This article deals with issues of litigation based on claims of personal injuries. It briefly describes the way that economists have tended to think about the “litigation process.” It discusses a number of areas of empirical work. It begins with case outcomes and looks at the ways in which the legal system itself can influence matter through the encouragement of information transfer and the rules used for allocating legal costs. It considers the role of lawyers by looking at (...) the effects of different legal fee arrangements on case outcomes. Furthermore, it discusses the liability-based legal system that produces the deterrence benefits often claimed for in conceptual work. The deterrent potentials of liability-based litigations are subject to objective and subjective contexts of the injurer. Finally, the article concludes that alternative means such as the “no fault” scheme that allots compensation irrespective of personal fault of the accused, require greater analysis. (shrink)

This paper makes the case for a wider acceptance of a probabilistic approach to causation in negligence. This acceptance would help to remove much of the incoherence which has come to afflict the English law of personal injury law. This incoherence can also be found in other common law jurisdictions (notably those of the United States, Canada and Australia). Concentrating upon recent UK case law, the argument opposes the contention that ‘naked statistics’ can play no role in establishing causation. (...) The argument is controversial but it can be reduced to three unremarkable grounds: (1) With its acceptance (albeit in certain carefully prescribed circumstances) of liability for a negligently increased risk which has eventuated, the common law has already embraced a probabilistic conception of causation; (2) The English common law already employs a probabilistic (frequentist) approach to identifying coincidences; and (3) With the ‘balance of probabilities’ as the standard of proof in civil cases, the common law has long had a probabilistic (epistemic) concept at its core. Probabilistic approaches (at both the type and token level) are shown to be consistent with laypersons’ understanding of the concepts such as risk, chance, odds and likelihood. Moreover, a wider acceptance of a probabilistic perspective on causation would entail no major challenge to the fundamental aims of tort, viz. deterrence and corrective justice. (shrink)

Though judges and lawyers encourage claimants to settle disputes out of courts, lawyers may struggle managing out-of-court dispute resolution processes. Some of the dispute management struggles are related to emotions of clients. One of the reasons why it may be difficult to manage a client’s emotions is because out-of-court disputes require a different communication skillset from lawyers. The following note features some advice for law students on how to incorporate compassionate communication methods in personal injury disputes. Personal injury (...) disputes may be emotionally challenging for clients. Such challenges may manifest in communication issues and prolonged suffering of clients. Yet, both students and academics may dismiss the importance of soft-skill development in due course of legal education. As lawyer-socialization institutions, law schools have a duty to foster skills that are necessary to successfully assist clients in emotionally challenging disputes. This contribution discusses the notion of human suffering and compassion-based counselling scholarship in relation to personal injury disputes. The paper advocates for normalizing emotions in personal injury disputes, and through testimonials of Michigan lawyers, presents real life examples of how lawyers can communicate compassionately with their clients. Law students can benefit from learning about real-life examples of communication patterns between lawyers and clients to have better conversations with their clients. (shrink)

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

: The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.

The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term outcome. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipalities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the Philosophy (...) for Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from structured observations of filmed dialogues early and late in the intervention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. (shrink)

Reappraisal is a widely investigated emotion regulation strategy, often impaired in those with acquired brain injury. Little is known, however, about the tools to measure this capacity in pat...

People diagnosed with Borderline Personality Disorder (BPD) may engage in what are called self-injurious acts. This paper situates self-injury within a larger cultural context in which body modifications are differently evaluated according to inscribed meanings. To provide a framework for ethical interactions with people diagnosed as BPD who self-injure, I draw on two concepts from theories of meaning: signification and uptake. I suggest possible significations of self-injury, but argue that clinicians have a duty to give uptake to the patient's own (...) interpretations of her behavior. Proper giving of uptake, which involves responding to others' communications such that the communicator's integrity is preserved, is crucial to ethical practices for clinicians, and uptake is never simply neutral or objective. This analysis suggests that sense-making about a client's self-injurious acts involves an understanding not only of the client's own interpretation of her behavior and its meaning, but also of the discursive production and function of such signs in our culture. I offer five maxims to guide the therapeutic process for clinicians working with self-injurious behavior in BPD patients. (shrink)

