mais « entre péché et jouissance », c’est-à-dire hors du temps. L’introduction ouvre bien une perspective chronologique, mais de manière très originale : elle présente trois documents qui d’une part illustrent la complexité psychologique, philosophique, métaphysique, du sujet, d’autre part ann...

Julien Offray de La Mettrie (1709-51), author of Machine Man (1747), was the most uncompromising of the materialists of the eighteenth century, and the provocative title of his work ensured it a succès de scandale in his own time. It was however a serious, if polemical, attempt to provide an explanation of the workings of the human body and mind in purely material terms and to show that thought was the product of the workings of the brain alone. This (...) fully annotated edition presents a new English translation of the text together with the most important of La Mettrie's other philosophical works, translated into English for the first time, and Ann Thomson's introduction examines his aims and the scandalous moral consequences which he drew from his materialism. (shrink)

Cette thèse en impose par la masse de travail qu'elle représente, mais plus encore par les questions qu'elle pose à l'histoire des femmes et par l'éclairage nouveau qu'elle apporte sur les milieux populaires. La vie privée a reçu droit de cité en histoire grâce à la haute approbation de Philippe Ariès et de Georges Duby (ainsi que de leurs nombreux collaborateurs). Le concept de vie privée reste pourtant difficile à cerner. La première audace d'Anne Marie Sohn consiste à donner (...) une dé.. (shrink)

Cette thèse en impose par la masse de travail qu'elle représente, mais plus encore par les questions qu'elle pose à l'histoire des femmes et par l'éclairage nouveau qu'elle apporte sur les milieux populaires. La vie privée a reçu droit de cité en histoire grâce à la haute approbation de Philippe Ariès et de Georges Duby (ainsi que de leurs nombreux collaborateurs). Le concept de vie privée reste pourtant difficile à cerner. La première audace d'Anne Marie Sohn consiste à donner (...) une dé... (shrink)

Cette thèse en impose par la masse de travail qu'elle représente, mais plus encore par les questions qu'elle pose à l'histoire des femmes et par l'éclairage nouveau qu'elle apporte sur les milieux populaires. La vie privée a reçu droit de cité en histoire grâce à la haute approbation de Philippe Ariès et de Georges Duby (ainsi que de leurs nombreux collaborateurs). Le concept de vie privée reste pourtant difficile à cerner. La première audace d'Anne Marie Sohn consiste à donner (...) une dé... (shrink)

Après avoir publié de nombreux ouvrages sur la maternité, Yvonne Knibiehler s’intéresse ici aux sages-femmes et à leurs rapports avec les médecins pendant la seconde moitié du XXe siècle. Contribution à l’histoire des femmes et à l’histoire du temps présent, les sources de ce livre reposent sur une centaine de témoignages écrits de sages-femmes, recueillis lors d’un colloque organisé par la Société d’histoire de la naissance. Forte de ces témoignages – lesquels ne sont pas nécessairement r...

Les vingt-quatre contributions qui composent ce volume collectif se donnent pour objectif de fournir au lecteur un ensemble de repères historiques et conceptuels permettant de s'orienter dans le vaste territoire des théories contemporaines de l'imagination, de 1918 à aujourd'hui. Cet ouvrage présente ainsi, grâce à une enquête pluraliste et interdisciplinaire, un point de vue privilégié pour apprécier les différentes stratégies qui, au cours des cent dernières années, en réhabilitant l'importance et la puissance féconde de la "folle du logis", repensent la (...) valeur du savoir littéraire et humaniste."--Page 4 of cover. (shrink)

SummaryThis article looks at the discussions of natural law by the eighteenth-century French materialists Julien Offray de La Mettre, Denis Diderot, Paul Thiry d'Holbach and Claude-Adrien Helvétius. It is particularly concerned with their discussion of moral values and their attempt to find a materialistic basis for them as part of their rejection of religion. The discussion brings out the différences between them and analyses their dialogues on this question, including the other materialists' rejection of La Mettrie's amoralism, which threatened (...) to undermine their attempt to found a natural law taught by experience and based on human nature. Particular attention is paid to Diderot's many writings which grapple with the subject, beginning with his Encyclopédie article droit naturel, probably written in 1754. He discussed the question in many of his later writings, including in his annotations on the works of Helvétius, who based natural law on the general interest. These writings reveal a tension between Diderot's emphasis on the search for individual happiness and the interests of society as he, together with d'Holbach, attempted to provide a natural basis for morality and government from which to criticise existing institutions. (shrink)

Julien Offray de La Mettrie, author of Machine Man, was the most uncompromising of the materialists of the eighteenth century, and the provocative title of his work ensured it a succès de scandale in his own time. It was however a serious, if polemical, attempt to provide an explanation of the workings of the human body and mind in purely material terms and to show that thought was the product of the workings of the brain alone. This fully annotated (...) edition presents an English translation of the text together with the most important of La Mettrie's other philosophical works translated into English, and Ann Thomson's introduction examines his aims and the scandalous moral consequences which he drew from his materialism. (shrink)

Anne Cova s'est emparée d'un sujet central pour l'histoire des femmes : la maternité. En 1977, Catherine Fouquet et Yvonne Knibiehler avaient publié la première synthèse, Histoire des mères du Moyen Age à nos jours. Élisabeth Badinter, en 1980, attirait elle aussi, avec L'Amour en plus, l'attention du public sur l'historicité du sentiment maternel, soulignant la mutation survenue au XVIIIe siècle : début de la limitation des naissances, rapprochement de la mère et de l'enfant, valorisa..

Anne Cova s'est emparée d'un sujet central pour l'histoire des femmes : la maternité. En 1977, Catherine Fouquet et Yvonne Knibiehler avaient publié la première synthèse, Histoire des mères du Moyen Age à nos jours. Élisabeth Badinter, en 1980, attirait elle aussi, avec L'Amour en plus, l'attention du public sur l'historicité du sentiment maternel, soulignant la mutation survenue au XVIIIe siècle : début de la limitation des naissances, rapprochement de la mère et de l'enfant, valorisa...

Taking our lead from Solomon’s emphasis on the importance of the intentional object of emotion, we review the history of repeated attempts to make this object disappear. We adduce evidence suggesting that in the case of James and Schachter, the intentional object got lost unintentionally. By contrast, modern constructivists seem quite determined to deny the centrality of the intentional object in accounting for the occurrence of emotions. Griffiths, however, downplays the role objects have in emotion noting that these do not (...) qualify as intentional. We argue that these disappearing acts, deliberate or not, generate fruitless debate and add little to the advancement of our understanding of emotion as an adaptive mechanism to cope with events that are relevant to an organism’s life. (shrink)