BackgroundPsychological distress/morbidity is amongst the primary reason for the cause of pain at multiple sites, its progression, and recovery. Though still not very clear if physical pain in the neck or the back may predict psychological morbidities or not. Thus, we investigated the association between combined neck or back pain and psychological distress/morbidity.MethodsA cross-sectional study was conducted in Al-Kharj, Saudi Arabia, including 1,003 individuals. The questionnaire comprised of General Health Questionnaire-12 and some questions about neck (...) and back pain. Data analysis was done using statistical software SPSS version 26.0.ResultsThe results of the multivariate analysis revealed a significant positive association between neck/back pain status and total GHQ score. Having neck/back pain had almost a 2.5 times greater risk of psychological distress/morbidity. Further, females were more likely to have a higher risk of psychological distress/morbidity than males while adjusting for sociodemographic and clinical characteristics.ConclusionThe combination of neck and back pain was significantly associated with the Saudi population’s psychological problems. Therefore, the Saudi government needs to devise high-risk strategies and allocate adequate resources to the cause so that at-risk people can be shielded from the adverse complications arising from this condition in the long run. (shrink)

Low‐back pain can be invalidating physically as well as mentally. Despite professional help to treat and prevent low‐back pain, the pain often persists, and so do the problems related to low‐back pain. An intervention that made it possible for a significant part of patients with low‐back pain to improve health and well‐being raised the question: Why was it possible to help some and not others? The aim of the present paper was (...) to achieve a deeper understanding of factors patients experienced as helpful in professional support related to low‐back pain. This was explored using a hermeneutic‐phenomenological approach while analysing 20 interviews with patients with low‐back pain purposively chosen interviews conducted in relation to the intervention. An analysis was made using Ricoeur's interpretation theory. Data on both positive and negative experiences were read and reflected upon. We found that healthcare professionals’ adoption of a narrative approach facilitating the patient's perspective was perceived as helpful. Patients experienced this as being taken seriously; an experience that could be explained at a deeper, more nuanced level using Heidegger's philosophy. Facilitating the patient's perspective was conditional not only on the professional obtaining access to the patient's perspective but also on understanding and acknowledging the patient's existence. The challenge for healthcare professionals in this respect is to bridge the gap between the consultation's fact‐focused concern with the medical implications of low‐back pain and the patient's concern with the implications low‐back pain has for his or her personal identity and life. Listening to the patient's perspective in itself supports the subjective recovery process, while also supporting the quality of patient‐centred support and strengthening the patient's trust in its helpfulness. (shrink)

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low (...) class='Hi'>back pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of (...) a moral experience, (2) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter. (shrink)

Chronic back pain (CBP) is a leading cause of disability and results in considerable socio-economic burdens worldwide. Although CBP patients are commonly diagnosed and treated with a focus on the ‘end organ dysfunction’ (i.e., peripheral nerve injuries or diseases), the evaluation of CBP remains flawed and problematic with great challenges. Given that the peripheral nerve injuries or diseases are insufficient to define the etiology of CBP in some cases, the evaluation of alterations in the central nervous system becomes (...) particularly necessary and important. With the development of advanced neuroimaging techniques, extensive studies have been carried out to identify the cortical abnormalities in CBP patients. Here, we provide a comprehensive overview on a series of novel findings from these neuroimaging studies to improve our understanding of the cortical abnormalities originated in the disease. First, CBP patients normally exhibit central sensitization to external painful stimuli, which is indexed by increased pain sensitivity and brain activations in pain-related brain regions. Second, long-term suffering from chronic pain leads to emotional disorders, cognitive impairments, and the abnormalities of the relevant brain networks among CBP patients. Third, CBP is associated with massive cortical reorganization, including structural, functional, and metabolic brain changes. Overall, a deep insight into the neural mechanisms underlying the development and outcome of CBP through more sophisticated neuroimaging investigations could not only improve our current understanding of the etiology of CBP but also facilitate the diagnosis and treatment of CBP based on precision medicine. (shrink)

OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. -/- METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a (...) patient's preference plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. -/- RESULTS: A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. -/- CONCLUSIONS: Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective. (shrink)

