BackgroundMultiple sclerosis, the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life. Since MS is generally diagnosed at a young age—a period of great significance for personal, relational, and professional development—adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to (...) promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS and to the involvement of patients in the development of such programs.AimsIn collaboration with MS patients, this study aims to develop a bio-psycho-social intervention for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects.MethodsTo tailor the intervention to the specific needs of YawMS, “patient engagement principles” will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre–post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention. (shrink)

ABSTRACT:Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of (...) each framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

Small but significant gender differences in emotion expressions have been reported for adults, with women showing greater emotional expressivity, especially for positive emotions and internalizing negative emotions such as sadness. But when, developmentally, do these gender differences emerge? And what developmental and contextual factors influence their emergence? This article describes a developmental bio-psycho-social model of gender differences in emotion expression in childhood. Prior empirical research supporting the model, at least with mostly White middle-class U.S. samples of (...) youth, is presented. Limitations to the extant literature and future directions for research on gender and child emotion are suggested. (shrink)

The different approaches of the mind-body problem a fortiori have implications on the foundations of Psychology, Psychopathology and Psychiatry, leading to many clashing theories about the determinants of "normal" human behavior, as well of the mental illnesses. These schools of research on the human mind may on a first approach be divided in two main branches: 1) the neurogenetic ones; 2) the psychogenetic ones. This paper sprang up from a lifelong pondering on its subject by its author, while working as (...) a Clinical Psychiatrist and conducting a Ph D in Philosophy. (shrink)

Chronic pain patients often miss receiving acknowledgement for the multidimensional struggles they face with their specific conditions. People suffering from chronic pain experience a type ofinvisibilitythat is also borne by other chronically ill people and their respective medical conditions. However, chronic pain patients face both passive and active exclusion from social participation in activities like family interactions or workplace inclusion. Although such aspects are discussed in the debates lead by the bio-psycho-social model of pain, there seems (...) to be a lack of a distinct interest in assessing more specifically the social aspects regarding chronic pain. As a result, the social aspects have yet to be taken into a more thorough theoretical consideration of chronic pain and to be practically implemented to help affected patients. By addressing chronic pain patients’ struggle for recognition, this paper attempts to shed light on some of these social aspects. We base this attempt on a theoretical framework that combines patients’ statements with an adaptation of Axel Honneth’s social-philosophical work onrecognition. Thus, this paper tries to make a suggestion on how the bio-psycho-social model of pain can live up to its name by helping to address more adequately some of the more neglected aspects in chronic pain patients’ suffering than has been possible to date. (shrink)

Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those where (...) it is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, (...) the patients' bio-psycho-social information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

This study is considered as a proposal to identify some metaphysical support of the self-care for a patient suffering from a chronic disease, as an extension of the bio-psycho-social paradigm. The methodology is dominated by a phenomenological perspective, supported by a hermeneutic conceptual analysis of the care of the self in Michel Foucault, focused on the Socratico-Platonic period and pervaded by the intention of having a translation and application to self-care. Foucault pleads for an aesthetics of the self, (...) called subjectivity, in which the subject is self-constituted through the so-called technologies of the self. The care of the self comes from the resignification of the philosophy as a way of life in which the subject is objectified. The translation and the applicability of the care of the self at the idea level to self-care are identified precisely in the acquisition of some important principles of the philosophy of care of the self from the Greek Antiquity: the role of awakener of consciousness of the one who is concerned about oneself as the first moment of the metaphor of awakening from the sleep, the ēthos as a way of being, a way of behaving and a life model. The pair self-knowledge – care of oneself justifies informing the former by the latter, in which being concerned about oneself means knowing oneself. Nevertheless, knowledge means care of the self where the self is synonymous with the soul and moreover, with the divine element in man. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hildegard and HolismSuzanne M. Phillips (bio) and Monique D. Boivin (bio)Keywordsbiopsychosocial, integration, medieval, mental illnessWe appreciate the careful and enriching commentary offered by Kroll and by Radden on our paper about holistic views of mental illness in the writings of the twelfth-century abbess and healer Hildegard of Bingen. Both reviewers are well-established figures in the study of historical perspectives on mental illness, an area that we have just begun (...) to explore. We are glad for the opportunity to respond to their observations and thereby to continue the dialogue.First, we would like to clarify our purpose in preparing this paper. Nowhere do we claim that Hildegard used a biopsychosocial model of mental illness, either in addressing the needs of the particular case of Sigewiza, or more generally in her writings on illness and health. In fact, we agree with Kroll (2007, 370), when he states that Hildegard did not use a biopsychosocial model. We use the term “biopsychosocial” only three times in the paper, always by contrast with what we see in Hildegard’s writings. The present-day biopsychosocial model focuses on getting a range of perspectives on the table, encouraging the consideration of biological, psychological, and social issues when thinking about mental illness. This is a good thing, but we argue that it does not go far enough. Specifically, there has been insufficient attention to ways these perspectives might interact.How, then, might we describe Hildegard’s way of conceptualizing mental illness? In place of the label “biopsychosocial model,” Kroll suggests that Hildegard’s approach could be described as a “religious model” (p. 372). Here we disagree. By our reading, Hildegard’s description of mental illness involves religious components, certainly, but also humoral, astrological, interpersonal, community, and intrapsychic components. Radden correctly notes that we are not so much interested in the particular components as we are in their interactions. We are attracted to Hildegard’s writings because she attends to these interactions. Our students, like Kroll’s (p. 371), are curious about mind–body relationships, which represent one example of the interplay between components. Our concern is that the current biopsychosocial model often fails to satisfy our own, and our students’, interest in the nature of those interactions. Our hope is that Hildegard’s writings might help us to think more richly about the interactions.As Radden (2007, 373) points out, present-day psychiatrists and psychologists do in fact use mul-ticausal accounts of depression. And we agree that such accounts need not be reductionistic (Kroll, 371). But we also recognize that psychology and psychiatry have well-established reductionist (more specifically, materialist) habits. To borrow [End Page 377] Kroll’s phrase, the biological model threatens “to swallow all other models” (p. 371). We must guard against such reductionism, given the habits of our disciplines. As we noted, McHugh and Slavney (1998) respond to that threat by building walls between the perspectives, suggesting that we might use different perspectives when thinking about different sorts of problems. We think that there ought to be more synthetic, holistic ways of responding to that threat, and we are hopeful that Hildegard’s writings can help us to develop those.At a basic level, we see Hildegard asking different questions than people ask today. On the first page of his commentary, for example, Kroll poses the question of “which of these three modalities [bio-, psycho-, social] may be sufficient” (p. 369) in the particular medieval text. We found that the sufficiency of one modality or another does not concern Hildegard. We are not able to speak to the general point that Kroll raises, that one or another element is emphasized depending on the goal of the medieval text; we can report our experience in reading Hildegard, where we found no sense in which one or another component is privileged. Even though Hildegard operated within a thoroughly religious context, we did not find examples of her subsuming other factors under religion. Everything interacts with spiritual concerns, to be sure, but everything also interacts with the biological, and with the interpersonal, and with the astrological. Although it may seem odd to us post-Darwinian thinkers, Hildegard’s model is essentially... (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

