SCOTT A and WILSON L. Nursing Inquiry 2011; 18: 40–49 Valued identities and deficit identities: Wellness Recovery Action Planning and self-management in mental healthWellness Recovery Action Planning (WRAP) is a self-management programme for people with mental illnesses developed by a mental health consumer, and rooted in the values of the ‘recovery’ movement. The WRAP is noteworthy for its construction of a health identity which is individualised, responsibilised, and grounded in an ‘at risk’ subjectivity; success with this programme requires (...) development of an intensely focused health lifestyle. We draw on Bourdieu and Giddens to argue that what is being developed is a ‘reflexive health habitus’, which is not equally accessible to all social groups, and is in tension with WRAP’s recovery-orientated aims. However, it is understandable that such a programme developed in mental health, because people with mental illness are highly stigmatised as ‘a risk’ and viewed as in need of risk management. By developing their own form of self-monitoring ‘at risk’ identity, mental health consumers are, paradoxically, able to construct themselves as ideal health citizens and no longer a risk, thus re-entering the moral community. We conclude by suggesting some changes to WRAP practice. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mourning and SubjectivityFrom Bersani to Proust, Klein, and FreudL. Scott Lerner (bio)Near the end of his recent essay “Psychoanalysis and the Aesthetic Subject,” Leo Bersani makes an unexpected conceptual turn, briefly adopting a vocabulary of “human destiny” [174]. Jacques Derrida made a similar move in 2003 when he dropped his guard, abandoning the language of critical exposition to point out, with uncharacteristic bluntness (“de façon plus crue” [18]), (...) the relevance of autobiography—his experience as a Jewish boy in Algeria—to the development of deconstruction.1 In both instances, one senses a desire for intellectual self-exposure,2 to discover the relation of real-world experience and intellectual—critical, aesthetic, psychic—practices. For Bersani, not only the phrase but the essay as a whole signals the culmination of a decades-long inquiry into the relation of human subjectivity and a “solidarity of being” both among subjects and with the world [“Psychoanalysis” 161].If there is an affirmation of a universal human condition in Bersani’s work—and his reference to human destiny indicates that there is—then it is perhaps best defined as the inclination of human subjects to seek the annihilation of others as a prerequisite for subjectivity. In this state of affairs, where subjectivity encounters the external realm of human and nonhuman objects, Bersani has long been concerned with two chief protagonists: psychoanalysis and art. He has repeatedly shown, ever by new means, that both can be complicitous with the worst inclinations of human subjectivity, just as both can also uniquely provide the means by which human subjects may exceed their own subjectivity [161]. Psychoanalysis, in Bersani’s view, provides the language and conceptual framework to describe how and why subjects go about appropriating and annihilating objects. Psychoanalysis has been misdirected, however, toward two areas of relatively limited value: depth psychology and object relations [“Psychoanalysis” 161, 163; “Sociality” 647], while the main contribution of psychoanalysis, the discovery of the unconscious, has not been adequately exploited as a means of reconceptualizing subjects in solidarity, rather than antagonism, with objects [“Psychoanalysis” 161–64].By the same token, much of great art, literature especially, has served what Bersani calls the “culture of redemption,” promoting the misconception that experience is damaged or worthless and must be repaired via the work of art [Culture of Redemption 1]. [End Page 41] In psychoanalysis, the counterpart of the culture of redemption is located not, in fact, in the areas that Bersani devalorizes (depth psychology, object relations), but rather with the core exploration of unconscious subjectivity. The literary achievement that is paradigmatic of the culture of redemption is Marcel Proust’s À la recherche du temps perdu (In Search of Lost Time), whose theorizing narrator depicts experience, history, the real, as lost to us, damaged, fallen, and in need of repair—redemption—through art.3 The best illustration of the counterpart in psychoanalysis is the work of Melanie Klein. By portraying our relations with others as repetitions of dynamics already played out in unconscious fantasy, Kleinian theory, in Bersani’s view, similarly casts real relations as subordinate to and determined by the (unconscious) imagination. No sooner has Bersani exposed these dominant tendencies in Proust and Klein, however, than he redeems both from the sins of redemptiveness. At the periphery of each writer’s work he uncovers a radically alternative—and, implicitly, ethically superior—representation of the subject in the world. Bersani devoted a seminal essay to these two writers: “The Culture of Redemption: Marcel Proust and Melanie Klein,” reprinted as the first chapter of The Culture of Redemption (1990). In subsequent essays in this volume, he applied this same bifocal approach—consisting in condemnation of a dominant tendency and affirmation of a seemingly marginal one—to Freud, Flaubert, Melville, and others.If The Culture of Redemption thus aimed not only to expose the distortions created by the culture of redemption but also to promote an alternative vision, then the title assigned to the collection told only half the story. Three years later, Bersani and Ulysse Dutoit set out, as it were, to tell the other half. They brought together the work of three artists—a novelist and playwright, a painter, and a filmmaker... (shrink)