Chronic low back pain affects 50-80% of the population, while its consequences may impair the functioning of patients suffering from it, in many spheres of life. Hope is a factor which may influence coping with pain as well as cognitive reflection of pain experience. The aim of the study has been to check: 1) whether dependencies exist between hope-trait and hope-state and the perception of pain; 2) whether experiencing pain at the time of filling (...) questionnaires matters for the assessment of the level of hope; 3) whether there is interaction between hope, the pain experienced at the moment of investigation, and memory of the intensity of previously experienced pain. 150 patients participated in the study, they all reported aggravation of the chronic low back pain syndrome. The study was a cross-sectional study, based on questionnaires. On the third day of treatment the subjects were given the following questionnaires: Trait Hope Scale, State Hope Scale, and Numerical Rating Scale of Pain to fill. Poor correlation was demonstrated to exist between hope-state and hope-pathways on the one hand, and the intensity of minimum pain level experienced during the first three days of treatment. It has been noted that the presence of pain at the time of filling questionnaires results in reducing the hope-state, but only in those persons, who had experienced severe pain previously. On the other hand, in case of patients who had experienced slight pain previously, the pain present when filling in the questionnaires is conducive to enhanced hope-state. The results of the study confirm the complex character of relations between hope and pain. (shrink)

Introduction Patients require an accurate knowledge about placebos and their possible effects to ensure consent for placebo-controlled clinical trials is adequately informed. However, few previous studies have explored patients’ baseline levels of understanding and knowledge about placebos. The present online survey aimed to assess knowledge about placebos among patients with a history of back pain. Design A 15-item questionnaire was constructed to measure knowledge about placebos. Additional questions assessed sociodemographic characteristics, duration and severity of back pain, (...) and previous experience of receiving placebos. Setting Participants recruited from community settings completed the study online. Results 210 participants completed the questionnaire. 86.7% had back pain in the past 6 months, 44.3% currently had back pain. 4.3% had received a placebo intervention as part of a clinical trial and 68.1% had previously read or heard information about placebos. Overall knowledge of placebos was high, with participants on average answering 12.07 of 15 questions about placebos correctly. However, few participants correctly answered questions about the nocebo effect and the impact of the colour of a placebo pill. Conclusions The findings identified key gaps in knowledge about placebos. The lack of understanding of the nocebo effect in particular has implications for the informed consent of trial participants. Research ethics committees and investigators should prioritise amending informed consent procedures to incorporate the fact that participants in the placebo arm might experience adverse side effects. (shrink)

This full-color, user-friendly book features simple meridian exercises that combine breathing, movement, stretching, and focused attention to improve overall balance and flexibility. The book identifies specific meridian exercises to alleviate common ailments, including headaches, colds, and the flu, as well as more serious conditions, such as high blood pressure, diabetes, and thyroid disorders. Meridian exercise is a technique developed and perfected over the course of thousands of years in the Asian healing arts traditions. This book includes the following features: Low-impact, (...) time-efficient exercises that relieve stress, restore physical health, and rebalance the mind Step-by-step instructions with accompanying photos for dozens of exercises specifically designed for common symptoms Breathing and relaxation techniques to awaken innate healing power and. (shrink)

The question of whether a fetus can experience pain is an immense challenge. The issue demands consideration of the physical and psychological basis of being and the relation between the two. At the center of this debate is the question of how it is that we are conscious, a question that has inspired the writing of some of our most brilliant contemporary philosophers and scientists, with one commentary suggesting surrender. In my earlier review I attempted to draw together the (...) various strands of thinking that had attacked the question of fetal pain and relate them back to the bigger question of consciousness. In their vituperative response, Benatar and Benatar bite off my finger before looking to where I am pointing. I will examine each of their criticisms and attempt to redirect the readers' interest towards examining the subjectivity of pain and the mediating links between physiology and experience. (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat (...) these problematic views. However, when considering pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated (...) by painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated (...) by painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

Consider the following two sentences: " I see a dark discoloration in the back of my hand. I feel a jabbing pain in the back of my hand. " They seem to have the same surface grammar, and thus prima facie invite the same kind of semantic treatment. Even though a reading of ‘see’ in where the verb is not treated as a success verb is not out of the question, it is not the ordinary and natural (...) reading. Note that if I am hallucinating a dark discoloration in the back of my hand, then is simply false. For to be true, therefore, I have to stand in the seeing relation to a dark discoloration in the back of my hand, i.e., to a certain surface region in the back of my hand marked by a darker shade of the usual color of my skin, a certain region that can be seen by others possibly in the same way in which I see it. Also note that although the truth of doesn’t require the possession of any concept by me expressed by the words making up the sentence, my uttering of to make a report typically does — if we take such utterances as expressions of one’s thoughts. So my seeing would typically induce me to identify something in the back of my hand as a dark discoloration. This is a typical case of categorization of something under a concept induced by perception. Of course, my uttering of does more than attributing a physical property to a bodily region, it also reports that I am seeing it. (shrink)