In this original and compelling book, Jeffrey P. Bishop, a philosopher, ethicist, and physician, argues that something has gone sadly amiss in the care of the dying by contemporary medicine and in our social and political views of death, as shaped by our scientific successes and ongoing debates about euthanasia and the "right to die"--or to live. __The Anticipatory Corpse: Medicine, Power, and the Care of the Dying__, informed by Foucault's genealogy of medicine and power as well as by (...) a thorough grasp of current medical practices and medical ethics, argues that a view of people as machines in motion--people as, in effect, temporarily animated corpses with interchangeable parts--has become epistemologically normative for medicine. The dead body is subtly anticipated in our practices of exercising control over the suffering person, whether through technological mastery in the intensive care unit or through the impersonal, quasi-scientific assessments of psychological and spiritual "medicine." The result is a kind of nihilistic attitude toward the dying, and troubling contradictions and absurdities in our practices. Wide-ranging in its examples, from organ donation rules in the United States, to ICU medicine, to "spiritual surveys," to presidential bioethics commissions attempting to define death, and to high-profile cases such as Terri Schiavo's, __The Anticipatory Corpse__ explores the historical, political, and philosophical underpinnings of our care of the dying and, finally, the possibilities of change. A ground-breaking work in bioethics, this book will provoke thought and argument for all those engaged in medicine, philosophy, theology, and health policy. "With extraordinary philosophical sophistication as well as knowledge of modern medicine, Bishop argues that the body that shapes the work of modern medicine is a dead body. He defends this claim decisively with with urgency. I know of no book that is at once more challenging and informative as __The Anticipatory Corpse. __To say this book is the most important one written in the philosophy of medicine in the last twenty-five years would not do it justice. This book is destined to change the way we think and, hopefully, practice medicine." --_Stanley Hauerwas, Duke Divinity School _ "Jeffrey Bishop carefully builds a detailed, scholarly case that medicine is shaped by its attitudes toward death. Clinicians, ethicists, medical educators, policy makers, and administrators need to understand the fraught relationship between clinical practices and death, and __The Anticipatory Corpse __is an essential text. Bishop's use of the writings of Michel Foucault is especially provocative and significant. This book is the closest we have to a genealogy of death." --_Arthur W. Frank, University of Calgary _ "Jeffrey Bishop has produced a masterful study of how the living body has been placed within medicine's metaphysics of efficient causality and within its commitment to a totalizing control of life and death, which control has only been strengthened by medicine's taking on the mantle of a bio-psycho-socio-spiritual model. This volume's treatment of medicine's care of the dying will surely be recognized as a cardinal text in the philosophy of medicine." --_H. Tristram Engelhardt, Jr., Rice University, Baylor College of Medicine_. (shrink)

The principles of classical and quantum holography are used to develop the theoretical basis for a non-phonemic method of detecting membership in secret social groups, such as cults, criminal gangs, drug cartels, and terrorist cells. Grounded in the basic sociological premise that every group develops a distinctive sociocultural order, the theory postulates that the primary features of a group's collective identity will be encoded, via a multilevel socio-psycho-physiological process, into the field of bio-emotional relations connecting group members. The (...) principles of classical holography (Gabor 1948) are used to describe how this information is recorded in the members' brains and communicated in interaction by a holographic-like process as a tacit signature of group affiliation —a constancy in group-related interactions. It is hypothesized that the identity signature is enfolded as a hologram in the energy spectra of vocal interactions among group members. The principles of quantum holography (Gabor 1946) are used to provide a description of the group's ongoing interactions as a dynamic process—a continuous, quantized series of snapshots (quantum holograms). Linked together, two forms of holography provide a model of how the group's collective identity evolves and is communicated over time to its members, as the group adapts to the ever-changing reality of its endogenous and exogenous circumstances. Using spectral analysis techniques, it should be possible to detect the group's identity signature in the recordings of relatively small samples of vocal interactions. In clandestine groups, the effort to remain hidden actually enhances the signal strength of the identity signature. It is predicted, therefore, that detection of unknown members can be achieved by using the spectral commonality identified in the analysis of recordings of vocal interactions among known members as a reference signature for comparison with those of the vocal spectra of suspected or potential members. (shrink)

A brief theoretical review of the current state of the art of embodiment research in clinical psychology has been expounded in order to highlight the key role that embodied conceptualization has on the understanding and explanation of several mental disorders, such as eating disorders, schizophrenia and depression. Evidence has suggested that mental disorders may be explained as disturbances of embodiment, from the disembodiment to the hyperembodiment. In order to understand how some clinical conditions are affected by cultural models, we propose (...) and define a new framework called Exbodiment, complementary to the Embodiment approach to cognition. Mental disorder is strictly related to the subject-culture interaction that may be explained as a two way process in which embodiment and exbodiment are complementary points of view. In this perspective, embodiment may be seen as the “top-down” process, while exbodiment the “bottom-up” one. The introduction of exbodiment conceptualization highlights how subject is both receiver and interpreter of social influence. Subject is the target of a cultural pressure and, at the same time, enacts its own embodied culture in world. Exbodiment conceptualization may help clinicians to better understand and explain the role of culture in the onset and maintenance of mental disorders. (shrink)

This article addresses salient conceptual issues in social organisational psychology in probing change in organisational systems, e.g., culture, innovation and implementation, reflective practice and change models. Insights from chaos–complexity research in the natural sciences which underpin the dynamics of flux and change to unravel the hidden, the unexplained, the disordered will be built on to explore the phenomena of change from a social psychological perspective. The concept of nano-psychology is introduced to open up a creative debate in the (...) social psychological field on creative change which builds on the nano-insights evolving in the natural science field. (shrink)

