Background: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data (...) were collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of (...) psychiatric power. As I will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and qualitative research methods to (...) illuminate experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

Although historians of addiction have long debated whether an oral culture of “sharing” or “Big Book”-based reading practices are foundational to 12-step recovery culture, the role other types of media have played in the development of contemporary recovery discourse has remained largely unexplored. This essay compares the production, reception and formal elements of the films The Lost Weekend and Smash Up in relation to the popularization of the disease concept of alcoholism. Through an analysis of archival sources, addiction narratives, and (...) nascent alcoholism research, this paper argues that, by emphasizing the importance of popular representations of alcoholics above scientific inquiry, early recovering “experts” successfully promulgated the disease concept of alcoholism, but the testimonials of later recovering alcoholics became relegated to the sphere of popular culture. (shrink)

In this essay, I analyze two memoirs—Rafael Campo's The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire and Abraham Verghese's My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS—which describe the effects of treating HIV/AIDS on each doctor's identity, on his desire for community and belonging, and on his identification and/or disidentification with the medical profession in the United States. My readings of Campo and Verghese revolve around three key (...) terms provided by Campo's subtitle: identity, empathy, and desire. I shift the order of these terms in Campo's subtitle because I want to read identity, empathy, and desire in Campo and Verghese through and along with the theoretical “pragmatics” of Gilles Deleuze and Felix Guattari. (shrink)

While law and justice issues are well represented in the vast and diverse world of Japanese Manga, the medium’s predilection for fantasy tends to produce futuristic or overblown fiction far removed from everyday life. Fantastic treatments may also reflect relatively low awareness of legal matters in a society of low crime and litigation. One law and order institution that most people are familiar with, however, is the network of community police boxes that covers Japan, and this has spawned a (...) gag-ridden yet somewhat more realistic genre of justice-related comics. This article focuses on Ishikawa Chika’s KOBAN, whose humour revolves around the contrasting personalities and petty squabbles of two cops in their dealings with mundane police work. The characters, plots and conversations are visually supported by juxtaposing the weaponry and equipment of law enforcement with childlike facial features and cute mascots, thereby constructing the police box as a halfway house between local neighbourliness and state bureaucracy. (shrink)

The burgeoning use of experimental methods to consider questions of human nature and personal identity has been a fruitful and exciting development, yielding significant and provocative results. This essay argues for the value of including reflection on the treatment of these topics in fictional narratives to complement and deepen results in experimental philosophy. Experimental vignettes are by necessity brief and schematic. This is part of what makes them so effective in the experimental context. The space afforded for detail, complexity, and (...) ambiguity by the format of fiction allows it to highlight and explore issues that cannot easily be incorporated into experimental method. By juxtaposing a fictional narrative in which we are led to view a character as fundamentally bad with a structurally similar experimental vignette in which participants judge the protagonist to be fundamentally good, I demonstrate how reflection on fiction can contribute to debates in experimental philosophy and reveal distinctions between different dimensions of questions about identity and morality. (shrink)

Resumen La figura femenina en el arte cinematográfico ha sido mostrada mediante arquetipos y cumpliendo distintas funciones. Nos proponemos en este estudio analizar los personajes femeninos por medio de la narrativa audiovisual en dos películas emblemáticas de la cinematografía de Hitchcock: Recuerda y Vértigo, en las que la mujer se contempla como empoderada, pero también sometida, llegando a una negación de su propia identidad. Consideramos que la forma del tratamiento de la mujer en el cine de dicha época radica en (...) la situación social de la misma, sufriendo un tratamiento discriminatorio, que es admitido por los personajes femeninos justificándolo en un enamoramiento, que anula la propia personalidad. Abstract The female figure in cinematographic art has been shown through archetypes and performing different functions. We propose in this study to analyze female characters through the audiovisual narrative in two emblematic films of Hitchcock’s cinematography: Spellbound and Vertigo, in which women are seen as empowered, but also subjected to a denial of their own identity. We consider that the treatment of women in the cinema of that time lies in the social situation of the same, suffering a discriminatory treatment, which is admitted by the female characters justifying it in a crush, which annuls the own personality. (shrink)