The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- (...) and sex-matched healthy individuals in a pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

“Talking Back to Frida: Houses of Emotional Mestizaje” is, in part, a historical meditation on the silencing of three women, Frida Kahlo, Maria Enríquez, a Mexican woman who was sexually assaulted in 1924, and me. Written in an innovative historical fashion that joins techniques drawn from fiction, journalism, and history, the article attempts to understand specific assaults on women’s voices by drawing readers into the historical worlds of the protagonists. “Talking Back” also seeks to respond to Hans Kellner’s (...) incisive theoretical challenge: how do historians’ person histories affect their historical choices? The article’s organization depends on my understanding of language, color, and physicality, as the emotional architecture of the Deep Southern and Mexican places tend to both enclose and partially free the protagonists. The essay begins by leading the reader into my own past in the Deep South, a past where German Jewish and Russian Jewish relatives engaged in a cultural battle over form, personal style, and will. Confronting a German Jewish world where only things—never feelings—seemed to matter, I found solace in the friendship of a black servant. That friendship, in turn, helped prompt a particularly empathic historical voice. The southern section is followed by a journey into Frida Kahlo’s Mexican world. In that world, Kahlo’s severe physical pain and solitude construct inner and outer universes. The people who populate these worlds are friends, lovers, husband, and the Mexican poor. Kahlo’s artistic renditions of these people reflect, the article suggests, both the depth of her love for them and a tendency to use them in response to her despair. Finally, “Talking Back” reconstructs the world of María Enríquez, a Michoacán peasant woman assaulted in public by her former boyfriend. Abandoned by friend, sister, and Catholic women on the way to church, Enríquez develops a voice laced with generosity, cultural insight, and a rare self-possession. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pains And Gains Of Rural Health Practice:Lessons Books Never TaughtSridevi Seetharam, Bindu Balasubramaniam, G. S. Kumar, and M. R. SeetharamHow The Journey BeganIn the early 1980s, as fresh graduates from Mysore Medical College in southern India, we were brimming with a zeal to "cure the sick" and "change the world." We had an ideal of evidence-based, rational, ethical and equitable health care and set out to serve rural and (...) under-served communities which included displaced forest-based tribes. In the initial years, with the naivety of the inexperienced, we believed that by correcting the dehydration of the doe-eyed six-year-old Mare and giving her a free course of antibiotics, we had made health care accessible to her. Much to our dismay, within a month, Mare was back in the outpatient clinic, with diarrhea all over again and looking thinner than ever. We realized that it was a losing battle to keep her healthy as long as she continued to drink water from the same contaminated stream, live in unhygienic surroundings, and eat only the paltry meals that her family could barely afford. We gradually began to connect these living examples to what our preventive medicine text books had stressed all along—there are many social determinants of health which, if left unaddressed, do not permit realization of the vision of health for all.Such instances continually pulled us out of the hospital building and into the villages and tribal hamlets. We discovered that our textbook of Preventive and Social Medicine (Park, 1986) (P&SM as we used to call it), was our most valuable possession. [End Page 106] We devoured the descriptions of national health programs, sanitation procedures, water treatment protocols, and maintenance of cold chain for vaccines with a completely new perspective. We discovered the Manual of Basic Techniques for a Health Laboratory, (World Health Organization, 1980) detailing how to set up a laboratory with low cost, reliable and simple methods. We learned to drive a jeep to haul supplies and patients. To step up the level of clinical care, some of us pursued post-graduate programs and equipped ourselves to provide more specialized care too. It has been over two decades since we embarked on this journey. We have encountered a variety of perplexing dilemmas with no clear solutions. We have sometimes been compelled to adopt health practices that were not really evidence-based, seemingly irrational, inequitable and even downright unethical. This narration describes only a few of our thousands of cases, and hopefully conveys our periods of self-doubt, despair and hope, as well as, the challenges we face to reconcile with the difficult choices we are forced to make every day.Unforeseen Challenges in Saving Mothers and ChildrenHigh maternal and child mortality rates have been one of the most disturbing aspects of the health care scenario in rural India. To ensure immunization of all children, health workers with vaccine carriers go from village to village and hamlet to hamlet to reach those infants that would have missed visits to the immunization clinics. Our grass-root workers facilitate these visits by identifying households with such children. Occasionally, they encounter families who spirit away the infant into the adjoining woods as soon as the health worker is seen approaching, and