This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of (...) the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel’s bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a ‘stratified conception of health’ reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships. (shrink)

To explain agent-identification behaviours, universalist theories in the biological and cognitive sciences have posited mental mechanisms thought to be universal to all humans, such as agent detection and face recognition mechanisms. These universalist theories have paid little attention to how particular sociocultural or historical contexts interact with the psychobiological processes of agent-identification. In contrast to universalist theories, contextualist theories appeal to particular historical and sociocultural contexts for explaining agent-identification. Contextualist theories tend to adopt idiographic methods aimed at recording the heterogeneity (...) of human behaviours across history, space, and cultures. Defenders of the universalist approach tend to criticise idiographic methods because such methods can lead to relativism or may lack generality. To overcome explanatory limitations of proposals that adopt either universalist or contextualist approaches in isolation, I propose a philosophical model that integrates contributions from both traditions: the psycho-historical theory of agent-identification. This theory investigates how the tracking processes that humans use for identifying agents interact with the unique socio-historical contexts that support agent-identification practices. In integrating hypotheses about the history of agents with psychological and epistemological principles regarding agent-identification, the theory can generate novel hypotheses regarding the distinction between recognition-based, heuristic-based, and explanation-based agent-identification. (shrink)

Anthony C. Yu, Carl Buck Distinguished Professor in Humanities, Chairman, Division of East Asian Languages, University of Chicago, Divinity School, writes: "Robert Allinson's book represents tremendous thoughtfulness, originality, and erudition. Its wide-ranging and lucid discussions cover a huge terrain, from ancient metaphysics to quantum mechanics. The enlistment of certain classical Confucian concepts and themes at critical junctures to advance the book's argument also provides luminous comparison. His interpretation of the Confucian emphasis on life as social and self-preservation is both (...) humane and interesting, much as his analysis of the Mencian notion of compassion deserves our attention." In Space, Time and the Ethical Foundations ideas about space and time are developed, unique to the history of philosophy, that match the new physics. A well grounded metaphysics is presented which offers a safe haven between stifling skepticism and wild imagination, and an original philosophical method is demonstrated which sharply demarcates philosophy from the empirical sciences.A new foundation is laid for ethics by grounding ethics on the author's psycho-biological deduction of the emotions that offers a progressive model to replace the Freudian paradigm. An originally designed trans-cultural ethics, doubly grounded on both Eastern and Western thought, presents an antidote to the contemporary retreat into relativism. Insights from biology, psychology, evolutionary theory and ethics are brought together in a unique and fruitful synthesis. At the same time, human barbarisms such as the Holocaust are pointed to as reminders that there are just limits to compassion. This book presents a sophisticated text for metaphysics, epistemology and systematic ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Non-Cartesian Frameworks”James Phillips (bio)Whither psychoanalytic theory and practice? This is the question raised by Louis Berger as he confronts psychoanalysis’s response to the collapse of Cartesianism that has shaken the foundations of other humanist disciplines (as well as the natural sciences) and has finally caught up with Freud’s heirs. Anyone wanting evidence of this shakeup in psychoanalysis need only consult the final 1994 issue of the International (...) Journal of Psycho-Analysis. For the seventy-fifth anniversary edition of the journal, the editors organized a symposium on “The Conceptualization and Communication of Clinical Facts in Psychoanalysis.” In his foreword to the 300-page issue, the editor, David Tuckett (1994, 865–70), evokes the theoretical pluralism that has beset the field and asserts what is the presupposition of all the articles that follow: There are no theory-free facts, and the challenge now is to deal with this reality.I think I can assume, however, that for Berger these papers would mostly fall into his category of “not going far enough.” He invokes a Cartesian representationalism, critiqued variously by Heidegger, Wittgenstein, and Castoriadis, that continues to infect even such discussions of fact and theory in psychoanalysis as those in the landmark volume of the International Journal. Thus, though that volume may represent the official announcement of the death of positivism in psychoanalysis, it stops short of announcing the profession’s entry into the postmodern era. Indeed, it should be noted that in much contemporary discussion, an awareness of the issues of theoretical pluralism and fact/theory dilemmas rests quite comfortably with the most blatant examples of representational thinking. The object-relations tradition, for instance, remains such a dominant force that most of us would have a hard time giving up our talk of internal objects and internal representations.Berger’s presentation of the three critics of representational thought is clear and enlightening. The inclusion of Castoriadis is important because he, unlike Heidegger and Wittgenstein, is a clinician. Berger’s application of this critique of representation to psychoanalysis, and specifically to the question of the theory/practice relationship, is also developed in a meaningful way. (For a development of the critique of representational thinking that emphasizes the role of Locke in expanding the Cartesian tradition, see Nasser 1994.) Since I am in agreement with the thrust of Berger’ s presentation and have little to add to it, I will focus my comments on one area that I think does warrant further discussion—the relations between the postmodern and other postempiricist or postpositivist traditions. Although some writers (e.g., Leary 1994; Silverman 1994) tend to group movements such as postmodernism, hermeneutics, [End Page 187] and social constructionism together, Berger’s argument singles out postmodernism as the only truly nonrepresentational postempiricist movement.Of the other non-Cartesian traditions, Berger says that “their tacit retention of representationalism (including its concomitant, the theory/practice dichotomy) demonstrates their failure to identify, adequately understand, or avoid key Cartesian difficulties and limitations. They fail to appreciate the effects which accompany enframing.” He adds later: “I have been making my point with examples drawn mostly from the American Middle School, but I submit that any analytic position that invokes models or analogous logical formalisms—e.g., hermeneutic, self-psychological, constructionist, action linguistic—is subject to the identical criticisms.” I wish to take up the case of hermeneutics and question whether its differentiation from postmodernism does indeed revolve around the issue of representational thought. Sorting this issue out will bear on the final conclusions of Berger’s paper. It is true, as Berger points out, that hermeneutic discussion in psychoanalysis often involves a comparison of (representationally articulated) models; but that is not the whole story regarding hermeneutics. Remember, after all, that Heidegger—directly in Being and Time (1962, 62), and indirectly through his profound influence on Gadamer—was a pivotal figure in the development of hermeneutics. Heidegger considered his analysis of man’s precognitive enmeshment in the world to be a “hermeneutic of Dasein.” For his part, Gadamer’s analysis of man’s relations to others and to the world concludes in a relationship that is mediated through a language that is fully dialectical and... (shrink)

