Financing innovative and costly treatments in various therapeutic fields entails a number of problems in countries where costs are covered by public services. Providing these drugs is forcing actors to define the maximum sums of money society is willing to spend for given health improvements. This raises the question of whether maximum financing should vary according individuals’ circumstances, such as the rareness of a disease, lifestyles, social inequalities experienced over a life time, etc. This article examines a particular priority, namely (...) that given to the youngest patients, such prioritising usually refers to the “fair innings argument”. We question what could justify such a prioritization criterion. Three arguments are considered. At first we consider that FIA could be justified by the objective of equalizing the opportunities of well-being. Next, we proposed justifying the fair innings argument with the aim of equalizing the time provided to individuals to achieve their plan of life, in accordance with Rawls’s theory of justice as fairness. Finally, we proposed considering the FIA as being justified because of the goal of equalizing the time provided to individuals to accept death. These three arguments, of course, have many limitations, some of which we have highlighted. This article doesn’t aim to convince about the superiority of one argument over the other ones. We seek to contribute to the discussions which could happen on prioritization criteria regarding health care, by making explicit what could justify one specific criterion: the age criterion. (shrink)

In this paper, I argue that within the Japanese social context, the act of suicide is a positive moral act because the values underpinning it are directly related to a socially pervasive moral belief that any act of self-sacrifice is a worthy pursuit. The philosophical basis for this view of the self and its relation to society goes back to the writings of Confucius who advocated a life of propriety in which being dutiful, obedient, and loyal to one's group takes (...) precedence over the desires of the individual selves that make up the group. I argue that this philosophical perspective poses formidable challenges to Japanese psychiatry (which accepts a contrary western perspective) because, as western psychiatry is based on the concept of autonomous individuality, the Japanese conceive of the self as socially embedded. Because suicide in Japan is viewed as a potentially honorable, virtuous, and even beautiful act of self-sacrifice expressing one's duty to one's group, the western perspective is quite foreign to the Japanese self-conceptual framework. Therefore, since Japanese psychiatry and law have embraced the western medical tradition of viewing suicide as a non-rational response to mental illness, which runs counter to the cultural view that suicide is a moral (and rational) act, I argue that western explanations of suicide present significant cross-cultural problems for Japanese psychiatry. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis’s critique of the brain evidence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, I defended the view (...) that addiction is a medical disorder and a brain disorder. In Part 2, I consider some broader philosophical issues raised by Lewis’s arguments: I consider a larger puzzle, at the heart of the neo-Kraepelinian program in contemporary psychiatry, that is raised by Lewis’s argument that addiction is not a disorder because the brain displays no damage but only normal learning: must all mental disorders be brain disorders, or can mental disorders occur in normal brains? I argue that mental disorders can occur in normal brains. I critique Lewis’s response to the evolutionary “novel environment” approach to explaining why addiction is a disorder. Lewis agrees with brain-disease proponents that interpreting addiction as brain disorder relieves addicts of moral censure, but I argue that moral defect and brain disease are not exclusive. Finally, I consider Lewis’s “developmental-learning” account of addiction that encourages positive and empowering narrativizing of addiction, but I argue that the developmental-learning view is vacuous due to use of an overly broad notion of “development.”. (shrink)

We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that (...) physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals. (shrink)

Henry Sedgewick's The Methods of Ethics challenges comparison, as no other work in moral philosophy, with Aristotle's Ethics in the depth of its understanding of practical rationality, and in its architectural coherence it rivals the work of Kant. In this historical, rather than critical study, Professor Schneewind shows how Sidgewick's arguments and conclusions represent rational developments of the work of Sidgewick's predecessors, and brings out the nature and structure of the reasoning underlying his position.

Part I: The birth of religious naturalism -- Philosophical religious naturalism -- Theological religious naturalism -- Analyzing the issues -- Interlude religious naturalism in literature -- Part II: The rebirth of religious naturalism -- Sources of religious insight -- Current issues in religious naturalism -- Other current religious naturalists -- Conclusion: Living religiously as a naturalist.