blandly proclaim that the child is not at home. Despite reassurance and counseling about the safety and necessity of the vaccine, their apprehensions and misconceptions are insurmountable. What is the extent of the responsibility of the health worker? Is it ethical to hunt down the child and force the administration of the vaccine in view of the public health gains, besides the child's welfare?A few months ago, a pre-term neonate was admitted to our hospital, but worsened and needed referral to a higher centre in the city. The family refused to go despite repeated persuasion and detailed explanation about the technical limitations of care at our centre. From the family's perspective, the variety of social, cultural, and monetary challenges they would face in the city were themselves limitations for care. We were compelled to retain the baby and continue giving the best care we could.Two... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Pain in the Patient’s KneeMary Jacobus* (bio)We know very little about pain either.—Sigmund Freud, Inhibitions, Symptoms, and AnxietyPain cannot be absent from the personality.—Wilfred Bion, The Elements of Psycho-AnalysisBetween Therapy and HermeneuticsWhat is the place of a psychoanalysis that exists “between” therapy (considered both as a theory and a practice, but also as a theory of practice) and hermeneutics, or the theory of interpretation and understanding? (...) How do we understand psychoanalytic “understanding” itself, as a mental process that involves both the analyst and the analysand in the analytic encounter? I want to approach these related questions by way of the writing of the British psychoanalyst Wilfred Bion (1897–1979). Bion is best known outside the psychoanalytic profession as a pioneer of the so-called leaderless group and a theorist of group process [see Bion, Experiences in Groups]. But his collected theoretical and clinical oeuvre represents—especially in its “epistemological” period during the early 1960s, from Learning from Experience (1962) to Transformations (1965)—the most systematic, original, and philosophical revision of psychoanalytic theory since Melanie Klein’s controversial development of Freudian ideas during the middle decades of this century.1 Consequently, Bion’s influence pervades, and in some cases underpins, the rethinking of psychoanalytic theory and practice that characterizes British object relations in the wake of Klein. In particular, it gives contemporary post-Kleinian analysis its distinctive focus on (not) learning, (non)meaning, and (un)knowing, with an accompanying emphasis on the destruction of the links that make thought possible, as well as on the importance of being able to learn from experience and being able to bear not knowing. In other words, it brings to the fore difficulties associated specifically with questions involving interpretation and understanding in an analytic context.Bion’s writing is noted for its paradoxical combination of directness and difficulty, and for its emphasis on primitive emotional states and experiences, on the one hand, and epistemology and consciousness, on the other. Rigorous in its clinical focus, it also makes [End Page 99] frequent reference to philosophy, mathematics, and other branches of contemporary science. André Green, in the context of the new impetus that Bion gave to orthodox Kleinianism by linking it back to Freud, suggests that his particular contribution lay in realizing that the unconscious phantasies and archaic anxieties emphasized by Klein coincided with thought processes. Finding in Bion “an author who could measure up to Lacan,” Green saw the two as engaged in the common project of “reformulating psychoanalytic theory within a contemporary epistemological framework.” But for Green, “Lacan made the error of excessive abstraction, whereas Bion, with his constant reference to affect and the process of transformation, is the more authentically intellectual” [10–11].2 Although Bion’s writing is read wherever the theory and practice of British object relations psychoanalysis is seriously taught and studied, for the most part it remains surprisingly unknown within the academy. This is especially the case in America—even when it comes to literary critics and theorists with an interest in the “authentically intellectual,” who are often, by contrast, steeped in Lacan and well versed in recent Continental psychoanalytic writing. If only for this reason, but also because Bion’s work is particularly relevant to issues involving the relation between therapy and hermeneutics, I want to focus on the culminating book of Bion’s “epistemological” period during the early 1960s, Transformations—so called because of Bion’s analogy between the psychoanalyst’s representation of the experience of the analytic encounter and the artist’s transformation of the experience of what he sees.Bion’s writing, although terse and at times humorous, makes considerable demands on the reader, particularly on the capacity of the mind to entertain a new thought or consider it from a radically new perspective. He places pressure on thinking (including his own), as well as attempting to communicate the seeming incomprehensibility or hallucinatory dimensions of psychotic thought processes (which are often continuous with normal thought processes). In what follows, I will address both the kind of communication made by Bion himself—which is subject to its own interpretive difficulties and obscurities—and the relation between therapy... (shrink)

