In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Fairness is central to the ethical and responsible development and use of AI systems, with a large number of frameworks and formal notions of algorithmic fairness being available. However, many of the fairness solutions proposed revolve around technical considerations and not the needs of and consequences for the most impacted communities. We therefore want to take the focus away from definitions and allow for the inclusion of societal and relational aspects to represent how the effects of AI systems impact and (...) are experienced by individuals and social groups. In this paper, we do this by means of proposing the ACROCPoLis framework to represent allocation processes with a modeling emphasis on fairness aspects. The framework provides a shared vocabulary in which the factors relevant to fairness assessments for different situations and procedures are made explicit, as well as their interrelations. This enables us to compare analogous situations, to highlight the differences in dissimilar situations, and to capture differing interpretations of the same situation by different stakeholders. (shrink)

The correspondence between Hannah Arendt and Karl Jaspers begins in 1926, when the twenty-year-old Arendt studied philosophy with Jaspers in Heidelberg. It is interrupted by Arendt's emigration and Jasper's 'inner emigration' and resumes in the fall of 1945. From then until Jaspers's death in 1969, the initial teacher-student relationship develops into a close friendship. Three countries figure prominently in the correspondence: Germany, Israel, and the United States. Among the topics are Fascism, the atom bomb and the threat of global (...) destruction, German guilt for the Holocaust, Jewishness, the State of Israel, American politics and American universities, the Eichmann trial in Jerusalem. Arendt and Jaspers discuss people both famous and obscure. They gossip, joke complain, and argue. They commiserate with each other over the illnesses and infirmities of old age. And they converse about the world's great philosophers: Spinoza, Kant, Marx, Max Weber, Heidegger. Here is a fascinating dialogue between a woman and a man, a Jew and a German, a questioner and a visionary, both uncompromising in their examination of our troubled century. (shrink)

I defend the normativity of meaning against recent objections by arguing for a new interpretation of the ‘ought’ relevant to meaning. Both critics and defenders of the normativity thesis have understood statements about how an expression ought to be used as either prescriptive or semantic. I propose an alternative view of the ‘ought’ as conveying the primitively normative attitudes speakers must adopt towards their uses if they are to use the expression with understanding.

Although Hannah Arendt is considered one of the major contributors to social and political thought in the twentieth century, this is the first general anthology ...

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to (...) take the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

After 100+ years of studying syllogistic reasoning, what have we learned? Well, Riesterer and colleagues suggest that we have learned to throw away most of the data! If that seems like a bad idea to you then, be assured, that the authors agree with you. The sad fact is that the conclusion of “No Valid Conclusion” (NVC) is one of the most frequently selected responses in syllogistic reasoning but these “majority data” have been ignored by most researchers. Riesterer and colleagues (...) introduce heuristic rules for predicting NVC and provide directions to modelers on how to up their game. (shrink)

A unique selection of the most significant interviews given by Hannah Arendt, including the last she gave before her death in 1975. Some are published here in English for the first time. Arendt was one of the most important thinkers of her time, famous for her idea of "the banality of evil" which continues to provoke debate. This collection provides new and startling insight into Arendt's thoughts about Watergate and the nature of American politics, about totalitarianism and history, and (...) her own experiences as an emigre. Hannah Arendt: The Last Interview and Other Conversations is an extraordinary portrait of one of the twentieth century's boldest and most original thinkers. As well as Arendt's last interview with French journalist Roger Errera, the volume features an important interview from the early 60s with German journalist Gunter Gaus, in which the two discuss Arendt's childhood and her escape from Europe, and a conversation with acclaimed historian of the Nazi period, Joachim Fest, as well as other exchanges. These interviews show Arendt in vigorous intellectual form, taking up the issues of her day with energy and wit. She offers comments on the nature of American politics, on Watergate and the Pentagon Papers, on Israel; remembers her youth and her early experience of anti-Semitism, and then the swift rise of the Hitler; debates questions of state power and discusses her own processes of thinking and writing. Hers is an intelligence that never rests, that demands always of her interlocutors, and her readers, that they think critically. As she puts it in her last interview, just six months before her death at the age of 69, "there are no dangerous thoughts, for the simple reason that thinking itself is such a dangerous enterprise.". (shrink)

In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...) prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsibility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prognostic justifications for deprioritization. (shrink)