The sounds produced by animals have been a topic of research into animal behaviour for a very long time. If acoustic signals are undoubtedly a vehicle for exchanging information between individuals, environmental sounds embed as well a significant level of data related to the ecology of populations, communities and landscapes. The consideration of environmental sounds for ecological investigations opens up a field of research that we define with the term ecoacoustics. In this paper, we draw the contours of ecoacoustics by (...) detailing: the main theories, concepts and methods used in ecoacoustic research, and the numerous outcomes that can be expected from the ecological approach to sound. Ecoacoustics has several theoretical and practical challenges, but we firmly believe that this new approach to investigating ecological processes will generate abundant and exciting research programs. (shrink)

This book, the product of a lifetime of research by one of the founders of developmental psychology, takes on the powerful assumptions behind these questions- ...

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick (...) role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

When Gadamer speaks of the “unavoidability” or “uncircumventability” [Unhintergehbarkeit] of art,Cf. Hans-Georg Gadamer . there are at least two claims involved: he has in mind both the concrete autonomy of a given artwork—its independence from systems of signification and representation—as well as the crucial importance that art bears for any account of human understanding. Yet even if this central significance remains a distinct concern and peculiar inheritance of the continental philosophical tradition as such, it still remains unclear what it would (...) even mean for the question of art to be properly raised, let alone resolved. If anything, art’s significance currently lies in its continuing questionability.In Between Word and Image, Dennis Schmidt attunes the reader to this questionability and ends up bolstering the validity of Gadamer’s claims, broadly carrying the latter’s legacy forward in a number of ways: by extending the inquiry concerning the ontology of the artwork into .. (shrink)

Three reservations about Keller & Miller's (K&M's) argument are explored: Serious validity problems afflict epidemiological criteria discriminating disorders from non-disorders, so high rates may be misleading. Normal variation need not be mild disorder, contrary to a possible interpretation of K&M's article. And, rather than mutation-selection balance, true disorders may result from unselected combinations of normal variants over many loci. (Published Online November 9 2006).

Volume 21 of _The Annual of Psychoanalysis_ is especially welcome for bringing to English-language readers timely contributions from abroad in an opening section on "Psychoanalysis in Europe." The section begins with a translation of Helmut Thomae's substantial critique of the current state of psychoanalytic education; Thomae's proposal for comprehensive reform revolves around a redefinition of the status of the training analysis in analytic training. Diane L'Heureux-Le Beuf's clinical diary of an analysis focusing on the narcissistic elements of oedipal conflict probes (...) the degree to which the analytic method can be applied to "nonstructured" analysands. And Nella Guidi shows the clinical value of supplementing Freud's notion of unobjectionable positive transference with the complementary notion of unobjectionable negative transference. Section II, on "Psychoanalysis and Hysteria," offers original contributions to Freud scholarship in the form of Jules Glenn's reconsideration of Dora's "Dynamics, Diagnosis, and Treatment"; William McGrath's analysis of the way Freud's hostility to religious superstition gained expression in his early work on hysteria; and Marian Tolpin's self-psychological reprise on the case of Anne O. The section concludes with Elisabeth Young-Bruehl and Sarah Cummin's provocative "What Happened to 'Anorexie Hysterique'?" which questions the contemporary separation of anorexia from hysteria and explore the sociohistorical reasons the separation came about. Section III, "Clinical and Theoretical Studies," begins with Nancy Kobrin's discussion of Freud's ideas about autonomy, including the terms Freud used and the way Strachey translated them into English. Her goal is to deepen our understanding of how Freud spoke and thought about an individual's sense of self. Frank Summers shows how object relations principles, which are shared by various object relations theories, can inform the conduct of analysis at all levels of pathology, including neurosis. And Henry Smith examines the meaning and value of the "analytic surface," a metaphor that highlights the relationship between the analyst's attention and the patient's attention. A final section on "Applied Psychoanalysis" offers contemporary examples of applied analytic inquiry in anthropology, art, and literature. Roy Grinker, III and Roy Grinker, Jr., in a methodological contribution to psychoanalytic anthropology, examine what is revealed when a native people are asked to retell a story introduced by them by their Western observers. Danielle Knafo explores the art and life of the Mexican surrealist Frida Kahlo through the concepts of the mirror, the mask, and the masquerade. And David Werman closes the volume with a comparative study of Edgar Allan Poe's and James Ensor's obsession with revenge, and the role it played in Poe's writing and Ensor's etchings, respectively. Bringing readers the influential reform proposals of Thomae, a rich sampling of recent Freud scholarship, applied contributions traversing three disciplines, and original clinical contributions reflecting American and European sensibilities, Volume 21 of _The Annual_ is true to the spirit of this distinguished series. It testifies to the scope of analytic inquiry, and it exemplifies the yield of such inquiry in the hands of gifted scholars and clinicians. (shrink)

