In this chapter we give an overview of current and historical conceptions of the nature of obsessions and compulsions. We discuss some open questions pertaining to the primacy of the affective, volitional or affective nature of obsessive-compulsive disorder (OCD). Furthermore, we add some phenomenological suggestions of our own. In particular, we point to the patients’ need for absolute certainty and the lack of trust underlying this need. Building on insights from Wittgenstein, we argue that the kind of certainty the patients (...) strive for is unattainable in principle via the acquisition of factual knowledge. Moreover, we suggest that the patients’ attempts to attain certainty are counter-productive as their excessive conscious control in fact undermines the trust they need. (shrink)

The Restoration settlement, the political backcloth to Aubrey's essay, proceeded in two stages. The first, in, saw the rehabilitation of the King and the ...

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

Collective moral agents can cause their own moral incapacity. If an agent is morally incapacitated, then the agent is exempted from responsibility. Due to self-induced moral incapacity, corporate responsibility gaps resurface. To solve this problem, I first set out and defend a minimalist account of moral competence for group agents. After setting out how a collective agent can cause its own moral incapacity, I argue that self-induced temporary exempting conditions do not free an agent from diachronic responsibility once the agent (...) regains its moral faculties. For collective agents, any exempting condition is potentially temporary due to the ‘malleability’ of their constitution. Therefore, in cases of self-induced moral incapacity and subsequent wrongdoing, unlike individuals, every collective agent can be (made) morally responsible for its actions even though it did not qualify as a moral agent at the time of wrongdoing. Hence, this is no reason for skepticism concerning corporate responsibility. (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best for which (...) patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

Author Aubrey Neal suggests that one of these issues that lingers with us today is scepticism, and in 'How Skeptics do Ethics', he unravels the thread of this philosophy from its origins in enlightenment thinking down to our present age.

In this paper we introduce a new property of families of functions on the Baire space, called pseudo-dominating, and apply the properties of these families to the study of cardinal characteristics of the continuum. We show that the minimum cardinality of a pseudo-dominating family is min{.

There is good reason to think that moral responsibility as accountability is tied to the violation of moral demands. This lends intuitive support to Type-Symmetry in the collective realm: A type of responsibility entails the violation or unfulfillment of the same type of all-things-considered duty. For example, collective responsibility necessarily entails the violation of a collective duty. But Type-Symmetry is false. In this paper I argue that a non-agential group can be collectively responsible without thereby violating a collective duty. To (...) show this I distinguish between four types of responsibility and duty in collective contexts: corporate, distributed, collective, shared. I set out two cases: one involves a non-reductive collective action that constitutes irreducible wrongdoing, the other involves a non-divisible consequence. I show that the violation of individual or shared duties both can lead to irreducible wrongdoing for which only the group is responsible. Finally, I explain why this conclusion does not upset any work on individual responsibility. (shrink)

An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

I argue that culpable ignorance can be irreducibly collective. In some cases, it is not fair to expect any individual to have avoided her ignorance of some fact, but it is fair to expect the agents together to have avoided their ignorance of that fact. Hence, no agent is individually culpable for her ignorance, but they are culpable for their ignorance together. This provides us with good reason to think that any group that is culpably ignorant in this irreducibly collective (...) sense is non-distributively collectively responsible for subsequent unwitting acts and consequences. (shrink)

If the argument of this short study is sound, we have here a point of view which needs to be borne in mind as an aid to the solution of, not only textual and literary problems, but even more those problems which are associated with the attempt to employ such terms as 'polytheism' and 'monotheism' in connexion with Israelite thought, and also those which are inherent in the question of the prophetic psychology or, again, that of revelation. It may also (...) be argued that along this line we gain a new approach to the New Testament extension of Jewish Monotheism in the direction of the later Trinitarianism. . . . At any rate, we can see how it was possible for a Jewish Christian to relate his Messiah so closely with the divine Being as to afford a basis for the later (and Greek) metaphysical formulation of the doctrine of the Trinity. --from the author's conclusions. (shrink)