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy. Patients’ experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup’s and Ricoeur’s philosophy, and Mattingly’s and Frank’s narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and (...) cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one’s own. (shrink)

Understanding how meaning mechanisms are unleashed in film has been at the center of numerous theoretical surveys of the last few years. Emphasis has especially fallen on seeing as a constructive, meaningful activity and on the diegetic implications of vision. This book is an attempt to extend film theorizing into a new realm, where hearing proves as important as seeing and where the relevance of filmic narrative is differently explored. New paths for future research are suggested by means (...) of associations with the works of linguists or philosophers who have never addressed film theory directly in their writings. Nonetheless, several concepts posited by them (relevance, natural versus non-natural meaning or the notion of Mental spaces) find their application in the present survey. A wide range of examples starting with point-of-view and editing occurrences, passing through the use of music and sound and culminating with the study of whole filmic ensembles, enables the reader to re-examine code-bound or, on the contrary, deviational structures. These are often drawn from familiar sources, proving that not only art films of the Eisenstein or Godard type enhance innovative meaning spaces. Finally, the viewer is seen as a «silly little kitty», an active not passive receiver of textual structures who relies on patterns of known visual or aural backgrounds open to an unlimited field of perspectives. (shrink)

Grant Gillett's (2009) welcome and extremely thought-provoking target article addresses many complex issues of such far-ranging consequence that it seems impossible to provide a commentary worthy o...

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients (...) are situated. A second goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

The paper contrasts Hegel's often quite negative treatment of Eastern thought with the generally more positive treatment by W. F. J. Schelling. Especially significant for Schelling's treatment are the exceptional importance of female deities in Eastern myths and systems of thought and the positive role played by storytelling and mythology in the East.

In researching the biomedically-engineered drug Neulasta, a breast cancer patient becomes aware of the extent to which knowledge about the development and marketing of drugs influences her decisions with regard to treatment. Time spent on understanding the commercial interests of insurers and pharmaceutical companies initially thwarts but ultimately aids the healing process. This first-person narrative calls for physicians to recognize that the alignment of commercial interests transgresses the patient’s humanity.

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in serious illness (...) and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

I am lying on a small table in a tiny room, dizzy with nausea and apprehension. A young woman busies herself with the preparations of a plaster mold that will be used to position my arm and chest for the twenty five ‘shots’ of radiotherapy that I will undergo during the ensuing five weeks. I had called the hospital that morning to say that I was too sick to come for this appointment. I had better come, said a young man (...) from the department, because if I missed this appointment I would I might not get a new appointment in time start the treatments within the recommended time frame. So I am here, on the table. I mention the nausea to the technician. My apprehension at this moment is that I might become so dizzy as to somehow swirl out of control. The young woman gives me a mask to blunt the smell of the plaster. The procedure will take twenty-five minutes. I keep my mind focused on each breath and get through the ordeal breath by breath. She seems, in contrast to me, gloriously free of distress and worry, listening to the radio while she works. I envy her good fortune. As we finish up the procedure I take a chance and share my experience: I say that being a cancer patient can be tricky because you are sometimes utterly in the grip of the idea that the cancer will spread and you’ll die soon and in a very unpleasant way. After each round of chemo I was admitted to hospital for extreme nausea and dehydration. During those days in the cancer ward some of those who were dying called out and moaned distressingly, sometimes for hours, during the night. I was, at those moments, unable to shake off the belief that I too would be in that state within a few months. The signs of cancer had been missed on the mammogram two years earlier and, when the lump made itself evident, I was in Stage III. When I mentioned this experience of being gripped by the idea of death she said “Oh I know exactly what you mean, my mother has breast cancer, and every time she has an examination I go searching the internet to find out what I can.” This young woman was twenty four, and I fifty six at the time, and she had given me an unexpected small precious gift that I took with me out of that little cupboard of a room.. (shrink)

Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium’s particular combination of words and (...) images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

"For description and defense of the narrative configurations of everyday life, and of the practical and social character of those narratives, there is no better treatment than Time, Narrative, and History.... a clear, judicious, and truthful account, provocative from beginning to end." —Journal of the British Society for Phenomenology "... a superior work of philosophy that tells a unique and insightful story about narrative." —Quarterly Journal of Speech.