As the rising costs of lifestyle-related diseases place increasing strain on public healthcare systems, the individual’s role in disease may be proposed as a healthcare rationing criterion. Literature thus far has largely focused on retrospective responsibility in healthcare. The concept of prospective responsibility, in the form of a lifestyle contract, warrants further investigation. The responsibilisation in healthcare debate also needs to take into account innovative developments in mobile health technology, such as wearable biometric devices and mobile apps, which may change (...) how we hold others accountable for their lifestyles. Little is known about public attitudes towards lifestyle contracts and the use of mobile health technology to hold people responsible in the context of healthcare. This paper has two components. Firstly, it details empirical findings from a survey of 81 members of the United Kingdom general public on public attitudes towards individual responsibility and rationing healthcare, prospective and retrospective responsibility, and the acceptability of lifestyle contracts in the context of mobile health technology. Secondly, we draw on the empirical findings and propose a model of prospective intention-based lifestyle contracts, which is both more aligned with public intuitions and less ethically objectionable than more traditional, retrospective models of responsibility in healthcare. (shrink)

Proponents of manipulation arguments against compatibilism hold that manipulation scope (how many agents are manipulated) and manipulation type (whether the manipulator intends that an agent perform a particular action) do not impact judgments about free will and moral responsibility. Many opponents of manipulation arguments agree that manipulation scope has no impact but hold that manipulation type does. Recent work by Latham and Tierney (2022, 2023) found that people's judgments were sensitive to manipulation scope: people judged that an agent was less (...) free and responsible when a manipulation was existential (impacting at least one but not all agents) than when the manipulation was universal (impacting every agent). This study examines people's judgements about existential and universal manipulation cases that involve both intentional and non‐intentional outcomes. We found that manipulation scope also affects people's free will and responsibility judgments in manipulation cases involving both intentional and non‐intentional outcomes. Interestingly, we also found that manipulation type influences the effect that manipulation scope has on people's free will judgments but not their moral responsibility judgments, which indicates that people's free will and responsibility judgments can come apart. This puts pressure on the prevalent assumption that judgments about free will and moral responsibility are conceptually bound together. (shrink)

: Jerry Fodor proposes a solution to Quine's inscrutability–of–reference problem for certain naturalized semantic theories, thereby defending such theories from charges that they cannot discriminate meanings finely enough. His proposal, combining elements of informational and inferential–role semantics, is to eliminate non–standard interpretations by testing predicate compatibility relations. I argue that Fodor's proposal, understood as primarily aimed at Mentalese, withstands Ray's and Gates's objections but nonetheless fails because of unwarranted assumptions about ontological homogeneity of target language predicates, and problems with Fodor's (...) reliance on predicate conjunction to resolve ambiguity. Naturalized semantics thus remains without an answer to the inscrutability objection. (shrink)

Speakers’ perception of a visual scene influences the language they use to describe it—which objects they choose to mention and how they characterize the relationships between them. We show that visual complexity can either delay or facilitate description generation, depending on how much disambiguating information is required and how useful the scene's complexity can be in providing, for example, helpful landmarks. To do so, we measure speech onset times, eye gaze, and utterance content in a reference production experiment in which (...) the target object is either unique or non-unique in a visual scene of varying size and complexity. Speakers delay speech onset if the target object is non-unique and requires disambiguation, and we argue that this reflects the cost of deciding on a high-level strategy for describing it. The eye-tracking data demonstrate that these delays increase when speakers are able to conduct an extensive early visual search, implying that when speakers scan too little of the scene early on, they may decide to begin speaking before becoming aware that their description is underspecified. Speakers’ content choices reflect the visual makeup of the scene—the number of distractors present and the availability of useful landmarks. Our results highlight the complex role of visual perception in reference production, showing that speakers can make good use of complexity in ways that reflect their visual processing of the scene. (shrink)

Jerry Fodor (1994) proposes a solution to Quine's inscrutability–of–reference problem for certain naturalized semantic theories, thereby defending such theories from charges that they cannot discriminate meanings finely enough. His proposal, combining elements of informational and inferential–role semantics, is to eliminate non–standard interpretations by testing predicate compatibility relations. I argue that Fodor's proposal, understood as primarily aimed at Mentalese, withstands Ray's (1997) and Gates's (1996) objections but nonetheless fails because of unwarranted assumptions about ontological homogeneity of target language predicates, and problems (...) with Fodor's reliance on predicate conjunction to resolve ambiguity. Naturalized semantics thus remains without an answer to the inscrutability objection. (shrink)