Psychiatric disorders involve changes in how you feel, think, perceive, and/or act—and the same goes for psychotropic medication. How then do you know whether certain thoughts or feelings are genuine expressions of yourself, or whether they are colored by your psychiatric illness, or by the medication you take? Or, as Karp nicely sums up the problem: “if I experience X, is it because of the illness, the medication, or is it “just me’?” Such “self-illness ambiguity” seems to be quite an (...) ubiquitous problem in psychiatry. It is a very unsettling problem, moreover, and not easy to resolve.In their... (shrink)

The feasibility of reversing human aging within a matter of decades has traditionally been dismissed by all professional biogerontologists, on the grounds that not only is aging still poorly understood, but also many of those aspects that we do understand are not reversible by any current or foreseeable therapeutic regimen. This broad consensus has recently been challenged by the publication, by five respected experimentalists in diverse subfields of biogerontology together with three of the present authors, of an article (Ann NY (...) Acad Sci 959, 452–462) whose conclusion was that all the key components of mammalian aging are indeed amenable to substantial reversal (not merely retardation) in mice, with technology that has a reasonable prospect of being developed within about a decade. Translation of that panel of interventions to humans who are already alive, within a few decades thereafter, was deemed potentially feasible (though it was not claimed to be likely). If the prospect of controlling human aging within the foreseeable future cannot be categorically rejected, then it becomes a matter of personal significance to most people presently alive. Consequently, we suggest that serious public debate on this subject is now warranted, and we survey here several of the biological, social and political issues relating to it. BioEssays 24:667–676, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

I Am grateful for the honour of being invited to give the second Manson Lecture. Dr. Manson believed that the study of sick people leads into the widest fields of thought, but that increasing specialization within medicine diverts the doctor from seeing man and his nature whole: the chief question seems to be , “whether medicine is in the bondship of practice, whether it is a skilled art, or whether it can emerge to give its own contribution to abstract thought (...) and philosophy.” Indeed, pleading with doctors to join this Institute of Philosophy, he declared that medicine should be the most philosophic of the professions. In this he was reviving an ancient claim: the arguments for it have lately been restated with much Aristotelian piety by Scott Buchanan. Now here I find myself in a difficulty at the outset: I am to speak of the relationship between philosophy and medicine, at a lecture founded by a passionate believer in their conjunction, yet I am engaged in a particular branch of medicine which was for longer than any other preoccupied with philosophy and dependent on it, but had so little profit from its fidelity that it reckons progress from the time when it struggled away from this allegiance. Psychiatry has not been able to refrain since then from many a backward glance at the older philosophy she once swore by, and she has been much influenced by the philosophies of later times: she has—doubtless in punishment for her defection—become entangled now and then in bad, unrecognized philosophy of her own making. She has, at all events, never achieved more than a temporary indifference to philosophic thought. (shrink)

We challenge Gallagher’s distinction between the sense of ownership and the sense of agency as two separable modalities of experience of the minimal self and argue that a careful investigation of the examples provided to promote this distinction in fact reveals that SO and SA are intimately related and modulate each other. We propose a way to differentiate between the various notions of SO and SA that are currently used interchangeably in the debate, and suggest a more gradual reading of (...) the two that allows for various blends of SO and SA. Such an approach not only provides us with a richer phenomenology but also with a more parsimonious view of the minimal self. (shrink)

I argue that agents can have duties to cooperate with one another if this increases their combined efficiency and/or efficacy in addressing ongoing collective moral problems. I call these duties cooperative duties of efficiency and efficacy. I focus particularly on collective agents and how agents ought to reason and act in the face of global moral problems. After setting out my account, I argue that a subset of cooperative duties of efficiency and efficacy of collective agents are duties of justice (...) in virtue of the roles these agents have taken up. (shrink)