The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness. Philosophical analysis of background assumptions of the current paradigmatic model. While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that (...) frame our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of “the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care. If patients are seen also as “agents” this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’ motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling” diseases and their purported “mechanisms” to understanding complex contributing factors and their interplay. (shrink)

BackgroundThe success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness.MethodsPhilosophical analysis of background assumptions of the current paradigmatic model.ResultsWhile these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame our (...) thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of “the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care.ConclusionsIf patients are seen also as “agents” this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’ motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling” diseases and their purported “mechanisms” to understanding complex contributing factors and their interplay. (shrink)

This paper addresses a problem concerning the rational stability of intention. When you form an intention to φ at some future time t, you thereby make it subjectively rational for you to follow through and φ at t, even if—hypothetically—you would abandon the intention were you to redeliberate at t. It is hard to understand how this is possible. Shouldn't the perspective of your acting self be what determines what is then subjectively rational for you? I aim to solve this (...) problem by highlighting a role for narrative in intention. I'll argue that committing yourself to a course of action by intending to pursue it crucially involves the expectation that your acting self will be ‘swept along’ by its participation in a distinctively narrative form of self-understanding. I'll motivate my approach by criticizing Richard Holton's and Michael Bratman's recent treatments of the stability of intention, though my account also borrows from Bratman's work. I'll likewise criticize and borrow from David Velleman's work on narrative and self-intelligibility. When the pieces fall into place, we'll see how intending is akin to telling your future self a kind of story. My thesis is not that you address your acting self but that your acting self figures as a ‘character’ in the ‘story’ that you address to a still later self. Unlike other appeals to narrative in agency, mine will explain how as narrator you address a specifically intrapersonal audience. (shrink)

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the (...) sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea. In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases. (shrink)

In researching the biomedically-engineered drug Neulasta (filgrastim), a breast cancer patient becomes aware of the extent to which knowledge about the development and marketing of drugs influences her decisions with regard to treatment. Time spent on understanding the commercial interests of insurers and pharmaceutical companies initially thwarts but ultimately aids the healing process. This first-person narrative calls for physicians to recognize that the alignment of commercial interests transgresses the patient’s humanity.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 361-367 [Access article in PDF] Psychopathology and Two Kinds of Narrative Account of the Self Tim Thornton Keywords self, narrative, reductionism, embodiment, Dennett, Strawson, McDowell The self plays an important role in psycho pathology. Conditions such as dementia raise the question of how much loss of memory and awareness there can be before there is, if ever, also a loss of (...) the self. Syndromes such as Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD) raise the possibility of a fragmentation of one self into a number of selves. Depersonalization disorder suggests a kind of diminution both of the sense of self and the reality of the world. Symptoms such as thought insertion suggest a different kind of fragmentation of the coherence of thought within a self.At the same time there is something prima facie paradoxical about the very idea of the fragmentation or loss of self. It seems to be one thing for a self to suffer loss, quite another to think of the self as being lost. Although the experiences or beliefs had or entertained by a self might be disordered or chaotic, how can a self be anything other than whole and seem real and whole to itself?The narrative approach to the self looks like a tool purpose built to shed light on some aspects of psychopathology. The papers in this issue have examined its application to four revealing case histories and questioned its effectiveness in accounting for features of psychopathology. But in this short note I wish to stand back from the particular cases discussed in previous papers and to shed light on the general approach by setting out two contrasting versions of it. Crudely put, the first forges a connection between the concepts of self and personality; the second between the concepts of self and person. I will use the contrast between these two to draw some general lessons for the philosophy of psychopathology. Dennett's Austere Narrative Account I will start with Dennett's influential version of a narrative account of the self. His central idea is that the very idea of a self should be understood as dependent on a particular kind of interpretative strategy. Roughly, this contrasts with the idea that it is a more basic datum calling out for notice prior to adopting a specific theoretical perspective.Dennett suggests an analogy with centers of gravity both to outline the consequences of this view for the reality of selves, and the connection between the self and the interpretative strategy involved. [End Page 361] A center of gravity is just an abstractum. It's just a fictional object. But when I say it's a fictional object, I do not mean to disparage it; it's a wonderful fictional object, and it has a perfectly legitimate place within serious, sober, echt physical science. (Dennett 1992) The concept of a center of gravity is deployed within a branch of physics to describe and predict the behavior of physical systems acting under physical forces. It is the theoretical context that determines the nature of centers of gravity; at the same time, they contribute to that broader context. Dennett stresses that they are abstract or calculation-bound theoretical objects to contrast with objects that are also theoretically posited but causally interactive, such as microphysical particles (Dennett 1987, 53).Dennett has also used the analogy with abstracta to account for mental states such as beliefs, desires, and other propositional attitudes, which he suggests are ascribed using a particular interpretative strategy: the "Intentional Stance" (Dennett 1987, 13-42). The suggestion is that by showing the necessity of adopting that stance to make sense of human behavior he can defend a form of objectivity about mental states even while rejecting the industrial-strength realism that requires identifying mental states with physical, and thus causally interactive, internal states.Selves are given similar treatment. Like centers of gravity or mental states, they are theoretical, even fictional, entities articulated within an interpretative theoretical stance: A self is also an abstract object, a theorist's fiction... (shrink)