Volume 25 of _The Annual_ is dedicated to the memory of Michael Franz Basch, who achieved distinction as both a psychoanalytic theorist of the first rank and an authority on the nature and conduct of dynamic psychotherapy. A wide range of original contributions bear witness to his theoretical, clinical, and educational interests. A number of papers remind us of Basch's prominence as a self-psychological theorist: Elson's self-psychological reappraisal of self-pity, dependence, and manipulation as self-states; Ornstein's developmental perspective on power, self-esteem, (...) and destructive aggression; Tolpin's review of sexuality from the standpoint of normal self development; and Wolf's discussion of self psychology and the "aging self." Basch's life-long educational concerns gain expression in Goldberg's discussion of clinical teaching, particularly the challenge of leading of case conferences; and Ornstein's and Kay's thoughtful consideration of "enduring difficulties" in American medical education. Additional highlights of the volume include: Fawcett's consideration of the role of pharmacotherapy in psychodynamic treatment; Jaffe's consideration of the applicability of hierarchical models to assessment and intervention in brief psychotherapy; Galatzer-Levy's review of the "witch" metapsychology; Gedo's analysis of mythic themes in the operas _Don Giovanni_ and _Der Rosenkavalier_; Modell's reflections on metaphor and affects; and Kernberg's discussion of a "new psychoanalytic mainstream," which he compares and contrasts with a parallel convergence of Kohutian and interpersonal analytic approaches. Many of these contributions incorporate reflections on Basch as a teacher and colleague, and the entire volume is framed by Goldberg's moving tribute. Analysts and psychotherapists sharing Basch's commitment to academic and clinical excellence and his keen awareness of the pragmatic requirements of doing effective therapy will find in Volume 25 a cornucopia of riches. (shrink)

Volume 28 of _The Annual_ features stimulating, original essays on the relationship between psychoanalysis and the neurosciences. Edelman's Neural Darwinism informs Barry's investigaton of the psychoanalytic theory of internalization and Fajardo's reassessment of "breaks in consciousness" whereas Gedo's hierarchical model of mental functioning informs Fisher's presentation of the treatment of an autistic child. Elsewhere, Hadley proposes a neurobiologically distinct motivational system devoted to the development of autonomy; Solms attempts to bridge psychoanalysis and the neurophysiology of dreaming; Levin and Trevarthen examine (...) the relationship of conscious and unconscious functions to the executive control network of the brain; Levin examines the contributions of chaos theory to psychoanalysis; and Modell explores metaphor as the crucial aspect of the developing mind and brain through which cognition itself occurs. Moraitis's examination of why analysis has been so slow to integrate its findings with the insights of contemporary neuroscience and cognitive psychology, and Sadow's reprise on the role of theory in the evolution of psychoanalysis usefully frame the contributions to this section. Section II of Volume 28 reengages a subject area for which _The Annual_ has become well-known. The four characteristically excellent studies in applied psychoanalysis found here cover the effect of early father loss on the work of the American watercolorist Charles Burchfield, "The Creativity of Women," the unconscious influence of metaphor on attitudes and value judgments, and the application of self psychology to the dramas of Eugene O'Neill. It is altogether typical of this fine series that a collection of essays dedicated to the development of a psychobiologically sophisticated psychoanalysis should be followed by contributions that testify to the explanatory vitality of psychoanalysis with respect to issues of literature, art, and creativity. (shrink)

_Sigmund Freud and His Impact on the Modern World_, volume 29 of The Annual of Psychoanalysis, is a comprehensive reassessment of the influence of Sigmund Freud. Intended as an unofficial companion volume to the Library of Congress's exhibit, "Sigmund Freud: Conflict and Culture," it ponders Freud's influence in the context of contemporary scientific, psychotherapeutic, and academic landscapes. Beginning with James Anderson's biographical remarks, which are geared specifically to the objects on display in the Library of Congress exhibit, and Roy Grinker (...) Jr.'s more personal view of Freud, the volume branches out in various directions in an effort to comprehend the multidimensional and multidisciplinary richness of Freud's contribution. In section II, we find authoritative summaries of Freud's scientific contributions, of his continuing impact as a thinker, of his notion of symbolization in the context of recent neuroscientific findings, and of his status as a "cultural subversive". In section III, contributors hone in on more specific aspects of Freud's legacy, such as an experimental method to review how Freud's idea of childhood sexuality has fared and a look at the women who became analysts in the United States. In the concluding section of the volume, contributors turn to Freud's influence in various humanistic disciplines: literature, drama, religious studies, the human sciences, the visual arts, and cinema. With this scholarly yet highly accessible compilation, the Chicago Institute provides another service to its own community and to the wider reading public. Sure to enhance the experience of all those attending "Sigmund Freud: Conflict and Culture," _Sigmund Freud and His Impact on the Modern World_ will appeal to anyone desirous of an up-to-date overview of the man whose work shaped the psychological sensibility of the century just past and promises to reverberate throughout the century just born. (shrink)