It is well documented that people with moderate-to-severe traumatic brain injury (TBI) can undergo personality changes, including becoming more impulsive in terms of how they behave. Legal guidance and academic commentary support the view that impulsiveness can render someone decisionally incompetent as defined by English and Welsh law. However, impulsiveness is a trait found within the healthy population. Arguably, impulsiveness is also a trait that gives rise to behaviours that should normally be tolerated even when they cause harm to the (...) person enacting the behaviours. The purpose of this paper is to show why both of these considerations present as significant challenges to the law in England and Wales. (shrink)

Guilt is a moral emotion that plays an important role in some understandings and manifestations of moral injury. In “Ulterior Motives and Moral Injury in War,” I note that soldiers returning from war are often assailed by profound feelings of guilt. Such soldiers might feel irrevocably diminished as persons, which is characteristic of a type of moral injury. I explore how the ulterior motives of the leaders who authorized the war might exacerbate the moral injury of soldiers. According to the (...) argument I develop, civilian and military leaders, by virtue of their practical authority over combatants serving in the military, confer upon those combatants a particular purpose. The ulterior motives that the leaders harbor constitutively determine the content of the purpose they confer. So long as a combatant remains under the practical authority of her leaders, there is nothing she can do to divest herself of the specific purpose conferred upon her. Even if the war and her conduct in it are just by hypothesis, her sense of integrity might demand more: that she helps kill only for scrupulous purposes. It might be impossible to reconcile the demands of integrity with the cynical purpose that her self-serving, career-minded, opportunistic leaders confer upon her. This failure to justify to herself the carnage she helps cause can exacerbate the severity of any psychological trauma she suffers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 25-27 [Access article in PDF] Gender, Body, Meaning:Anthropological Perspectives on Self-Injury and Borderline Personality Disorder Carolyn Sargent THE CENTRAL THEMES OF "Commodity Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior" reflect issues that cut across the disciplines represented by this journal and have received increasing attention from anthropologists. Medical anthropologists, as well as psychological anthropologists and others interested in symbolic analysis (...) of the body, have addressed such topics as the culture of biomedicine and the cultural shaping of psychiatric classification, the multiple meanings of body modifications, power relations in therapeutic interactions between doctor and patient, and cultural variation in understandings of normality and abnormality.Curiously, there is little anthropological literature that directly focuses on either borderline personality disorder (BPD) or self-injurious acts per se. Indeed anthropological research on psychiatric diagnosis, classification, and treatment, as well as ethnopsychiatry, include scant reference to personality disorders. One exception is Nuckolls' 1992 article, "Toward a Cultural History of the Personality Disorders," which raises pertinent questions for one of Potter's introductory statements—that the majority of those diagnosed with BPD are women. Nuckolls directly addresses gender ideology and gender roles in the United States in his comparison of antisocial personality and histrionic personality diagnoses. In his paper, he argues that these personality disorders have cultural histories and are strongly congruent with prevailing gender stereotypes, such that men are many times more likely to be diagnosed as antisocial than women and women much more likely to be diagnosed as histrionic (Nuckolls 1992, 37). He also historicizes the emergence of certain behavioral styles that have been seen as characteristic of women and men, and the evolution of psychiatric diagnoses that classify extreme manifestations of these behavioral styles.The issue of why women, rather than men, are more frequently diagnosed with BPD is not elaborated in Potter's article, although she notes the importance of considering the intersection of gender and "identifying behaviors" associated with BPD. Cultural analyses of gender ideology in the [End Page 25] United States might suggest that the connection involves gendered expectations concerning emotionality and relational context but these articulations remain intriguing and underexplored. One might speculate that BPD/self-injury occurs in the context of particular gender ideologies, perhaps in class-based, industrialized societies where the body is highly commodified. It appears that the history of this constellation of symptoms and behaviors remains to be written.Cultural analysis of self-injury, a theme that runs through Potter's article, tends to be embedded in the anthropological literature on body ornamentation, initiation rituals, and "culture-bound" syndromes. Mascia-Lees and Sharpe (1992, 1) describe the body as "a site of adornment, manipulation, and mutilation," practices with roots reaching back as far as 30,000 years, and include as examples head deformation, scarification, foot binding, tooth filing, lip plates, nose rings, tattoos, subincision, and genital cutting.However, the concept of self-injury, as Potter notes, is problematic in the discipline of anthropology given the significance historically accorded to cultural relativism. Correspondingly, body "modification" is not "self-injury" as long as it is socially normative, for example, a facet of an initiation ordeal or body ornamentation (e.g., circumcision, scarification, piercing). Among the rare examples of acts that seem readily identifiable as "self-injury" are New Guinea practices of cutting off a finger to demonstrate mourning and Baatombu (West African) male finger amputation to show grief and anger over a wife's infidelity. Both are, however, considered culturally legitimate and not indicative of pathology.Potter's argument draws heavily on the notion of "body as text," derived largely from literary theory and feminist philosophy (Butler 1990; Jaggar and Bordo 1989). The perspective of "body as text" has influenced anthropological theory over the past two decades, particularly in the interpretive and postmodernist schools of thought. The body as a text of femininity is aptly characterized by Bordo, who argues that the continuum between female disorder and normal femininity is revealed by means of an analysis of symbolic meaning of gender in... (shrink)