Surveillance programs supporting the management of One Health issues such as antibiotic resistance are complex systems in themselves. Designing ethical surveillance systems is thus a complex task (retroactive and iterative), yet one that is also complicated to implement and evaluate (e.g., sharing, collaboration, and governance). The governance of health surveillance requires attention to ethical concerns about data and knowledge (e.g., performance, trust, accountability, and transparency) and empowerment ethics, also referred to as a form of responsible self-governance. Ethics in reflexive governance (...) operates as a systematic critical-thinking procedure that aims to define its value: What are the “right” criteria to justify how to govern “good” actions for a “better” future? The objective is to lay the foundations for a methodological framework in empirical bioethics, the rudiments of which have been applied to a case study to building reflexive governance in One Health. This ongoing critical thinking process involves “mapping, framing, and shaping” the dynamics of interests and perspectives that could jeopardize a “better” future. This paper proposes to hybridize methods to combine insights from collective deliberation and expert evaluation through a reflexive governance functioning as a community-based action-ethics methodology. The intention is to empower individuals and associations in a dialogue with society, which operation is carried out using a case study approach on data sharing systems. We based our reasoning on a feasibility study conducted in Québec, Canada (2018–2021), envisioning an antibiotic use surveillance program in animal health for 2023. Using the adaptive cycle and governance techniques and perspectives, we synthesize an alternative governance model rooted in the value of empowerment. The framework, depicted as a new “research and design (R&D)” practice, is linking operation and innovation by bridging the gap between Reflexive, Evaluative, and Deliberative reasonings and by intellectualizing the management of democratizing critical thinking locally (collective ethics) by recognizing its context (social ethics). Drawing on the literature in One Health and sustainable development studies, this article describes how a communitarian and pragmatic approach can broaden the vision of feasibility studies to ease collaboration through public-private-academic partnerships. The result is a process that “reassembles” the One Health paradigm under the perspective of global bioethics to create bridges between the person and the ecosystem through pragmatic ethics. (shrink)

In philosophy, the last thirty years or so has seen a split between 'simulation theorists' and 'theory-theorists', with a number of variations on each side. In general, simulation theorists favour the idea that our knowledge of others is based on using ourselves as a working model of what complex psychological creatures are like. Theory-theorists claim that our knowledge of complex psychological creatures, including ourselves, is theoretical in character and so more like our knowledge of the world in general. The (...) body of this paper is divided into three parts. In Part I, I introduce the 'contrastive case' of autism. Autism is a developmental disorder that has recently become the focus of sustained philosophical and psychological attention because of the selective way in which it affects individuals' social capacities. Theory-theorists argue that autistic children's unique profile of assets and deficits is most fruitfully explained by their inability to develop and deploy a theory of mind. After considering the strengths of this hypothesis, I claim theory-theorists face two unresolved difficulties: explaining why high-functioning autistics who develop some theory of mind capacities still fail to engage in normal psychological knowing; and explaining why autistics are generally as unknowable to us in the privileged sense of normal psychological knowing as we are to them. In Part II, I provide the theoretical framework for addressing these challenges by developing an account of normal psychological knowing as psycho-practical expertise. In Part III, I return to the problem of autism, showing how this psycho-practical approach to normal psychological knowing may further suggest how to encompass various aspects of the disorder that tend to be ignored under the prevailing theory-theory approach. (shrink)

An argument that moral functioning is immeasurably complex, mediated by biology but not determined by it. Throughout history, humanity has been seen as being in need of improvement, most pressingly in need of moral improvement. Today, in what has been called the beginnings of “the golden age of neuroscience,” laboratory findings claim to offer insights into how the brain “does” morality, even suggesting that it is possible to make people more moral by manipulating their biology. Can “moral bioenhancement”—using technological or (...) pharmaceutical means to boost the morally desirable and remove the morally problematic—bring about a morally improved humanity? In The Myth of the Moral Brain, Harris Wiseman argues that moral functioning is immeasurably complex, mediated by biology but not determined by it. Morality cannot be engineered; there is no such thing as a “moral brain.” Wiseman takes a distinctively interdisciplinary approach, drawing on insights from philosophy, biology, theology, and clinical psychology. He considers philosophical rationales for moral enhancement, and the practical realities they come up against; recent empirical work, including studies of the cognitive and behavioral effects of oxytocin, serotonin, and dopamine; and traditional moral education, in particular the influence of religious thought, belief, and practice. Arguing that morality involves many interacting elements, Wiseman proposes an integrated bio-psycho-social approach to the consideration of moral enhancement. Such an approach would show that, by virtue of their sheer numbers, social and environmental factors are more important in shaping moral functioning than the neurobiological factors with which they are interwoven. (shrink)

The concept of “Bio-Digital Architecture” is not new and it is within an area of great speculation and few well-demarcated definitions. A key factor in the definition and practice of technology is the difference between its production and use. If we assume that forms of use are also technical, this distinction is intrinsic to countries based on economies without added value and their histories focused on reverting this situation. This article proposes the revision of a paradigm shift in South America (...) that combined the sustainable “Bio Architecture” background from the developmental state with a different economic model era. Through a historical review of the sociology of symbolic production, and the development of devices and interfaces, mechanisms are proposed to recognize paradigm shifts, in a context where technological utopias are associated with the materialization of new social utopias of developing. Focused on specific cases, this research explains the culmination of the principles of “Second-order cybernetics”, in the epistemological formulation of “Autopiesis”, and the early visualization of these principles through digital media in the experience of “Protobio”. Finally, this work concludes with the description of the concrete application of these principles, not in an illustrative way, but in the design of the electronic information architecture of the operating system, continuing with the challenge of translating the logic of the immune system into an economic, political and social context completely different from its predecessors, with “Virus Detection”—VirDet—and “Oyster 2.0”. (shrink)