During a showing of the video Some Everybodies, which observes tourist behaviour at a non-tourist site in Bath, the work will be discussed as evolving through non-dualist processes of film-making (enabled through new technology), whilst also attempting to create a non-dualist filmic experience for the spectator. Shot with a fixed-frame camera at a corner scene (which is the site of a minor accident), the film does not possess a traditional narrative structure or design, and has been described as (...) a moving painting. There is no central character (people are viewed more as moving bodies), and the momentum (rather than linear progression of scenes) has been made entirely in the editing suite, rather than on-site through a directorial eye. Dialogue from the site has been included as a multivalent communal poem that scrolls as subtitles beneath the images. Here the traditional understanding of subtitles is, once again, questioned, and they no longer exist as semiotic colonizers of othered national experiences, but evolve as asides from the passers-by themselves. Time-as-intervention will be discussed through the bleached colouration of the pictorial image, reminiscent of old postcards. This visual sense of well-worn familiarity is juxtaposed against a soundtrack that has been slowed down, creating primal groans and utterances. The significance of still-images within film-making will be explored, as the narrative freezes whilst the tourists themselves freeze, or snap, their own narratives. These mementos are also included on postcards and posters as part of a larger installation. The walk-through, yet high-walled cross design of the installation creates corners (said to be the places where people meet), and optimal viewing points a tourist leit-motif. The site is designed to illustrate the dislocation of time and place, where images of the video site (as posters and postcards) are seen before the video itself. Reference will be made to film-maker Joseph Robakowski, artist Barbara Kruger, the scientist Dirk Helbing (with particular reference to dynamical flow and pilgrim crowd behaviour at Mecca) and film theorist and film-maker Professor Laura Mulvey. (shrink)

The choice to pursue fertility treatments is a complex one. In this paper I explore the issues of choice, agency, and gender as they relate to assisted reproductive technologies (ARTs). I argue that narrative approaches to bioethics such as those by Arthur Frank and Hilde Lindemann Nelson clarify judgments about autonomy and fertility medicine. More specifically, I propose two broad narrative categories that help capture the experience of encounters with fertility medicine: narratives of hope and narratives of (...) resistance. This narrative typology captures the inevitable conflict that women feel when they become subjects of fertility medicine. On the one hand, they must remain hopeful; on the other, they must not surrender themselves completely. Nelson's account of counterstories as narratives of resistance helps us see how women can reconcile the experience of a strong desire to have children with the desire to remain authentic and whole. (shrink)