The American School of Empire considers how an American idea of empire evolved in the 1790s and would shape and be shaped by the literature and art of the early US. Hamilton's introductory essay suggests that empire was as important to the foundation of the US as concepts like democracy, freedom, nation, and republic. This book thus begins from the premise that the history of empire in the United States can be traced back to the inception of the country, (...) if not earlier. It contends that the United States was conceived as an empire, culturally, politically, and legally. Empire, as a broad theory for organizing not only the state but also the understanding of difference and the relationship to space, in other words, was a crucial conceptual frame shaping the culture of the early US"--Provided by publisher. (shrink)

My paper is going to illustrate how a universal normative ground can be individuated behind Richard Rorty’s political philosophy, chiefly as he develops it in his well-known Contingency, Irony, and Solidarity. I shall show how a foundational moral assumption is constantly backing his active defence of liberalism, which defines “cruelty” as “the worst thing we do” and claims that “no well-grounded theoretical answer” can be given in reply to the interrogative “why not be cruel?” After delineating very briefly Rorty’s two (...) crucial concepts of “ethnocentrism” and “antirepresentationalism”, a clear understanding of which is necessary to appreciate Rorty’s position, I shall focus my attention on Rorty’s conception of cruelty. Structuring within a consistent frame the many hints that he furnishes with regard to this issue, I shall determine its most frequent and characteristic features, the study of which shall resolve into the individuation of the concept working as the universal normative ground for his liberalism, namely an underlying pain-aversion principle, which regularly supports Rorty’s claims against cruelty – and ergo his claims in favour of liberalism. Such a discovery is tantamount to the realisation that a contradiction undermines Rorty’s negation of the possibility to find a “well-grounded theoretical answer” to the question “why not be cruel?” Specifically, either a metaphysical aversion to pain is presupposed by Rorty, as Christine Korsgaar’s study on the sources of normativity can help us to see, or a similar point is actually inherent to Rorty’s arguing and acting pro liberalism, as he has been doing for more than twenty years. In the former case, the contradiction would be formal; in the latter case, the contradiction would be performative. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 235 Vivyan Adair Stigmata: A Memoir of Pain and Resistance For some of us poverty is not experienced from a distance or from the position of an audience member or critic, but as the most pressing truth of our existence, past or present and our core sense of identity. —Roxanne Rimstead, Remnants of Nation: On Poverty Narratives (...) by Women Shame My own mother—with four children under the age of seven by the time she was twenty five—taught, nurtured, and loved us ferociously but struggled and utterly failed to keep us fed, sheltered, and safe. We clung desperately to her fragile dignity, grace, and laughter, against all the forces of a cruel and indifferent world. Yet, in the end she was crushed by the weight of our shame and our raw, unrelenting pain as my brothers and sister and I were bent and broken and taken from her; with scars that never faded; injuries, infections, and ailments for which we found neither respite nor repair; with feet mangled by cheap, used Salvation Army shoes; the gnawing void of hunger and insecurity clawing at our tender backs; public indignities and humiliations for which I still can find no words. With access to neither medical insurance nor care, when my already fragile, toddling sister’s forehead was split open by a car door slammed in frustration, my brother and I had to pin her tiny body to the ground as 236 Vivyan Adair my mother sewed the angry gash together with needle and thread, practicing the meticulous dressmaker’s stitches for which she had received a modicum of acclaim, but so little reward. My sister somehow endured, but registered the pain, the terror, and the trauma with a brand, a stigmata, an angry and frightening scar as an indelible sign of our poverty, visually cleaving her very forehead in two, for the remainder of her life. In our school cafeteria “free lunchers” were reminded with a large and colorful sign to “line up last.” In that auditorium each fall we were coerced up onto a makeshift stage, with the promise of first dibs on free milk. There, our pristine school nurse sat upright and sucked air through her teeth as she donned surgical gloves to cautiously check only the hair of poor hungry children, one by one, for lice. I burned and choked and raged with shame, as our far more decent working-class colleagues and friends, in color-coordinated Sears sweater sets and matching tartan knee high socks, averted their eyes from our reluctant genuflections, while silently spooning their mac and cheese and sipping their Tree Top from tiny Dixie cups. In dilapidated and unsafe housing often without heat, hot water, or lights and with access to only public bathrooms, I developed a stubborn case of ringworm, scabies, and a series of painful urinary tract infections. When my second grade teacher would not excuse me every hour or so—because, as she said I was “willful”—I could not help but wet my pants in class. My schoolmates guffawed