Assessment of decision-making capacity can be difficult in acquired brain injury particularly with the syndrome of organic personality disorder. Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can be (...) present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: necessary for DMC, threatened by ABI, and assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Recent research suggests that spiritual experiences are related to increased physiological activity of the frontal and temporal lobes and decreased activity of the right parietal lobe. The current study determined if similar relationships exist between self-reported spirituality and neuropsychological abilities associated with those cerebral structures for persons with traumatic brain injury (TBI). Participants included 26 adults with TBI referred for neuropsychological assessment. Measures included the Core Index of Spirituality (INSPIRIT); neuropsychological indices of cerebral structures: temporal lobes (Wechsler Memory Scale-III), right (...) parietal lobe (Judgment of Line Orientation), and frontal lobes (Trail Making Test, Controlled Oral Word Association Test). As hypothesized, spirituality was significantly negatively correlated with a measure of right parietal lobe functioning and positively correlated (nonsignificantly) with measures of left temporal lobe functioning. Contrary to hypotheses, correlations between spirituality and measures of frontal lobe functioning were zero or negative (and nonsignificant). The data support a neuropsychological model that proposes that spiritual experiences are related to decreased activity of the right parietal lobe, which may be associated with decreased awareness of the self (transcendence) and increased activity of the left temporal lobe, which may be associated with the experience of specific religious archetypes (religious figures and symbols). (shrink)

Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury. Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In (...) addition, we examined potential differences between within-day and between-day effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS or active tDCS. The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics, peak trailing limb angle, intralimb coordination, the Berg Balance Scale, and the Falls Efficacy Scale-International questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT03237234]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 29-31 [Access article in PDF] On the Border:Reflections on the Meaning of Self-Injury in Borderline Personality Disorder Robert L. Woolfolk Keywords borderline personality disorder, values, psychotherapy, diagnosis IT IS A PLEASURE to comment on Nancy Potter's elegantly written, provocative paper. Professor Potter raises important and intriguing issues that have not only clinical implications for practitioners, but also are of theoretical significance for those (...) who ponder the conceptual status of mental illnesses and their manifestations.Borderline personality disorder (BPD) is the mental health professional's bête noire. In the diagnostic context, borderline is an adjective that is evocative, albeit imprecise. Persons with BPD tend to the worst of multiple pathological worlds, to fall through the diagnostic cracks, to occupy the boundaries of decorum and safety. Even such intrepid and astute folk as Marsha Linnehan and Otto Kernberg, who have devoted careers to understanding and treating those with BPD, have acknowledged the limited state of current knowledge. Justice Stewart's theory of natural concepts seems to apply to patients to whom we give the label borderline personality disorder: we cannot define the disorder readily, but we know one when we see one. And when we see such a patient it is costly in time and stress and corrosive of one's sense of professional efficacy. So with these patients, any assistance in conceptualizing the problem or in modification of therapeutics is welcome.Professor Potter's phenomenological formulation of self-injury is cogent and helpful in a number of ways. Self-injurious behavior is, when conventionally interpreted, a prototype for irrationality and affliction. It is also dramatic, graphic, and often repugnant. Professor Potter's analysis brings us face to face with what most of us know but sometimes forget or fail to apply: Psychotherapy is a value-laden endeavor. Early on, both Max Weber and Carl Jung were eloquent on this point and we have been reminded often enough of it in the last four decades (Rieff 1966; Woolfolk 1998; Woolfolk and Murphy, in press). Usually it is the moral values residing in the underlying ideologies of treatment and diagnosis that are brought to our attention. The axiological underpinnings of psychotherapy, however, are aesthetic as well as ethical. Professor Potter successfully argues that, as therapists, we may be in the thrall of a parochial aesthetic that produces [End Page 29] a kind of tunnel vision inimical to therapeutic effectiveness and to the ethical treatment of the human beings who are our patients. She has impeccable advice for therapists on this topic: Although none of us can step outside of culture altogether, we can evaluate our attitudes, beliefs, and values from a second-order level (Taylor 1989; Frankfurt 1971). Complete objectivity is an unlikely ideal. But clinicians can, and should, think critically about ways in which prevailing norms and values may be influencing their understanding of the world and their ways of being in it. (Potter 2003, 11) Professor Potter also quite effectively persuades that a comprehensive understanding of disorders that occur mostly in women (e.g., somatization disorder) must effectively comprehend feminist scholarship and the sociocultural realities of gender. The concept of the commodification of the female body has been informative in both the epidemiology and treatment of yet another woman's disorder, anorexia nervosa. And although the linkages of somatic commodification to self-injurious behavior may not appear to be so straightforward, the paper points the way to deeper and possibly richer explanations of phenomena that seem at first glance to be inexplicable.The introduction of the concept of uptake into clinical contexts is also a valuable contribution. Those of us familiar with the traditions of psychotherapy recognize a concept both familiar and central. Uptake has family resemblance to the empathic attitude so extensively discussed by both Rogers and Kohut. Those with hermeneutic leanings will recognize affinities with Verstehen and the Gadamerian anticipation of completeness (Vorgriff der Vollkommenheit). Any truly humanistic approach to treatment or diagnosis must encompass the lived experience of the patient. This is not to... (shrink)

This book turns to virtue language as an important resource for understanding moral injury, a form of subjectivity where one feels they can no longer strive to be good as a result of wartime experience. Drawing specifically on Iris Murdoch’s moral philosophy, and examining the experiences of civilians during the Bosnian War, Joseph Wiinikka-Lydon argues that current research into war and current understandings of subjectivity need new ways to articulate the moral dimension of being a subject if we are to (...) understand how violence affects one’s moral being and development. He develops an understanding of the human person as a tensile moral subject, one that forefronts the moral challenges and vulnerability inherent in lives affected by war. With these resources, Wiinikka-Lydon argues for a moral vocabulary and images of the human as a moral being that can better articulate the experience of violence and moral injury. (shrink)

Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals’ moral systems are in large measure developmentally and socially derived and interpreted. (...) Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual’s formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with issues of religion, faith, and spirituality for many individuals, and recognizing that much of the current focus on moral injury is emanating out of healthcare contexts, we devote particular attention to how chaplains might be more intentionally engaged in healthcare systems such as the Veterans Health Administration to provide non-judgmental, person-centered, culturally-relevant care rooted in communities of practice to veterans with moral injury. (shrink)

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained of (...) their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

I argue that, given certain prominent views of personal identity and prudence, the nonidentity problem, or a very similar problem, can arise postconception. I clarify and defend this claim by considering the implications of these views for prenatal injury.

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms (...) included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained of (...) their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