RESUMO:Não é incomum que se tome o diálogo de Schelling conhecido como Clara por um estoque de proposições filosóficas, do qual se arrancam aquelas mais apropriadas para a tese que se queira sustentar. Procuramos nos afastar desse tipo de procedimento. Tomando seriamente seu tratamento literário, trata-se antes de investigar esse diálogo, apreendendo-o como um modelo, ensaiado pelo filósofo, para uma crítica do presente. Para tanto, analisamos a oscilação entre diálogo e narrativa, de modo a compreender sua composição e princípio formal, (...) o que acarreta uma reflexão, interna à obra, sobre o tempo histórico, o qual se apresenta numa dialética entre inatualidade e presente. ABSTRACT:It is not unusual that Schelling’s dialogue known as Clara is taken for a stock of philosophical propositions from which one may pluck ideas appropriate for the thesis one wishes to defend. In this article, we try to move away from this type of procedure. Taking Schelling’s literary treatment seriously, our purpose is to investigate this dialogue by looking upon it as a model, put forth by the philosopher, for a critique of the present. We therefore analyze the oscillation between dialogue and narrative in Clara in order to understand its composition and formal principle. This oscillation entails a reflection on historical time and presents a dialectic between inactuality and the present. (shrink)

In this paper, we respond to a critique by Erik Thorstensen of the ‘Deepening Ethical Engagement and Participation in Emerging Nanotechnologies’ project concerning its ‘realist’ treatment of narrative, its restricted analytical framework and resources, its apparent confusion in focus and its unjustified contextualisation and overextension of its findings. We show that these criticisms are based on fairly serious misunderstandings of the DEEPEN project, its interdisciplinary approachand its conceptual context. Having responded to Thorstensen’s criticisms, we take the opportunity to clarify (...) and develop our approach to narrative. We articulate the need for novel, theoretically robust approaches to the formation of public attitudes which transcend the limitations of both survey-based approaches—which remain wedded to methodological individualism and which presume that individuals hold distinct and relatively stable attitudes and preferences—and interactionist approaches to public talk, which focus too strongly on individuals-in-interaction as reasoning agents and which ignore the constitutive role of culture and discourse in the formation of public opinion. We suggest that our use of narrative can help to better understand the process through which public attitudes to emerging technology develop out of interactive an engagement with wider cultural arguments and accounts of science and technology. We finish by pointing to parallel developments in social thought—from Charles Taylor’s treatment of social imaginaries to recent developments in post-Bourdieuian cultural sociology—as related projects in understanding the cultural resources and grammars that provide the conceptual infrastructure for modern social life. (shrink)

Cases of severe and enduring Anorexia Nervosa (SEAN) rightly raise a great deal of concern around assessing capacity to refuse treatment (including artificial feeding). Commentators worry that the Court of Protection in England & Wales strays perilously close to a presumption of incapacity in such cases (Cave and Tan 2017, 16), with some especially bold (one might even say reckless) observers suggesting that the ordinary presumption in favor of capacity ought to be reversed in such cases (Ip 2019). -/- Those (...) of us who worry that such trends and proposals amount to (or at least pose a serious threat of) wrongful discrimination on the grounds of disability nevertheless feel the pull of judging many SEAN service users to be incapacitous with respect to decisions regarding (perhaps amongst other things) treatments involving feeding, artificial or otherwise. But it is difficult to get to grips with exactly what their incapacity consists in. Many such service users seem able to understand, retain, use and weigh information, and express a decision (i.e. they seem, prima facie, to satisfy the ‘MacArthur’ criteria). At the very least, they do not, generally. (shrink)

The literature of Twelve Step groups such as Alcoholics Anonymous contains apparently contradictory implications regarding powerlessness and personal responsibility. In this essay I examine the treatment of these concepts in Twelve Step literature and their implications for the self-conception of people in these programs. In the first section, I examine the literature to demonstrate that addicts are presented as powerless over, yet responsible for, their addictive behaviors. In the second section, I outline two potential ways people in Twelve Step programs (...) might reconcile this contradiction within their self-conception, but I argue that neither is satisfactory. In the third section, I draw on Paul Ricoeur's theory of narrative identity to develop an account of how someone ni a Twelve Step group could coherently understand herself as both powerless and responsible. (shrink)