We sought to expand on the concept of the moral self to include not just the duty to develop the moral self but the moral duty to develop the self in both moral and non-moral ways. To do this, we focused on how leaders can promote a climate in which individuals feel a sense of duty to develop themselves for the betterment of the team and organization. In our theoretical model, duty orientation plays a key role in determining whether followers (...) will seek performance feedback to develop their work selves. We hypothesized that followers with ethical leaders would experience a greater sense of duty to improve themselves and would therefore be more likely to seek and less likely to avoid leader feedback. Drawing on social learning theory, we hypothesized that duty orientation would mediate the relationship between ethical leadership and feedback-seeking/feedback-avoiding behavior, expert power would moderate the relationship between ethical leadership and duty orientation such that duty orientation would be higher when followers perceived their leader to be both highly ethical and competent, and expert power would moderate the indirect effect of ethical leadership on feedback-seeking/feedback-avoiding behavior through duty orientation. We tested our hypotheses using a sample of 249 followers across two waves of data collection. Results suggest that ethical leadership and leader competence interact to drive followers’ duty orientation, thereby reducing followers’ feedback-avoiding behaviors. Further, ethical leadership had a direct positive relationship with followers’ feedback-seeking behaviors. (shrink)

Neural substrates of fatigue in traumatic brain injury are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (...) and frontoparietal networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort utilized to manually squeeze a pneumostatic bulb across six 30-s trials. Network-based statistics assessed within-network organization and fluctuation with task manipulations by group. Results demonstrate small group differences in network organization, but considerable group differences in the evolution of task-related modulation of connectivity. The mild TBI group demonstrated elevated CO connectivity throughout the task with little variation in effort level or time on task, while CO connectivity diminished over time in controls. Several interregional CO connections were predictive of fatigue in the TBI group. In contrast, FP connectivity fluctuated with task manipulations and predicted fatigue in the controls, but connectivity fluctuations were delayed in the mild traumatic brain injury group and did not relate to fatigue. Thus, the mTBI group’s hyper-connectivity of the CO irrespective of task demands, along with hypo-connectivity and delayed peak connectivity of the FP, may allow for attainment of task goals, but also contributes to fatigue. Findings are discussed in relation to performance monitoring of prediction error that relies on internal cues from sensorimotor feedback during task performance. Delay or inability to detect and respond to prediction errors in TBI, particularly evident in bilateral insula-temporal CO connectivity, corresponds to day-to-day fatigue and fatigue during task performance. (shrink)

Hannah Ginsborg presents fourteen essays which establish Kant's Critique of Judgment as a central contribution to the understanding of human cognition. The papers bring out the significance of Kant's philosophical notion of judgment, and use it to address interpretive issues in Kant's aesthetics, theory of knowledge, and philosophy of biology.

Auf den ersten Blick haben Hannah Arendt und Michel Foucault kaum etwas gemein. Tatsächlich beziehen sie sich jedoch auf die identischen Topoi der Philosophiegeschichte - wenn ihre Auslegungen der Quellen auch denkbar verschieden sind. Als Grund hierfür bestimmt Hannah Holme die komplementären Perspektiven der beiden, die sie als Aneignungen des heideggerschen Sorgebegriffs deutet: die ethische Sorge um sich Foucaults und die politische Sorge um die Welt Arendts. Am Ende steht ein Plädoyer für eine Verbindung des machtkritischen Ethos der (...) Sorge um sich mit der Macht des politischen Handelns, das der Sorge um die Welt unterstellt ist. (shrink)

Using Marcuse's theory of the total mobilization of advanced technology society along the lines of what he calls “the performance principle,” I attempt to describe the complex composition of class oppression in the classroom. Students conceive of themselves as economic units, customers pursuing neutral interests in a morally neutral, socio‐economic system of capitalist competition. The classic, unreflective conception of the classroom responds to this by implicitly endorsing individualism and ideals of humanist citizenship. While racism and cultural diversity have come to (...) count as elements of liberal intelligence in most college curricula, attempts to theorize these aspects of social and individual identity and place them in a broader content of class appear radical and inconsistent with the humanistic notion that we all have control over who we are and what we achieve. But tags such as “radical” and “unrealistic” mark a society based on the performance principle. Marcuse allows us to recognize a single author behind elements of psychology, metaphysics, and capitalism. The fact that bell hooks hits upon a similar notion suggests that we might use Marcuse's theory of the truly liberatory potential of imagination to transform and reconceive our classrooms so that the insidious effects of class, racism, and individualistic apathy might be subverted. Specifically, I outline and place into this theoretical context three concrete pedagogical practices: (a) the use of the physical space of the classroom; (b) the performance of community through group readings and short full‐class ceremonies, and (c) the symbolic modeling represented by interdisciplinary approaches to teaching. All three of these practices engage students in ways that co‐curricularly subvert class (and, incidentally, race divisions) and allow students to imagine, and so engage in, political action for justice as they see it. (shrink)