This paper explores similarities and differences between grief over the death of a person and other experiences of loss that are sometimes termed 'grief', focusing on the impact of serious illness and bodily injury. It takes the form of a dialogue between a physician/ neurophysiologist and a philosopher. Adopting a broad conception of grief, we suggest that experiences of lost or unrealized possibilities are central to all forms of grief. However, these unfold in different ways over prolonged periods. Experiences of (...) grief are complex, diverse, difficult to articulate, and frequently under-acknowledged. This diversity, we note, complicates discussions of how to distinguish typical from pathological forms of grief. We raise the concern that thinking of grief through the lens of bereavement eclipses other circumstances in which people are required to comprehend and adapt to loss. With this lack of acknowledgment, the phenomenology of grief is characterized in ways that are overly tidy and people are deprived of important interpretive resources. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 17-21 [Access article in PDF] Self-Injury:Symbolic Sacrifice/Self-Assertion Renders Clinicians Helpless Christa Krüger Keywords feminism, iconic communication, moral conflict, oppression, psychiatrist/psychologist roles, societal norms. POTTER'S PAPER CONSIDERS self-injury in women diagnosed with borderline person ality disorder (BPD) to be a form of body modification where the body is used to communicate meaning. She touches on symbolism as a possible explanatory theory for this sort (...) of self-injury. She also refers to the culture of body commodification as underlying self-injury. She then argues that clinicians have a duty to give uptake to the patient's own interpretations about the meaning of the self-injury. Giving uptake is a virtuous approach for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity, along with other benefits. Potter offers five maxims for giving uptake properly. However, I shall argue that giving uptake can be very difficult for clinicians, and that an appreciation of this difficulty depends on an expansion and linkage of some of the theories that she touched on. Self-injury is revisited experimentally as a double-edged sword of symbolic sacrifice and iconic-symbolic self-assertion. This revisiting aims to illustrate how clinicians might be caught in a double bind, where giving uptake properly might be very difficult if not more or less doomed to fail.Potter's paper starts by situating self-injury in a broader discourse of body modifications. In this discourse the body is being used as a text, a tool to communicate meaning. The meaning that is communicated might be difficult or impossible to articulate otherwise (by using words, for example). The meaning of the communication is embedded in a context of social, cultural, religious, political, and other norms. Potter explores possible interpretations of the meaning of self-injury in women with BPD, including an interpretation of self-injury as symbolic sacrifice. She suggests that a cultural understanding/nonunderstanding of the meaning of a particular instance of self-injury is an important determinant of whether such self-injury is considered pathological/nonpathological. She then shifts the focus to the present-day culture in which women's bodies are commodified and objectified, and where women become alienated from their bodies. Self-injury might then be interpreted as an attempt to re-own one's body as a part of oneself. This re-owning is a socially transgressive act that violates repressive norms for the bodies of women. [End Page 17]Notwithstanding these possible significations of self-injury, Potter then argues that clinicians have a duty to give uptake to the patient's own interpretations, instead of jumping to conclusions (my oversimplification) about the meaning of the self-injury. Giving uptake, then, constitutes a framework for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity. Potter offers five maxims for giving uptake properly.At the risk of losing their essence, I translate the five maxims for practicing psychiatrists as involving the following: critical self-reflection about one's own conceptual framework and cultural context; being receptive to the patient's conceptual framework and cultural context; giving the patient the benefit of the doubt; being open to the emergence of new meanings of self-injury; and keeping a range of possible interpretative options open, rather than insisting on having the final word. We should try to understand what the world looks like from the patient's position. All of this requires some moral effort.Potter describes a number of benefits that result from giving uptake. Giving uptake is a crucial corrective to the human tendencies of becoming overly committed to prevailing societal norms and conceptual schemes (stuck in our ways), of imposing our views on others, and of silencing or distorting the communications of our patients. Giving uptake allows clinicians to be dialogically responsive and to treat patients with respect and dignity. Giving uptake fosters trust in a therapeutic relationship where clinicians do not exploit their patients' vulnerabilities. Giving... (shrink)

A central theme of law and society is that people's ideas about law and the decisions they make to mobilize law are shaped by community norms and cultural context. But this was not always an established concept. Among the first empirical pieces to articulate this theory was David Engel's 1984 article, 'The Oven Bird's Song: Insiders, Outsiders, and Personal Injuries in an American Community'. Over thirty years later, this article is now widely considered to be part of the (...) law and society canon. This book argues that Engel's article succeeds so brilliantly because it integrates a wide variety of issues, such as cultural transformation, attitudes about law, dispute processing, legal consciousness, rights mobilization, inclusion and exclusion, and inequality. Contributors to this volume explore the influence of Engel's important work, engaging with the possibilities in its challenging hypotheses and provocative omissions related to the legal system and legal process, class conflict and difference, and law in other cultures. (shrink)

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental effects on nurse's (...) capacity to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence‐based policies with implications for nurse's safety, education and training. (shrink)

After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything. The current research seeks to develop the construct of moral injury outside military contexts, (...) generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics. There are no data in this work. (shrink)