This paper presents findings from a linguistic and psycho-social analysis of nine design dialogues which sets out to investigate the interweaving of transactional and interpersonal threads in collaborative work. We sketch a model of the participants' positioning towards their own or their partner's design proposals, from association to dissociation towards the proposals, together with the conversational cues which indicate this positioning. Our aim is to integrate the role of interpersonal relationships into the study of co-operation, to stress (...) the importance of this dimension for the quality of collective work and to reflect on its potential for integration into the design of dialogue systems. (shrink)

Thure von Uexküll (1908-2004) ist einer der Väter der psychosomatischen Medizin in Deutschland. Sein lebenslanges Bemühen um eine naturphilosophisch-systemtheoretisch begründete bio-psycho-soziale Medizin ist unverändert aktuell. Ottmar Leiß nimmt sich diesem Pionier an und betrachtet in aktueller Relektüre seine theoretischen Ansätze und die Auswirkungen seiner Arbeiten u.a. auf das medizinische Menschenbild und das Verhältnis zwischen ärztlich Tätigen und Patient*innen. Die Integration von Salutogenese und Hartmut Rosas Resonanztheorie in Uexkülls Konzepte machen diese zum handlungsleitenden Kompass für eine humane Medizin.

In the last decades, Systems Biology (including cancer research) has been driven by technology, statistical modelling and bioinformatics. In this paper we try to bring biological and philosophical thinking back. We thus aim at making diferent traditions of thought compatible: (a) causality in epidemiology and in philosophical theorizing—notably, the “sufcient-component-cause framework” and the “mark transmission” approach; (b) new acquisitions about disease pathogenesis, e.g. the “branched model” in cancer, and the role of biomarkers in this process; (c) the burgeoning of (...) omics research, with a large number of “signals” and of associations that need to be interpreted. In the paper we summarize frst the current views on carcinogenesis, and then explore the relevance of current philosophical interpretations of “cancer causes”. We try to ofer a unifying framework to incorporate biomarkers and omic data into causal models, referring to a position called “evidential pluralism”. According to this view, causal reasoning is based on both “evidence of diference-making” (e.g. associations) and on “evidence of underlying biological mechanisms”. We conceptualize the way scientists detect and trace signals in terms of information transmission, which is a generalization of the mark transmission theory developed by philosopher Wesley Salmon. Our approach is capable of helping us conceptualize how heterogeneous factors such as micro and macro-biological and psycho-social—are causally linked. This is important not only to understand cancer etiology, but also to design public health policies that target the right causal factors at the macro-level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this particular (...) point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

The positive psychology landscape is changing, and its initial identity is being challenged. Moving beyond the “third wave of PP,” two roads for future research and practice in well-being studies are discerned: The first is the state of the art PP trajectory that will continue as a scientific discipline in/next to psychology. The second trajectory links to pointers described as part of the so-called third wave of PP, which will be argued as actually being the beginning of a new domain (...) of inter- or transdisciplinary well-being studies in its own right. It has a broader scope than the state of the art in PP, but is more delineated than in planetary well-being studies. It is in particular suitable to understand the complex nature of bio-psycho-social-ecological well-being, and to promote health and wellness in times of enormous challenges and changes. A unique cohering focus for this post-disciplinary well-being research domain is proposed. In both trajectories, future research will have to increase cognizance of metatheoretical assumptions, develop more encompassing theories to bridge the conceptual fragmentation in the field, and implement methodological reforms, while keeping context and the interwovenness of the various levels of the scientific text in mind. Opportunities are indicated to contribute to the discourse on the identity and development of scientific knowledge in mainstream positive psychology and the evolving post-disciplinary domain of well-being studies. (shrink)

This book attempts to develop a Marxist theory of the human individual. It contends that the standard description of the human as a bio-psycho-social being is fundamentally deficient as it doesn’t specify which of these attributes is the determining one. As long as this is not done, the real nature of humanity cannot be uncovered.

El trabajo presenta aspectos que permiten la conceptualización del enfoque del Derecho para el abordaje de la niñez y la adolescencia en el contexto chileno. A través del análisis de la evidencia existente en la literatura, se tratan aspectos bio-psico-sociales y legales que admiten la validación del niño como sujeto de derecho. Se hace especial hincapié en el análisis de los principios rectores de la Convención sobre los Derechos del Niño para la preparación hacia los próximos desafíos en el trabajo (...) con niños y adolescentes. This paper presents aspects that allow the conceptualization of the rights-based approach to childhood and adolescence in the Chilean context. Through the analysis of existing evidence in the literature, the bio-psycho-social and legal aspects that support the validation of children as subjects of law are dealt with. Special emphasis is given to the analysis of the guiding principles of the UNICEF´s Convention on the Rights of the Child in preparation for the forthcoming challenges in the work with children and adolescents in Chile. (shrink)

As a science and practice of intervention and control, medicine is concerned with cure and care, the promotion and protection of health, and the prevention of maladies and human suffering. This wide-ranging task is accomplished through medical practice and medical research, though no sharp boundary between them can be drawn. A widespread misconception about medicine has it that medicine is concerned with illness and disease. However, the subject of medicine is the patient, i.e., Homo patiens, but not illness or disease, (...) with the ends being directed toward the relief, prevention of human suffering, and saving human life. Accordingly, medicine needs a theory of the patient first of all. Nosology and pathology as studies of illness and disease may be viewed as elements of such a theory of the Homo patiens. Seen from this perspective, clinical research and practice are to be based on the question: What is a patient? That is, what characteristics distinguish a patient from a non-patient? The present chapter is concerned with this question. The inquiry into what a patient, i.e., Homo patiens, is, intersects with anthropology that is concerned with the question of what is a human being? This is the fundamental philosophical question of medicine because, as an experimental and diagnostic-therapeutic discipline, it undertakes momentous interventions in human life. It therefore needs an image of the human being so as to ascertain whether medical interventions are in accord with, or contravene, that image. For example, it is a legitimate question to ask whether the transplantation of animal cells, tissues, and organs into humans, i.e., xenotransplantation, or whether the designing of offspring by genetic engineering, is morally permissible. Since anthropology is basically a philosophical endeavor, medicine at its foundations turns out to intersect with philosophy. We shall consider the patient as a bio-psycho-social agent who is suffering or whose life is threatened by some occurrences inside or outside of her body, usually called diseases, pathogenic environments, etc. Our aim is to understand what these occurrences may look like and how they may be conceptualized, systematized, recognized, causally analyzed, and controlled. Thus, our discussion consists of the following five sections: 7.1 The Suffering Individual; 7.2 The Bio-Psycho-Social Agent; 7.3 Health, Illness, and Disease; 7.4 Systems of Disease; 7.5 Etiology (= Science of Clinical Causation). (shrink)