This paper investigates agents’ blameworthiness when they are part of a group that does harm. We analyse three factors that affect the scope of an agent’s blameworthiness in these cases: shared intentionality, interpersonal influence, and common knowledge. Each factor involves circumstantial luck. The more each factor is present, the greater is the scope of each agent’s vicarious blameworthiness for the other agents’ contributions to the harm. We then consider an agent’s degree of blameworthiness, as distinct from her scope of blameworthiness. (...) We suggest that an agent mostly controls her degree of blameworthiness—but even here, luck constrains what possible degrees of blameworthiness are open to her. (shrink)

This study examines a number of different answers to the question: wheredoes Avicenna demonstrate the existence of God within the Metaphysics of the Healing? Many interpreters have contended that there is an argument for God’s existence in Metaphysics of the Healing I.6–7. In this study I show that such views are incorrect and that the only argument for God’s existence in the Metaphysics of the Healing is found in VIII.1–3. My own interpretation relies upon a careful consideration of the scientific (...) order and first principles of the Metaphysics of the Healing, paying attention to Avicenna’s own explicit statements concerning the goals andintentions of different books and chapters, and a close analysis of the structure ofthe different arguments found in the relevant texts of the Metaphysics of the Healing. I conclude that Avicenna’s explicit goal in I.6–7 is to establish the properties that belong to necessary existence and possible existence, which consists, not in ademonstration of God’s existence, but in a dialectical treatment of the first principlesof metaphysics. (shrink)

According to some collectivists, purposive groups that lack decision-making procedures such as riot mobs, friends walking together, or the pro-life lobby can be morally responsible and have moral duties. I focus on plural subject- and we-mode-collectivism. I argue that purposive groups do not qualify as duty-bearers even if they qualify as agents on either view. To qualify as a duty-bearer, an agent must be morally competent. I develop the Update Argument. An agent is morally competent only if the agent has (...) sufficient positive and negative control over updating their goal-seeking states. Positive control involves the general ability to update one’s goal-seeking states, whereas negative control involves the absence of other agents with the capacity to arbitrarily interfere with updating one’s goal-seeking states. I argue that even if purposive groups qualify as plural subjects or we-mode group agents, these groups necessarily lack negative control over updating their goal-seeking states. This creates a cut-off point for groups as duty-bearers: Organized groups may qualify as duty-bearers, whereas purposive groups cannot qualify as duty-bearers. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

The relevance and potential value of insights from enactivism for the field of psychiatry have been recognized for some time now. Recently, two overarching frameworks have been proposed, one by Nielsen, and one by me.1 As mentioned by Nielsen, we developed our approaches largely in parallel: I was not aware of Nielsen’s work, and he only became aware of my work in the last phase of his PhD. Nielsen compares our approaches and concludes that our frameworks are ‘largely compatible, do (...) different work to one another, and are best understood as complimentary’. I think, however, that the differences between our... (shrink)

A new critical approach to Jewish thinking and praxis, drawing upon key thinkers such as Adorno, Wittgenstein, Gdel, Heidegger and Celan.

Whether extrovertive, introvertive, or some further hybrid, the process of the soul touching the fullness of its divine origins is itself undergoing transformation in the twenty-first-century cultural matrices of Israel. A remarkable exemplar of devotional Hebrew cultures can be found within the hybrid networks of haredi worlds in Israel today. R. Yitzhaq Maier Morgenstern, author of Yam ha-okhmah, Netiv ayyim, and De'i okhmah le-nafshekha, is arguably the most innovative mystical voice in Israel. Why are his works resonating so strongly both (...) inside and outside their haredi communities of origin? How is his innovative thinking affecting the devotional praxis of Devekut both inside and outside the unfolding Hasidic networks? This exploration of mystical apperception through Devekut builds upon studies of Garb, Huss, and Meir, while challenging the idea that Morgenstern's expanding impact is solely a function of his mystical-magical charisma and hypernomian spiritual practice. This study argues that it is Morgenstern's hybridized thinking through key theoretical issues in Kabbalah and Hasidism as they apply to the lived practice of a devotional life of Devekut that will likely remain his strongest innovation and contribution to contemporary Jewish mysticism. (shrink)