Selected writings from the most influential texts of the samurai era—in a pocket-size edition. The samurai of Japan, who were the country's military elite from medieval times to the end of the nineteenth century, were synonmous with valor, honor, and martial arts prowess. Their strict adherence to the code of bushido ("the way of the warrior"), chivalry, and honor in fighting to the death continues to capture the imagination of people today, inspiring authors, filmmakers, and artists. The Pocket Samurai contains (...) the essential writings of the era by the most esteemed samurai and philosophers of the age, including the iconic Miyamoto Musashi, author of The Book of Five Rings; Yamamoto Tsunetomo, author of Hagakure, the best-known explication of the samurai code; Takuan Soho, the Zen priest and adviser to samurai; Yagyu Munenori, whose The Life-Giving Sword describes a deeply spiritual approach to sword fighting; and others. (shrink)

This article treats religion as a central concern in Whitehead. His view of rational religion relies primarily on rational inference, not direct intuition. Taking seriously in religion the nonreflective elements in human cognition would not jeopardize, but would strengthen, his treatment of the reflective ones. While religion can certainly include vestiges of human savagery, it also promotes the ascent of humanity beyond social decay and enhances the art of life.

The present article challenges the bifurcation of the world established by Kant, a bifurcation that continues to plague contemporary thinking about science, religion, and morality. This challenge is aided by Whitehead's alternative worldview.

This article analyzes David Hume’s influential critique of worship from a process point of view informed by the thought of Whitehead and Hartshorne.

While central to the Christian religion, the act of faith has been notoriously difficult to define. This essay is an attempt to illuminate, with the aid of insights from cognitive science and process philosophy, what it means for a Christian to have faith, specifically in God. In doing so, the apriori and aposteriori aspects of faith are explored, along with its connections to science and empirical evidence, revelation, knowledge, doubt, morality, and additional Christian beliefs.

Previously published: Tokyo: Kodansha International, 2010.

This is a polemical essay providing an historical and cultural analysis of John Rawls’s political liberalism, and arguing that the “original position” in his philosophy is not only hypothetical, but also unrealistic by virtue of ignoring comprehensive religious and philosophical points of view. Rawls attempts to derive the ideas of liberty, equality, and fraternity from a mere thought experiment withoutconsidering the foundational role of the Christian religion, which was instrumental in the birth and refinement of these ideas.

This is the first complete edition of the Chronicon Anonymi Cantuariensis, a contemporary narrative that provides valuable insights into medieval war and diplomacy, written at Canterbury shortly after the mid-fourteenth century. The previous edition, published in 1914, was based on a manuscript from which the text for the years 1357 to 1364 was missing. Presented here in full with a modern English translation, the chronicle provides a key narrative of military and political events covering the years from 1346 to 1365. (...) Concentrating principally on the campaigns of the Hundred Years War and their impact upon the inhabitants of south-east England, the author took advantage of his position on the main news route between London and Paris to provide a detailed account of a crucial phase in British and European history. (shrink)