Pain management has no meaning without the stories of men and women, and boys and girls whose lives are dramatically altered by the presence of pain in their own and their loved ones lives. In this narrative section, four people present their perspectives on the enigma and challenge of pain, its power, and our on-going efforts to limit its hold on our lives.In the first story, Dr. Robert McQuillan, an anesthesiologist with Creighton University School of Medicine, conveys the fear (...) some patients suffering chronic pain face when seeking pain medication over the long term. Dr. Christine Cassel, chair of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center and immediate past president of the American College of Physicians, recounts the plight of a fellow physician whose pain treatment of a patient led to suspension of his professional license and to personal bitterness after many years of exemplary medical practice. (shrink)

Pain management has no meaning without the stories of men and women, and boys and girls whose lives are dramatically altered by the presence of pain in their own and their loved ones lives. In this narrative section, four people present their perspectives on the enigma and challenge of pain, its power, and our on-going efforts to limit its hold on our lives.In the first story, Dr. Robert McQuillan, an anesthesiologist with Creighton University School of Medicine, conveys the fear (...) some patients suffering chronic pain face when seeking pain medication over the long term. Dr. Christine Cassel, chair of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center and immediate past president of the American College of Physicians, recounts the plight of a fellow physician whose pain treatment of a patient led to suspension of his professional license and to personal bitterness after many years of exemplary medical practice. (shrink)

Despite concern that patients in the intensive care unit (ICU) may not be treated with respect and dignity, there is not conceptual clarity regarding what constitutes such treatment. In addition, measures specific to treatment with respect and dignity in the ICU are unavailable. Accordingly, a multidisciplinary group developed a conceptual model for treatment with respect and dignity in the ICU and used mixed methods to gather data on this issue. This effort included interviews with patients and families, focus groups with (...) health care professionals, and direct observations. These data were then compared and contrasted to synthesize what was learned. Finally, pilot quantitative patient and family survey data were collected and analyzed. Each of these approaches, which comprise the papers in this supplement to Narrative Inquiry in Bioethics, is briefly described in this article. (shrink)

Abstractabstract:This article examines the complexity of narratives of space and time which support the diagnosis of multiple sclerosis, and the consequences for patients disadvantaged by deficits in social cognition or socioeconomic status in areas relating to literacy. In the context of demonstrating the significance of narratives of space and time in the diagnostic process for multiple sclerosis, the article discusses new strategies for treatment that engage the arts and humanities and presents a brief history of the disease and current diagnostic (...) criteria, before discussing the MS Society of Great Britain and Ireland's awareness and fundraising campaign from the 1980s, and Tom Kempinski's play Duet for One, inspired by the life of cellist Jacqueline du Pré. The conclusion addresses the urgency of heightening patient and clinician awareness of how the presentation, interpretation, and sharing of narrative accounts of disease influence health outcomes and makes suggestions about how to adjust for these biases. (shrink)

Trauma informed care (TIC) “realizes the widespread impact of trauma… recognizes the signs and symptoms of trauma in clients, families and staff; responds by fully integrating knowledge of trauma i...

This article examines the way in which selfhood is constructed in direct-to-consumer advertisements for antidepressant medications. The sample consists of advertisements that appeared in nine popular magazines between 1997 and 2005, television commercials that ran between 2003 and 2005, and online promotional Web sites. The analysis is divided into three sections. First, it is argued that the ads rely on metaphors of communication, information exchange, and plenitude to construct a relationship between biology and selfhood. Second, in offering the choice for (...) antidepressant treatment, the ads grant individuals a new capacity for the exercise of personal agency. Third, the author describes antidepressants as pills that perform a narrative “magic.” In contrast to religious and psychoanalytic narratives that required individuals to incorporate disavowed elements of their selves into an ongoing life narrative, antidepressants are medications that allow individuals to put aside, or jump over, inexplicable and painful moments in their life. (shrink)