Background We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The (...) second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Results All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. Conclusions To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma. (shrink)

The tendency for judges to respond positively to negligence claims advanced by those who have rendered assistance to accident victims has recently come into collision with the judicial impulse to limit the range of circumstances in which recovery can be made for psychiatric injury. The upshot of this collision is identified as a reduction in the range of circumstances in which those rendering assistance to accident victims can recover for psychiatric harm. This development is criticized on the ground that it (...) has compromised pursuit of what is identified as one of the law's subsidiary purposes: namely, the promotion (in a narrow range of circumstances) of strongly altruistic activity. The ground for making this criticism is found in a body of doctrine that supports the claim that the law is informed by a commitment to the altruism principle. This principle is contrasted with the narrower rescue principle and is identified as supporting not only the claims of rescuers but also those of persons who render assistance in the aftermath of particularly harrowing accidents. While the House of Lords» decision is identified as exhibiting insensitivity to the altruism principle, it is none the less concluded that the position staked out by their Lordships is defensible. Support for this conclusion is found in the ideal of distributive justice, which provided one of the grounds for the House's decision in White. Further, the relationship between the ideal of corrective justice and the ideal of distributive justice is identified as a source of significant tension in the law of negligence. (shrink)

The highly publicized deaths of research participants Ellen Roche and Jesse Gelsinger are stark reminders that risk is inherent in medical research and while untoward outcomes are infrequent when compared to individual and societal benefits, injury and even death will happen. Who is responsible for the welfare of research subjects and what are they owed? Why were they put at risk to begin with? Are obligations, if any, to research subjects dependent on the type of study in which they participate, (...) in recognition that there may be personal benefit from participation in some studies?The issue of injury resulting from participation in research and answers to questions such as those just posed were last considered in depth nearly 20 years ago by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (shrink)

The highly publicized deaths of research participants Ellen Roche and Jesse Gelsinger are stark reminders that risk is inherent in medical research and while untoward outcomes are infrequent when compared to individual and societal benefits, injury and even death will happen. Who is responsible for the welfare of research subjects and what are they owed? Why were they put at risk to begin with? Are obligations, if any, to research subjects dependent on the type of study in which they participate, (...) in recognition that there may be personal benefit from participation in some studies?The issue of injury resulting from participation in research and answers to questions such as those just posed were last considered in depth nearly 20 years ago by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (shrink)

Psychiatrists working with war veterans have, in recent years, constructed ‘moral injury’ as a separate manifestation of war trauma that is distinct from Post-Traumatic Stress Disorder. This paper argues that for moral degradation to occur, it necessarily involves one’s commissions or omissions that transgresses one’s personal morality, and hence, distinguishes sufferers of moral injury from PTSD sufferers who were witnesses to traumatic and morally abhorrent events. To this end, it clarifies how some of the situations surrounding moral injury are (...) misunderstood, by discussing the process of moral reasoning in the context of moral dilemmas, dirty hands, and moral blind alleys. Finally, it concludes that when we conceptualise moral injury as being caused by one’s commissions and omissions in moral dilemmas, we find that shame and guilt are situation-appropriate responses with a role to play in what ethics mean. (shrink)

Psychiatrists working with war veterans have, in recent years, constructed ‘moral injury’ as a separate manifestation of war trauma that is distinct from Post-Traumatic Stress Disorder. This paper argues that for moral degradation to occur, it necessarily involves one’s commissions or omissions that transgresses one’s personal morality, and hence, distinguishes sufferers of moral injury from PTSD sufferers who were witnesses to traumatic and morally abhorrent events. To this end, it clarifies how some of the situations surrounding moral injury are (...) misunderstood, by discussing the process of moral reasoning in the context of moral dilemmas, dirty hands, and moral blind alleys. Finally, it concludes that when we conceptualise moral injury as being caused by one’s commissions and omissions in moral dilemmas, we find that shame and guilt are situation-appropriate responses with a role to play in what ethics mean. (shrink)

The appropriate goal of care for a person with a traumatic brain injury is rehabilitation in the broad, etymological sense of the word. The task is to bring the person back to the conditions of the living of a life. This requires the rehabilitation of the mind—the reconstruction of a subject.