This exploratory study examines awareness of the other party''s instrumental, terminal, and work values by members of supervisor and employee dyads. Subjective estimates of value congruence, provided by either member of the dyad, correlated with actual value congruence scores determine conscious awareness levels in all cases. Results demonstrate supervisory awareness of employee terminal values, but not work values or instrumental values, even though these latter value types probably possess the greatest relevance to achieving organizational goals. Further, employees possess awareness of (...) supervisor work values but not instrumental or terminal values. These findings challenge traditional assumptions underlying the functionalism position on organizational culture that appears in the literature most frequently read by practicing managers. (shrink)

This exploratory study examines awareness of the other party's instrumental, terminal, and work values by members of supervisor and employee dyads. Subjective estimates of value congruence, provided by either member of the dyad, correlated with actual value congruence scores determine conscious awareness levels in all cases. Results demonstrate supervisory awareness of employee terminal values, but not work values or instrumental values, even though these latter value types probably possess the greatest relevance to achieving organizational goals. Further, employees possess awareness of (...) supervisor work values but not instrumental or terminal values. These findings challenge traditional assumptions underlying the functionalism position on organizational culture that appears in the literature most frequently read by practicing managers. (shrink)

The aims of the present study were to analyse people’s natural ability to discriminate between true and false statements provided by people with intellectual disability (IQTRUE = 62.00, SD = 10.07; IQFALSE = 58.41, SD = 8.42), and the differentiating characteristics of such people’s statements using criteria-based content analysis (CBCA). Thirty-three people assessed 16 true statements and 13 false statements using their normal abilities. Two other evaluators trained in CBCA evaluated the same statements. The natural evaluators differentiated between true and (...) false statements with somewhat above-chance accuracy, even though error rate was high (38.19%). That lay participants could not effectively discriminate between false and true statements demonstrates that such assessments cannot be considered useful in a forensic context. The CBCA technique did discriminate at a better level than intuitive judgements. However, of the 19 criteria, only one significantly discriminated. More procedures specifically adapted to the abilities of people with intellectual disabilities are thus required. The presence of structured production, quantity of details, characteristics details and unexpected complications increased the probability that a statement would be considered true by non-expert evaluators. The classification made by the non-expert evaluators was independent of the participants’ IQ. A big data analysis is performed in search for better classification quality. (shrink)

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children’s pain experiences, the relationships nurses share with children who are suffering, (...) and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end. (shrink)

Part 1 of this exploratory study demonstrated that for terminal, instrumental, and work values, supervisors could only accurately assess the extent to which their terminal values are congruent with their employees, whereas, employees could only accurately describe degrees of alignment with their supervisors' work values. Thus, supervisors appear to possess conscious awareness of the terminal values held by their employees and employees similarly possess conscious awareness of their supervisors' work values. Part 2 of the study examined what each of these (...) two parties might do with their conscious knowledge concerning value congruence with the other member. Supervisor ratings and employee self-ratings concerning employee job performance, citizenship, climate fit, working relationship (LMX), and other issues, were correlated with supervisor terminal value congruence estimates and employee work value congruence estimates respectively. For supervisors, only one significant finding was noted, indicating a positive relationship between the supervisors' awareness of terminal value congruence with the employee and the supervisors' estimate of the employee's potential for future promotion. For employees, seven hypotheses received support demonstrating relationships between the employees' awareness of supervisor/employee work value congruence and self-ratings of work behaviours, citizenship behaviours, volunteerism behaviours, work climate behaviours, work climate attitudes, work climate organizational-wide attitudes, and the supervisor/employee working relationship. Implications for management and future research are discussed. (shrink)

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total (...) of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention or control. Fifty-eight Veterans completed pre- and post-testing. The intervention covered resilience strengths organized into four modules: engagement, social relatedness, transformation of pain and building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: Pain decreased in present severity [F = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F = 14.52, p < 0.01, η2p = 0.21], and pain interference [F = 6.82, p < 0.05, η2p = 0.11]; Affect improved in pain-related negative affect [F = 7.44, p < 0.01, η2p = 0.12], fear [F = 7.70, p < 0.01, η2p = 0.12], and distress [F = 10.87, p < 0.01, η2p = 0.16]; Well-being increased in pain mobility [F = 5.45, p < 0.05, η2p = 0.09], vitality [F = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth.Clinical Trial Registration: Registered with ClinicalTrials.gov. (shrink)