Recent advances in moral psychology and applications of virtue science have created promising opportunities to refine theories of media practice and ethical principles. This article sets forth the theoretical foundation for a model of virtuous action among media exemplars that is multidimensional, inductive, and informed by these developments. The model draws on a range of psycho-social assessment tools to explore five key dimensions of virtuous behavior: story of the self, personality, integration of morality into the self, (...) moral ecology, and moral skills and knowledge. The model's structure is designed to strengthen the empirical basis used to make normative and predictive claims about media practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 29.1 (2005) 1-23 [Access article in PDF] Literature and Evolution: A Bio-Cultural Approach Brian Boyd University of Auckland Many now feel that the "theory" that has dominated academic literary studies over the last thirty years or so is dead, and that it is time for a return to texts.1 But many more outside literary studies—in fields as diverse as anthropology, economics, law, psychology, and religion—have recently (...) come to recognize that the deep past that shaped our species can help to explain our present and recent past. Since a bio-cultural model of the human can only be richer than a solely cultural model, and since it implies neither genetic determinism nor limitation to the status quo, I want to argue for a bio-cultural or evolutionary approach to literature, first in very general terms, and then through a few aspects of a single familiar example, Hamlet.2 Such an approach, I suggest, can offer both a more comprehensive theory of literature and a closer investigation of literary texts. I Traditional views of literature tended to see it as reflecting nature, especially human nature, all the way from Plato's discomfort with, or Aristotle's admiration for, mimesis to Shakespeare's or Stendhal's images of art as holding the mirror up to nature. Common-sense traditional views of art and literature have easily shaded into transcendental views, widespread because religious beliefs have been so pervasive and because both artists and their patrons in state or church benefit by nurturing a sense of awe at art's putatively divine origins and power.In the twentieth century, first in sociology, anthropology, and even [End Page 1] psychology, then by the 1960s in the combination of these with Saussurean linguistics that produced structuralism and its aftershocks, and therefore impacted on literature, there has been a rejection of human nature as a given and a stress on human nature as the product only of culture and convention. "Theory," or what the Norton Anthology of Theory and Criticism more pointedly calls cultural critique, rightly critiques traditional common-sense and transcendental views of art, pointing out that the nature, human nature, or supernature that art or literature was supposed to reflect was merely what was assumed of these things from within a local cultural perspective.3 Roland Barthes, for example, criticized "the mystification which transforms petit-bourgeois culture into a universal nature."4 Modern Theory also rejects the individual as another bourgeois or capitalist or Western notion, as when Fredric Jameson echoed Barthes's Death of the Author by announcing the Death of the Subject.5 Criticism since the 1960s "has denied, on theoretical grounds, the relevance of the single historically definable author."6However, as many have lately realized, there are problematic ethical consequences of both the denial of human nature and the denial of the individual. After such denials, on what basis do we then claim equal rights for all humans, and on what basis do we assign responsibility for particular actions?7 If there is no "single historically definable author," does that mean that someone penning a racist screed cannot be held accountable?A critique of unquestioned Western assumptions about human nature was needed, but the post-1960s critique was shortsighted: it has not looked nearly far enough. While structuralism and its more or less rebellious offspring were continuing the lineage of early twentieth-century social sciences, the natural sciences were moving in the opposite direction, towards the first comprehensive scientific attempt to understand human nature in the context of evolution and human, animal, and artificial cognition and behavior.In the humanities there has of late been widespread skepticism about science. Some postmodernists have what they deem "a sophisticated appreciation of the futility of proof and the relativity of all knowledge claims." But, as Daniel Dennett comments, "this opinion, far from being sophisticated, is the height of sheltered naïveté, made possible only by... ignorance of the proven methods of scientific truth-seeking and their power."8 Science does not generate only true answers: ideas proposed within it can of... (shrink)

Western culture has a few traditions of representing the human body – among them mortuary art (gisants), the freak show, the culture of the relics, renaissance art and pre-modern and modern anatomy. A historical analysis in the spirit of Norbert Elias is offered with regard to body – person relationship in anatomy. Modern anatomy is characterized by separating the story of the person from the story of the body, a strategy that is incompatible with the bio-psycho-social paradigm of (...) clinical medicine. The paper discusses different aspects of the above traditions and how they might bear on this conflict and on contemporary bioethics and bedside practice. (shrink)

Thinkers as diverse as Kuhn and Salmon agree that should an account of scientific rationality not square with actual scientific practice, then this should be considered as a reductio ad absurdum of the proposed norms and not be taken as evidence that the history of science is in large measure irrational. While many are willing to accept the need to do justice to the history of science as a constraint on the acceptability of any candidate theory of scientific method, very (...) few are willing to use the history of science as evidence in the positive, confirming sense. However, some are; and I join them in believing that the history of science can be used as evidence for or against the various rival normative philosophies of science. That is, of the competing accounts which claim to be the scientific method , the history of science provides the sort of evidence which can lead to a choice from among them. ;This, then, is my starting point: There is a history-methodology evidential relationship. The problem to be tackled is how to characterize this relationship. Just how does what scientists have actually done support or refute an account of what scientists ought to do? This is the main quesion the thesis is devoted to answering. ;Starting from the same assumption that there is a history-methodology evidential relationship, Lakatos and Laudan have given accounts of just what the relationship is. They are critically investigated here and found wanting. ;The account which I think correct and which I defend is along these lines: That normative philosophy of science is correct which best is able to reconstruct the history of science so that it is maximally rational while maintaining a coherence with our best theories in other domains, e.g., psycho-social theories. In arguing for such an account of the history-methodology relation there are many difficulties to overcome. One is that the history of science has to be written up in order for it to be used as evidence. But such an historiography is loaded with normative concepts, so is it not the case that the testing procedure is circular? This is a problem of long standing, but it is shown that the account of testing rival methodologies that I offer will completely obviate the difficulty. This is one piece of strong evidence for my account, and others come from the fact that it overcomes the difficulties that I see in the accounts of Lakatos and Laudan. . . . UMI. (shrink)