Persons who experience severe brain injury often suffer significant disorders of consciousness. Anoxic injuries from cardiac arrest or strokes and traumatic injuries from falls, vehicular crashes, or assaults can result in several conditions in which patients lose or have diminished consciousness for an extended period of time. Two such conditions that create considerable public confusion and controversy are the vegetative state and the minimally conscious state. Although these conditions have generated significant medical and academic research, the general public (...) and policymakers are often confused about the nature of VS and MCS. The most recent evidence for this confusion is the acrimonious public debate, the extensive media coverage, the prolonged litigation, and the attempts of various governmental officials to intervene in dealing with the plight of Terri Schiavo. (shrink)

In this unflinching look at the experience of suffering and one of its greatest manifestations—torture—J.M. Bernstein critiques the repressions of traditional moral theory, showing that our morals are not immutable ideals but fragile constructions that depend on our experience of suffering itself. Morals, Bernstein argues, not only guide our conduct but also express the depth of mutual dependence that we share as vulnerable and injurable individuals. Beginning with the attempts to abolish torture in the eighteenth century, and then sensitively examining (...) what is suffered in torture and related transgressions, such as rape, Bernstein elaborates a powerful new conception of moral injury. Crucially, he shows, moral injury always involves an injury to the status of an individual as a person—it is a violent assault against his or her dignity. Elaborating on this critical element of moral injury, he demonstrates that the mutual recognitions of trust form the invisible substance of our moral lives, that dignity is a fragile social possession, and that the perspective of ourselves as potential victims is an ineliminable feature of everyday moral experience. (shrink)

The psychological factors influencing a return to sport has gained increased research attention. In the current investigation, we explored professional basketball players’ perceptions of the psychological factors facilitating a return to performance equal to or exceeding previous performance standards. We also sought to describe athletes’ experiences – both positive and negative – of returning to sport following injury recovery. Ten Italian professional male basketball players (age range 22-36 years), were retrospectively interviewed in relation to three time-periods: (1) from the commencement (...) of rehabilitation to their first official competition, (2) the first official competition, and (3) the six-months following the initial competition. Hierarchical content analysis of the data revealed numerous themes across the three time periods. In regards to Period 1, participants indicated that social support, investment in rehabilitation and training programs, coping skills and motivation were fundamental in reaching pre-injury performance levels. During their first official game (i.e. Period 2), athletes reported that realistic performance expectations, focusing on the performance, positive emotions, motivation, arousal and social support facilitated their return to sport. Athletes however, also described a predominance of factors that hindered their return to pre- injury levels (i.e., low confidence in personal abilities, decrements in skill execution and dysfunctional physical sensations). Moreover, participants typically described a substandard level of performance during their first competition back following injury. In recounting experiences during the six months following their first official game, basketballers reported improvements in skill execution and highlighted the importance of coping skills, motivation and social support. The process of restoring self-confidence in one’s ability to successfully perform was perceived as crucial in enabling participants to move beyond a mere return to sport to a return to high performance ─ that is, to reach a level of proficiency equal to or exceeding previous performance standards. Findings support the relevance of cognitive, emotional and behavioral responses highlighted in the Integrated Model and suggest the importance of addressing psychological factors throughout the return-to-sport process. Finally, results from the present study hold a number of practical implications for athletes’ aiming to achieve a return to pre-injury levels. (shrink)

Moral injury occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses their deeply held moral beliefs. The deeply held moral belief that physicians share is the oath they take when completing their lengthy training and embarking on their career: Put the needs of patients first. In today's American healthcare system, doctors, nurses, and other healthcare providers are increasingly forced to consider the demands of other stakeholders -- insurers, hospitals, even their own financial security (...) -- before the needs of their patients. Whenever they are forced to make a decision that contravenes their patient's best interest, they feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. Moral injury and its causes help explain why healthcare workers started leaving the field in droves long before the COVID-19 pandemic exposed weaknesses in the US system, why a rich country has such poor outcomes in certain categories, why there is a shortage of young doctors training for critical areas, and why patients feel so frustrated. In If I Betray These Words, Wendy Dean explores and exposes the impacts of moral injury through vividly told stories that are at once bewildering and eye-opening. Her book serves as a roadmap through a healthcare landscape that can be confounding, and at times even hellish, for those who must navigate it, and it suggest alternative routes for healers and their patients. (shrink)