ABSTRACT Although basic values have been linked with unethical attitudes and behavior in non-sport contexts, their association with doping in sport has yet to be established. We examined the relationships between basic values and doping likelihood. College athletes rated the importance of basic values using the Portrait Values Questionnaire Revised and indicated their likelihood of doping in a hypothetical scenario. In terms of basic value dimensions, self-enhancement values were positively related to doping likelihood, openness to change values were unrelated to (...) doping likelihood, and self-transcendence and conservation values were negatively related to doping likelihood. In terms of the values categories, the values-doping relationship was best characterized by an unethicality pattern of coefficients. In conclusion, the current evidence extends the values-unethicality relationship to the context of sport and confirms that doping resembles other forms of unethical behavior. (shrink)

ObjectiveStress can play a role in the onset and exacerbation of psoriasis. Psychological interventions to reduce stress have been shown to improve psychological and psoriasis-related outcomes. This pilot randomised study investigated the feasibility of a brief interaction with a Paro robot to reduce stress and improve skin parameters, after a stressor, in patients with psoriasis.MethodsAround 25 patients with psoriasis participated in a laboratory stress task, before being randomised to either interact with a Paro robot or sit quietly for 30 min. (...) Raman spectroscopy and trans-epidermal water loss were measured at baseline, after the stressor and after the intervention as indexes of acute skin changes. Psychological variables, including self-reported stress and affect, were also measured at the three time-points.ResultsNo statistically significant differences between the two conditions were found for any of the outcomes measured. However, effect sizes suggest significance could be possible with a larger sample size. Changes in the psychological and Raman spectroscopy outcomes across the experimental session were found, indicating the feasibility of the procedures.ConclusionThis pilot study showed that a brief interaction with a Paro robot was a feasible intervention for patients with psoriasis, but future trials should broaden the inclusion criteria to try to increase recruitment rates. Studying people who are highly stressed, depressed or who are stress-responders may increase the power of the intervention to show effects using a longer-term intervention. (shrink)

Christopher Boorse’s biostatistical theory of medical disorder claims that biological part-dysfunction (i.e., failure of an internal mechanism to perform its biological function), a factual criterion, is both necessary and sufficient for disorder. Jerome Wakefield’s harmful dysfunction analysis of medical disorder agrees that part-dysfunction is necessary but rejects the sufficiency claim, maintaining that disorder also requires that the part-dysfunction causes harm to the individual, a value criterion. In this paper, I present two considerations against the sufficiency claim. First, I analyze (...) Boorse’s central argument for the sufficiency claim, the “pathologist argument,” which takes pathologists’ intuitions about pathology as determinative of medical disorder and conclude that it begs the question and fails to support the sufficiency claim. Second, I present four counterexamples from the medical literature in which salient part-dysfunctions are considered nondisorders, including healthy disease carriers, HIV-positive status, benign mutations, and situs inversus totalis, thus falsifying the sufficiency claim and supporting the harm criterion. (shrink)

Previous studies have shown cognitive task performance to be affected by tinnitus severity, but also that the literature is conflicted. This study sought to identify neuroticism as a possible confound, since severe tinnitus distress is associated with higher levels of neuroticism. A total of 78 participants undertook two cognitive tasks. It was found that when undertaking a Stroop paradigm, controlling for neuroticism rendered previously significant results not significant. It was also found that neuroticism was not a significant covariate for a (...) change blindness task. Gender, age, anxiety, and depression were all controlled for, and future implications for the literature discussed. (shrink)

This paper deals with the challenges of rationing of existential goods due to scarcity and conflicting interests (at the latest in the question of costs). The legal-political example pursued in this paper is rationing in the health care system, i. e. in curative and partly also in preventive measures. In each case - and in everyday life and by no means only in extreme corona pandemic situations - it is a question of whether there are absolute, ponder-proof claims to certain (...) goods. Ultimately, this is to be denied, even if rationing, especially in Germany, is usually concealed behind vague concepts such as the medical necessity and economic efficiency of treatment. But the public authorities cannot escape the weighing process - even if its consequences are often fatal in industrial society. In particular, misunderstandings of human dignity as well as skewed accusations of utilitarianism and a misleading pseudo-controversy between deontology and consequentialism have for a long time obscured the fact that in liberal democracies a balancing of different aspects of freedom and freedom preconditions is inevitable. Due to parliamentary reservations, however, this weighing must not be outsourced to administrative committees. Caution is called for in all of this with the economic cost-benefit analysis, which is hardly tenable in its foundations, with egalitarian approaches, and with the traditional but unfounded idea that fundamental rights are primarily (or exclusively) protected in single situations and are not relevant in the case of mass concern. Based on the latter point, it can also be shown that the previous tendency is not convincing to judge areas such as curative health treatment, preventive corona hazard control and fine dust or climate policy as being completely different from each other in terms of fundamental rights. (shrink)

Wakefield’s harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction and a value component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that (...) dysfunctions need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction’s harmfulness is best understood in dispositional terms. (shrink)

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)