The issue of same-gender sexual identity has challenged our understanding of psychological development and psychological intervention throughout the century just past and continues to provoke discussion in the century upon us. Over the past three decades, psychoanalysis advanced toward a contemporary perspective, which holds that the dynamics of sexual orientation must be an important element of the psychoanalytic process, but must be approached without prejudice regarding the outcome of analytic exploration of wish and desire. Taken together, the essays in _Rethinking (...) Psychoanalysis and the Homosexualities, a thematic volume of The Annual of Psychoanalysis_, provide a developmentally grounded and clinically consequential enlargement of this basic premise. The result is a timely overview of contemporary approaches to the study of sexual orientation within psychoanalysis that highlights issues salient to clinical work with lesbian and gay patients. The section on "The Meaning of Sexualization in Clinical Psychoanalysis" demonstrates the importance of psychoanalytic study of same-gender desire and sexual orientation for analyst and analysand alike. Philips considers the analyst's own sexual identity as a factor shaping the analysand's experience of sexuality, whereas Shelby, Lynch, Roughton, and Young-Bruehl, from their various perspectives, address the problem of stigma and prejudice as they distort same-gender desire and same-gender sexual identity. Two concluding sections of the book explore the implications of a clinical psychoanalytic perspective for the study of gay and lesbian lives. Timely and essential reading for all mental health professionals, _Rethinking Psychoanalysis and the Homosexualities_ underscores the profound distance traversed by psychoanalysis in arriving at its contemporary understandings of gender, sexual identity, and sexual desire. (shrink)

Although its roots go back at least to Spinoza, religious naturalism is once again becoming a self–conscious option in religious thinking. This article seeks to (1) provide a generic notion of religious naturalism, (2) sketch my own “minimalist” variety of religious naturalism, and (3) view the science–religion dialogue from both of these perspectives. This last will include reflection on the nature of scientific practices, the contributions of religious traditions to moral reflection, and Ursula Goodenough's “religiopoiesis.”.

Background Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. (...) Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so. Discussion This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror". Summary If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government. (shrink)

The seventeenth and eighteenth centuries provide the tools to teach the history of modern moral philosophy. What makes this selection distinctive is that it covers not only the familiar figures - Hobbes, Hume, Butler, Bentham and Kant - but also the important but generally ignored writers: new translations of Nicole, Wolff, Crusius and d'Holbach; as well as substantial excerpts from natural law theorists such as Suarez, Grotius and Pufendorf; from rationalists such as Malebranche, Cudworth, Spinoza and Leibniz; from Epicurean writers (...) such as Gassendi; and from their 'moral sense' and other critics: Shaftesbury, Hutcheson and Price. In all, thirty-two authors are represented. The selections are preceded by a substantial contextual introduction, while each individual selection has a separate introduction, annotation and bibliography, and has been chosen for its centrality to a given philosopher's writings. The anthology can be used as an introductory survey or for more intensive graduate work as well. It can also be used as supplemental reading for courses on modern European intellectual history, the history of modern political thought, and the history of religious thought. (shrink)

There is something embarrassing about money. Everybody is seeking it but at the same time they are reluctant to talk about their bank balances and stock holdings. As a society we have so much of it that we can install 7000 saffron curtains all over Central Park, send tourists into outer space, and analyze the gas on the surface of Titan, yet we fail to spend it on millions of poverty-stricken people who die of disease or starvation each year. We (...) do open our pocketbooks sometimes, but only when television images of massive destruction overwhelm our sensibilities. Money often dominates our consciousness and bombards us in the headlines: Our national debt is 7.7 trillion dollars and it's increasing by more than 2 billion dollars a day; corporate executives of Enron walk away with millions while their employees lose their jobs and their pensions; and we had an endless fascination with Martha Stewart, who is worth millions, but went to jail trying to save a few thousand. (shrink)