at my flea bitten legs, my ducttaped shoes, my crooked and ill-serviced teeth, and the way my siblings and I stank. Kids, teachers, and strangers stepped away from us intuitively and then, with great shows of distress, feigned concern and then outrage and disgust. Regularly our teachers excoriated us for our inability to concentrate in school and our refusal to come to class with proper school supplies, calling us out as greedy when we tried to take more than our share of free lunch. Whenever backpacks or library books came up missing, we were publicly interrogated and sent home to think about our offenses, often accompanied by notes that reminded my bewildered mother that she should be working twice as hard to make up for the discipline and order that had supposedly walked out the door with my father. And when occasionally we cried foul and lashed out, our behavior was used to justify even more elaborate punishment that exacerbated the effect of our growing anomie. Vivyan Adair 237 Guilt As children, our disheveled and unkempt bodies were produced as... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Looking Back and Moving ForwardDebbie PittsI started my Nursing Assistant career forty-three years ago and have worked in the same long-term care facility for the past forty years now. Over the years, I have seen many cultural changes being made in the field. Back then everyone was referred to as patients, then residents and more recently elders. As these changes took place, it was difficult for us (...) to change in the sense of calling them patients to residents and now elders but we all manage to accomplish it. Our elders have so many more choices nowadays, which has been a wonderful additive for those who live in a facility.As I look back, I can remember when restraints were used routinely. The good old locked Posey belts, pelvic restraints, vest restraints and how many other types that we used to use. Already many years have passed since we have used these things and that is a blessing as they were nothing more than a pain to use for us and our elders. Sometimes they would be so knotted it was difficult to get them untied. I can remember that many who needed to have these were people that had symptoms of now what we call Alzheimer's or people with some sort of dementia. Back then they were unsure of this disease. These were definitely some challenging times to work in. Taking care of the combative person can be very difficult. At least now, we have much more knowledge through education as to how to handle and deal with these issues. I have been fortunate in my facility that we thrive on education, which helps me learn all the modern techniques and ways of dealing with the many issues we have today with dementias.When I go to work daily, I not only have to take care of my elders, but then I also have to deal with their families as well. This too, can be somewhat difficult at times. Some of them can become quite demanding with the cares needed for their loved one. After dealing with them I often find that they have a guilty feeling for having to place them in a nursing home, but it can still create a problem for you and make it hard to get your cares done for other elders on your daily schedule. As much as I try to reassure them that their family member is getting the best care and attention they need, sometimes it isn't enough to satisfy them. There are times if I feel pressured or frustrated I will talk with my supervisor, or a social worker, and ask them if they could have a talk with the family for me. I find that having [End Page 143] good communication with every department and all supervisors is vitally important in my job. Unlike years ago, today we are all a team and are there for our elders and their every need.On a more personal level, with my daily routine in care, I love when I can take my elder for a walk. Sometimes they may be fearful of falling or something else. Using reassurance and encouragement and getting them going can be a very rewarding situation. It's when they don't believe they are capable of doing this, and then they do, when you realize just how much you have done for them. The smiles, thank yous and hugs I get back can just warm your heart and even put tears in your eyes. The sense of accomplishment provided for them is very rewarding. This is just so true whether it be walking, eating, bathing or dressing. Taking the time to work individually with each elder on whatever levels needed is so important. When they tell their family member about their accomplishment that they achieved today, they are so proud. The smiles, twinkle in their eyes and the excitement shown is just amazing. Sometimes at this point I can develop a relationship with the difficult family member. Normally they will be happy for their loved one's accomplishment and grateful to you for helping them. My personal accomplishment is becoming a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflecting Back, Looking Forward:Ethics and the Environment at 25Lori Gruen (bio)Twenty-five years ago, when Ethics and the Environment launched, I remember having engaging conversations with the late founding editor, Victoria Davion, about just how important feminist thinking was to ethical explorations of our vexed relationships with the more than human world. She promised to promote feminist philosophical scholarship in this journal and she kept that promise. Although I'm (...) quite skeptical of "metrics" I did a search on the term "feminism" in the three prominent journals that publish on ethics and the environment