Subjects enrolled in studies testing high risk interventions for incurable or progressive brain diseases may be vulnerable to deficiencies in informed consent, such as the therapeutic misconception. However, the definition and measurement of the therapeutic misconception is a subject of continuing debate. Our qualitative pilot study of persons enrolled in a phase I trial of gene transfer for Parkinson disease suggests potential avenues for both measuring and preventing the therapeutic misconception. Building on earlier literature on the topic, we developed and (...) tested an interview guide that focuses on how the subjects decided to participate, emphasizing the integration of subjects’ various statements that are relevant to assessing the therapeutic misconception, rather than evaluating them as isolated statements. The results indicate that a subject’s understanding of the purpose of research is best explored in juxtaposition to the subject’s motivation for participating. (shrink)

Bioethicists have long been concerned that seriously ill patients entering early phase (‘phase I’) treatment trials are motivated by therapeutic benefit even though the likelihood of benefit is low. In spite of these concerns, consent forms for phase I studies involving seriously ill patients generally employ indeterminate benefit statements rather than unambiguous statements of unlikely benefit. This seeming mismatch between attitudes and actions suggests a need to better understand research ethics committee members’ attitudes toward communication of potential benefits and risks (...) of early phase studies to potential subjects. We surveyed the members of two U.S. research ethics committees using a phase I gene transfer study scenario, and compared the results to a previous survey of potential subjects’ perceptions and attitudes toward benefit and risk for the same protocol. The results show that there is indeed a gap between the subjects’ perceptions and the committee members’ views on what is appropriate to be communicated to research subjects. This discrepancy is the product of both the commonly assumed optimism of the subjects and to a “protective pessimism” of the research ethics committee members. We discuss this discrepancy using “frameworks of trust” and demonstrate the need to incorporate these frameworks into the existing model of informed consent. (shrink)

Many philosophers have argued against Singer’s claim that all animals are equal. However, none of these responses have demonstrated an appreciation of the complexity of his position. The result is that all of these responses focus on one of his arguments in a way that falls victim to another. This paper is a critical examination of a possible response to the full complexity of Singer’s position that derives from the work of Carl Cohen, Kathleen Wilkes, and F. Ramsey. On this (...) response, a being’s moral status depends not on the capacities and abilities she does in fact have, but instead on the capacities and abilities normal for the members of her species. However, this response is ultimately unacceptable, for it depends on a faulty conception of loss and misfortune and its underlying moral principle is irrational at best and morally objectionable at worst. The failure of even this response to Singer gives us good reason to conclude with Singer that all animals are equal. (shrink)

Pragmatism is America’s most distinctive philosophy. Generally it has been understood as a development of European thought in response to the "American wilderness." A closer examination, however, reveals that the roots and central commitments of pragmatism are indigenous to North America. Native Pragmatism recovers this history and thus provides the means to re-conceive the scope and potential of American philosophy. Pragmatism has been at best only partially understood by those who focus on its European antecedents. This book casts new light (...) on pragmatism’s complex origins and demands a rethinking of African American and feminist thought in the context of the American philosophical tradition. Scott L. Pratt demonstrates that pragmatism and its development involved the work of many thinkers previously overlooked in the history of philosophy. (shrink)

This chapter looks at the function of phobia in the work of Gilles Deleuze. It looks particularly at how Deleuze’s concepts of the ‘line of flight’ and ‘becoming’ find definition in a creative rethinking of Lacan’s understanding of phobia, transforming his own symptoms into a sinthome that links a fear of milk to the figure of the schizophrenic thereby offering a ‘nonsensical’ yet effective way of understanding the dynamic genesis and development of his philosophy, particularly the logic of sense.

Essays devoted to the work of the late Neil Wilson, Canadian philosopher and contributor to the field of semantic analysis that emerged from the fusion of logic, pragmatism, and ontology. Many of the essays in this volume take their initial inspiration from Wilson's seminal work Substances Without Substrata.

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting (...) Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core. (shrink)