A common complaint of biologists is that their subject receives poor treatment from philosophers—it gets but a fraction of the attention accorded to physics and chemistry, and what little it does receive, is usually of the type where ‘All swans are white’ is taken to be a paradigmatic example of the state of biological thinking. It cannot be denied that this complaint is, to a great extent, justified; however, there are some notable breaches in the wall of ignorance and silence, (...) amongst which must be numbered The Ascent of Life by T.A. Goudge. In this book, starting from what is obviously a very wide knowledge of biology, Goudge attempts a careful and thorough analysis of one of the major achievements of biological thought, evolutionary theory. The conclusions that Goudge draws are many; nevertheless, one can discern running through them a common theme, namely that whilst evolutionary theory is indeed a legitimate branch of science, to assume that it is a science of the same nature as physics and chemistry would be a grave error. Goudge argues that, despite certain similarities to other branches of science, the essential aims, methods and results of evolutionary theory are peculiar unto itself. (shrink)

Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients and their family members, and the highly technical nature of the environment. In attempt to understand various stakeholders’ perspectives of treatment with respect and dignity, patients (...) and family members were interviewed, a wide range of health care professionals participated in focus groups, and third party observers took field notes of interactions in the ICU. This paper compares and contrasts the data that were generated using these different methods. Triangulating the data in this way contributes to a more complete and nuanced understanding of treatment with respect and dignity in the ICU. (shrink)

The ArgumentThe paper offers a reconstruction of one aspect of Bakhtin's philosophy, focusing on a deep-seated ambivalence that has been largely overlooked in studies based on his late works. Bakhtin's early work, 1920–23, is set within a distinctly metaphysical framework, an outlook that seems diametrically opposite to what has become known as the Bakhtinian conception of culture. That ideological rift is manifest in the different treatment of Dostoevsky's works in these two phases.Extrapolating Bakhtin's perspective onto Dostoevsky's work, the paper briefly (...) outlines a theory of modernism as a “crisis of authority,” with particular emphasis on the role of closure — i.e., retrospective framing, both literary and existential — in the absence of metaphysical grounding.Finally, the paper offers a comment on Bakhtin's wholesale assimilation into the postmodernist canon, in an attempt to problematize it and to reformulate some relevant and persistent questions on the significance of narrativity in human existence. (shrink)

Deep brain stimulation (DBS) has in some cases been associated with significant psychological effects and/or personality change. These effects occur sometimes as acute changes experienced intraoperatively or during the initial setting of the stimulator and sometimes as longer term progressive changes in the months following surgery. Sometimes they are the intended outcome of treatment, and in other cases they are an unintended side-effect. In all of these circumstances some patients and caregivers have described the psychological effects of DBS as frightening (...) or disconcerting. I trace the source of these negative reactions to the fear that stimulation-related psychological and personality changes represent a threat to personal identity and agency. This issue has implications both for philosophical theories of personal identity and agency and for clinical concerns. A narrative account of personal identity is developed to illuminate the nature of the threat to identity and agency DBS potentially poses, and to suggest steps that might be taken to mitigate and avoid these threats. (shrink)

The article presents a model of understanding that takes into account interaction, cultural knowledge, and the constraints of organizations and institutions. It analyzes discourse and cognition in high school biology classes and clinical consultations involving discussions of genetics. The analytical lenses of constraint satisfaction, coherence-based reasoning, and collective cognition reveal multilayered social, cultural, and interactional components of authority and agency that influence understanding. The analysis reveals similarities across settings in discourse structure and the ways that participants relate to local constraints. (...) In both types of settings, participants attempt to develop process narratives that present a sequential or causal relationship between information and lead to remembered understandings of concepts. However, the absence of certain process information that links terms or concepts functions like a missing plot point in a story, hindering the development of process narratives and understandings. In order to cover such information gaps, students and patients construct and display grey boxes. In addition to talk and text, these consist of various actions and resources specific to a local discourse framework such as pointing at graphics, tabular information, and symbols. Grey boxes satisfy the organizational constraints of time, resources, and task structure that affect interaction related to understanding concepts and procedures, but their connection to a particular discourse framework restricts the transfer of knowledge between settings. The power of medical practitioners and teachers to enhance or restrict understandings relates to the ways that they accommodate the use of grey boxes during interactions with clients and students. Professional frames of reference that teachers or practitioners apply to task interactions may constrain the ways students or clients apply grey boxes and process narratives. Awareness of the functions of process narratives and grey boxes presents opportunities to modify local discourse frameworks and increase understandings of concepts, medical conditions, and treatment options. (shrink)