and was not surprised to find that this journal contains 147 results where there are 51 in Environmental Values and just 33 in Environmental Ethics, a journal that has been publishing longer than Ethics and the Environment.Before the journal launched, Vicky, Chris Cuomo, and I spoke regularly about the value that feminist philosophical insights brought to environmental ethics. While we disagreed on a variety of issues (should the climate be central? Should we center our relationships with other animals?) and names (should we think of ourselves as "ecofeminists" or "ecological feminists"?) and had lively debates with other ecofeminists, including Carol Adams, Greta Gaard, Marti Kheel, Deborah Slicer, Val Plumwood, and Karen Warren, among others, we all shared a commitment to feminist methodology as well as recognizing the crucial need to incorporate ecofeminism into environmental ethics and praxis.Part of the reason it is important to incorporate ecofeminist insights into environmentalism is that ecofeminism builds on work in feminist philosophy that uncovers various biases that distort our knowledge and our relationships. For example, feminist epistemologies help us to see how testimony from those outside the center are undervalued or ignored. This has become painfully clear in environmental justice struggles; communities of [End Page 3] color are disproportionately impacted by exposure to toxins and are then burdened with finding "experts" who can "objectively" assess their claims. Ecofeminists have helped identify the inequity of looking to so-called objective expertise when communities are suffering. This sort of epistemic injustice is getting worse in the face of extreme weather events, in at least two ways. Many people who are impacted by hurricanes, floods, and earthquakes, are often not well positioned to navigate institutions that may be able to help, if those institutions even exist. And as sea ice melts and oceans rise, indigenous people's multi-generational wisdom is often overlooked, while their communities are simultaneously imperiled.Another reason that feminist and ecofeminist analyses are crucial for environmental philosophy is that ecofeminists can correct certain problematic frameworks that often hinder our abilities to reshape our relationships with the more than human world. Ecofeminists have long been critical of the abstract individualism that has permeated environmental ethics, including animal ethics (Adams and Gruen, 2014). This focus on abstract individualism leads to faulty analyses of our place in the natural world, as many holistic environmental philosophers have argued. Ecofeminists have also provided important challenges to holism in environmental philosophy, as the categorical "wholes" tend to occlude important differences within and between them. (Kheel, 2007). Ecofeminists have sought to contextualize ecological sensibilities to illuminate how systems of power differentially structure our relationships with each other and our environments.Vicky's commitment to incorporating feminist and ecofeminist perspectives as a central part of this journal's vision has also provided newer scholars with a venue for further development of ecofeminist thinking, as can be seen in A.E. Kings' "Intersectionality and the Changing Face of Ecofeminism" (2017) and Chaone Mallory's "What's in a Name? In Defense of Ecofeminism (Not Ecological Feminisms, Feminist Ecology, or Gender and the Environment)" (2018) published in the special tribute issue to Vicky. New thinking is always important, but in the face of global climate collapse, it is more important than ever.This journal has also been one of the go-to venues for animal ethics. In the early days of environmental ethics, there was a complex debate about what role, if any, animal ethics should play in environmental ethics. Over 35 years ago, two of the early pioneers, J. Baird Callicott (1980) and the late Marti Kheel (1985), argued in the pages of... (shrink)

This paper is an attempt to spell out what makes the scientific study of pain so distinctive from a philosophical perspective. Using the IASP definition of ‘pain’ as our guide, we raise a number of questions about the philosophical assumptions underlying the scientific study of pain. We argue that unlike the study of ordinary perception, the study of pain focuses from the very start on the experience itself and its qualities, without making deep assumptions about whether (...) pain experiences are perceptual. This in turn puts scientific explanation in a curious position due to pain’s inherently subjective epistemic nature. The reason for this focus on the experience itself and its qualities, we argue, has to do with pain’s complex phenomenology involving an affective/motivational dimension. We argue for the scientific legitimacy of first‐person phenomenological studies and attempts to correlate phenomenology with neural events. We argue that this methodological procedure is inevitable and has no anti‐physicalist ontological implications when properly understood. We end the paper by commenting on a discussion between two prominent pain scientists in the field, Don Price and Howard Fields, about the need to distinguish more dimensions in the phenomenology of pain and how to classify them vis‐à‐vis the recent scientific findings. Our interest in this discussion is not only to introduce some clarifications but also to show how “neurophenomenology” has already been shaping the scientific research and to back our claim about why this methodology is inevitable with an example. (shrink)