This article proposes a Social Determinants of Health framework as a counter to the prominence of bio-determinist tropes in understandings of the relationship between concussion and later life neurodegenerative conditions in athletic populations. It is argued that debates about concussion (or repetitive head impacts) causing CTE have been particularly influenced by broader social trends towards neuro-essentialism. This paradigm reduces complex social behaviour to brain matter and continues to dominate the field despite the recent diversification of evidence from (...) autopsy-based studies of neuropathology to epidemiological studies comparing recorded causes of death among former elite athletes. In contrast, this article explores the ‘causes of causes’ of neurodegenerative conditions. It outlines the ways in which the distinct dynamics of: a) employment, b) education, income and wealth, c) health systems and services, and d) social environment and public safety relate to the specific occupational conditions of elite sport and likely negatively shape health outcomes of athletic populations. The article concludes by arguing that to more effectively address these particular health harms we must move beyond narrow, mono-causal models and evoke a cultural change that extends beyond making rule changes and adjusting psychological attitudes and behavioural norms, to redress the social structural parameters of elite sports participation. The continuation of narrower, neuro-centric and reductionist paradigms obscures the causes of the causes of neurodegenerative decline and limits the scope for change. (shrink)

This paper proposes a dynamic theory of embodiment that aims to get beyond the absent moving body in embodied social theory. The first somatic revolution, inspired by Merleau Ponty, provided theories based on the feeling and experience of the body. The theory of dynamic embodiment focuses instead on the doing itself as embodied social action, in which the embodied person is fore-grounded as a complex resource for meaning making. This represents a theoretical enrichment of the earlier turn to (...) the body in social theory, which tended to separate the semiotic, as necessarily representational and/or linguistic, from the somatic as a wide range of corporeal processes and practices assumed to be separated from mind, language and/or conscious thought. We argue that overcoming this persistent Cartesianism requires a New Realist approach to the proper location of human agency as a causal power, one that promotes a bio-psycho-social concept of personhood. Part one of the paper presents a general framework for this perspective, while part two applies this paradigm ethnographically to illustrate how bringing semiosis and somatics together requires a robust conception of multi-sensory modalities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in favor (...) of basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

Introduction: The COVID-19 pandemic is asking health care workers to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms.Purpose: The (...) aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19.Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model.Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant.Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher. (shrink)

The social and political problem of immigration forces us to reflect on ethical issues such as the relation of responding and bonding across sharp differences, the role that moral values play in relating to the other, and the possibility of solidarity as a way of being responsible for the others with whom we do not have any ready-made social bond. I take Levinas's notion of the ethical relation with the other as a primal society from which the third (...) is not excluded, as a starting point for thinking of social bond as solidarity. I argue that it allows for ethical social bond making in situations determined by bio-power; even in situations in which people are depersonalized and deprived of their right to rights, and of their ethical agency. I propose that the bond of solidarity with the immigrant can be a model for the ethical social bond. (shrink)

An idea is not a replicator because it does not consist of coded self-assembly instructions. It may retain structure as it passes from one individual to another, but does not replicate it. The cultural replicator is not an idea but an associatively-structured network of them that together form an internal model of the world, or worldview. A worldview is a primitive, uncoded replicator, like the autocatalytic sets of polymers widely believed to be the earliest form of life. Primitive replicators (...) generate self-similar structure, but because the process happens in a piecemeal manner, through bottom-up interactions rather than a top-down code, they replicate with low fidelity, and acquired characteristics are inherited. Just as polymers catalyze reactions that generate other polymers, the retrieval of an item from memory can in turn trigger other items, thus cross-linking memories, ideas, and concepts into an integrated conceptual structure. Worldviews evolve idea by idea, largely through social exchange. An idea participates in the evolution of culture by revealing certain aspects of the worldview that generated it, thereby affecting the worldviews of those exposed to it. If an idea influences seemingly unrelated fields this does not mean that separate cultural lineages are contaminating one another, because it is worldviews, not ideas, that are the basic unit of cultural evolution. (shrink)

Comprising almost a third of greenhouse gas emissions and having an equally prominent role in pollution of soils, fresh water, coastal ecosystems, and food chains in general, agriculture is, alongside industry and electricity/heat production, one of the three biggest anthropogenic causes of breaching the planetary boundaries. Most of the problems in agriculture, like soil degradation and diminishing biodiversity, are caused by unfit uses of existing technologies and approaches mimicking the agriculturally-relevant functioning natural ecosystems seem necessary for appropriate organization of our (...) toxic and entropic agro-technologies. Our thesis is that eco-curative and sustainable uses of agro-technology require a paradigm shift from the chemical model of agro-systems to the ecological system-design model of agriculture. Particularly, following the new biomimetic paradigm of ecological innovation, we question in what sense can we mimic natural solutions in agriculture. We discern among Integrated agriculture and Permaculture, analyze their biomimetic status from the perspective of the philosophy of biomimicry, and argue that the former nature-mentored approach is a more appropriate solution for sustainable broadscale agriculture necessary for the growing world. However, it is not clear how this agricultural bio-integration will interact with the predicted automatization of work, urban demographic momentum, and the Earth system instability, and can the Permaculture alternative emerge as a social safety-net for the anticipated technologically-redundant or economically or environmentally endangered workers. We argue both for the importance to understand Permaculture as a social safety-net and as experimental testing ground for cutting edge biomimetic technologies. (shrink)

Comprising almost a third of greenhouse gas emissions and having an equally prominent role in pollution of soils, fresh water, coastal ecosystems, and food chains in general, agriculture is, alongside industry and electricity/heat production, one of the three biggest anthropogenic causes of breaching the planetary boundaries. Most of the problems in agriculture, like soil degradation and diminishing biodiversity, are caused by unfit uses of existing technologies and approaches mimicking the agriculturally-relevant functioning natural ecosystems seem necessary for appropriate organization of our (...) toxic and entropic agro-technologies. Our thesis is that eco-curative and sustainable uses of agro-technology require a paradigm shift from the chemical model of agro-systems to the ecological system-design model of agriculture. Particularly, following the new biomimetic paradigm of ecological innovation, we question in what sense can we mimic natural solutions in agriculture. We discern among Integrated agriculture and Permaculture, analyze their biomimetic status from the perspective of the philosophy of biomimicry, and argue that the former nature-mentored approach is a more appropriate solution for sustainable broadscale agriculture necessary for the growing world. However, it is not clear how this agricultural bio-integration will interact with the predicted automatization of work, urban demographic momentum, and the Earth system instability, and can the Permaculture alternative emerge as a social safety-net for the anticipated technologically-redundant or economically or environmentally endangered workers. We argue both for the importance to understand Permaculture as a social safety-net and as experimental testing ground for cutting edge biomimetic technologies. (shrink)

Psychosomatic medicine, with its prevailing biopsychosocial model, aims to integrate human and exact sciences with their divergent conceptual models. Therefore, its own conceptual foundations, which often remain implicit and unknown, may be critically relevant. We defend the thesis that choosing between different metaphysical views on the ‘mind–body problem’ may have important implications for the conceptual foundations of psychosomatic medicine, and therefore potentially also for its methods, scientific status and relationship with the scientific disciplines it aims to integrate: biomedical sciences, (...) psychology and social sciences. To make this point, we introduce three key positions in the philosophical ‘mind–body’ debate and investigate their consequences for the conceptual basis of the biopsychosocial model in general and its ‘psycho-biological’ part in particular. Despite the clinical merits of the biopsychosocial model, we submit that it is conceptually underdeveloped or even flawed, which may hamper its use as a proper scientific model. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, (...) and the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

Social anxiety disorders are among the most prevalent mental disorders, with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy for SAD, and evaluated its feasibility in a pilot randomized controlled trial. The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social (...) network diagnostics, and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD : 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy. Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety, while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT. Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory ; this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

Introduction: the neuroscientific turn in political science The observation that brains and political orders are interdependent is almost trivial. Obviously, political orders require brain processes in order to emerge and to remain in place, as these processes enable action and cognition. Conversely, every since Aristotle coined man as “by nature a political animal” (Aristotle, Pol.: 1252a 3; cf. Eth. Nic.: 1097b 11), this also suggests that the political engagements of this animal has likely consequences for its natural development, including the (...) development of its psychological functions. Given these mutual interdependencies, it is remarkable that only since the 1960s, the more general domain of ‘biopolitics’ has attracted attention though first particularly in the form of behavioral politics (Alford and Hibbing). Since then biopolitics has gained in interest, so much so that different subdomains can be identified. Indeed, a 2008 review of the field of biopolitics identified five ‘headings’ of it: “(1) the case for a ‘more biologically oriented political science’, (2) ‘biologically related’ public policy issues, (3) physiological measures of political attitudes and behaviour, (4) the influence of physiological factors on actual political behaviour, and (5) the manner in which our species’ evolutionary history has left homo sapiens genetically endowed with certain social and political behavioural tendencies” (Somit and Peterson 43). Striking is how the relation between biology and politics is taken here in a rather unidirectional way, emphasizing particularly the decisive power of biology upon politics. The reverse relation is not mentioned specifically, reflecting the field of biopolitics, perhaps until quite recently. This absence of studies of political influences on our biology may have to do with the difficulty in investigating such influences. Empirical studies in biopolitics have two foci, broadly speaking: genetics and the brain, both of which have turned out to be complex and dynamic phenomena (Alford and Hibbing). Yet the studies of genetics and brain processes have made much progress in the last few decades, thanks to the development of research instruments - like fMRI brain scanners and TMS brain stimulation instruments - and of computational tools for data analysis and the simulation of explanatory models. For the field of biopolitics it is particularly relevant that within cognitive neuroscience the study of social and political issues has witnessed an increasing interest of researchers even more recently. Indeed, aware of the enabling and mediating role of the brain regarding those issues, a truly ‘neuroscientific turn’ can be observed in the social sciences, testified for example by the emergence of the field of ‘neuropolitics’ (Connolly; Vandervalk). Developing a systematic neuropolitics or biopolitics in general is a difficult challenge because of the wealth of causal influences on and interdependencies between biological, brain, cognitive and socio-political factors. Taking a somewhat more abstract perspective, this paper focuses on the process of emerging complexity in adaptive systems, enabling those to conduct ever more complex processes. Yet, parallel to that development can be observed that such systems, or organisms, are also capable in reducing the complexity of the information they are to process. Once they’re capable of developing and adjusting such compressed and complex representations of information, those systems or organisms can handle more information faster and more efficient and adaptive, yielding important benefits to the organism in navigating its environment (Halford, Wilson and Phillips). Before focusing on the role of narrative as a cognitive strategy for such a reduction of informational complexity, I will discuss the development of stable structures and increasing complexity in dynamic systems. Such a more general perspective prepares our discussion of the structures of both narratives and politics and in doing so contributes to the explanation of their interaction. (shrink)

Palliative care names as one of its central aims to prevent and relieve suffering. Following the concept of “total pain”, which was first introduced by Cicely Saunders, PC not only focuses on the physical dimension of pain but also addresses the patient’s psychological, social, and spiritual suffering. However, the goal to relieve suffering can paradoxically lead to a taboo of suffering and imply adverse consequences. Two scenarios are presented: First, PC providers sometimes might fail their own ambitions. If all (...) other means prove ineffective terminal sedation can still be applied as a last resort, though. However, it may be asked whether sedating a dying patient comes close to eliminating suffering by eliminating the sufferer and hereby resembles physician-assisted suicide, or euthanasia. As an alternative, PC providers could continue treatment, even if it so far prove unsuccessful. In that case, either futility results or the patient might even suffer from the perpetuated, albeit fruitless interventions. Second, some patients possibly prefer to endure suffering instead of being relieved from it. Hence, they want to forgo the various bio-psycho-socio-spiritual interventions. PC providers’ efforts then lead to paradoxical consequences: Feeling harassed by PC, patients could suffer even more and not less. In both scenarios, suffering is placed under a taboo and is thereby conceptualised as not being tolerable in general. However, to consider suffering essentially unbearable might promote assisted dying not only on an individual but also on a societal level insofar as unbearable suffering is considered a criterion for euthanasia or PAS. (shrink)

In this paper some very fundamental attitudes we have and assumptions we make in the US about persons, what they owe and what they are owed, are scrutinized and found to be indefensibly ageist. It is argued that these assumptions and the attitudes they engender are supported by logically and ethically suspect methods and conclusions. These errors are summarized and some remedial steps by which we might better protect against such illicit and unwarranted methods and conclusions in the future are (...) suggested. (shrink)