In the United States, at least 6% of all hospital beds are in the intensive care unit or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. (...) ICUs employ some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Breaking the Readmission CycleBrian HattenI want to share the story of my difficult patient Ms. L. She has twenty-seven current medical issues. Thirty-five active prescriptions. Limited mobility requiring the use of a motorized scooter. Non-medical care gaps. And over twenty hospital admissions since 2020. I met Ms. L approximately five years ago as her hospital attending and have continued to care for her during her frequent hospitalizations. I could (...) recite this 77-year-old female's litany of medical problems. But sufficed to say, her history is complex, with her admitting diagnoses running the gambit from cellulitis to gastrointestinal bleeding to altered mental status. But, her diagnosis and frequent exacerbations of congestive heart failure (CHF) are particularly frustrating for us both and will be my focus today.CHF makes her susceptible to fluid overload leading to feelings of shortness of breath, which progresses to respiratory distress. Like other individuals with CHF, she uses diuretics to prevent herself from becoming fluid overloaded. And, like many individuals who take diuretics, she hates them. She (un)affectionately calls her water pills "the bomb" because the effect is sudden, profound, and explosive when they begin working. The combination of the diuretic effect and her limited mobility causes significant emotional stress for Ms. L, a woman who values presenting herself outwardly as in control, well-dressed, and put together. Her dislike of the medical effect of her diuretics has led to her either taking them less often or outright discontinuing them. So, while discontinuation avoids those frustrating effects, it leads to fluid accumulation, subsequent respiratory distress, and readmission to the hospital.Her medical records mention she has memory issues. It is unclear how much her mild cognitive impairment affects her frequent readmissions. We have had many conversations where I would never suspect something was amiss. But sometimes, she can be forgetful and does not recall our recent discussions. That being said, she knows the names and uses of her medications. She can report to me her home weights when she checks them and knows what her "dry" weight should be. Yet, she does not act when her scales begin reading heavier or when she develops leg swelling. Instead, she presents to the emergency department in extremis. When directly questioned about why she lets her situation deteriorate to such a state that she requires hospitalization, she demurs. She comments that she can often be stubborn, that the diuretic effect of "the bomb" is burdensome, but always reminds me she is honest in admitting she wasn't taking her water pills.During several admissions, I worried for her survival after she had self-discontinued her medications and showed up at the emergency department in respiratory failure. For any patient with recurrent admissions, I discuss their overall goals of care to ensure we are working together toward achievable medical ends. But this conversation was essential to have with Ms. L. The possibility existed that she would present to the hospital too late in her disease process, and we would not be able to correct her respiratory failure. I wanted to ensure that the hospital staff and I respected her wishes regarding her care. Despite raising my concerns, she would [End Page 22] decline to discuss her wishes. Even worse, attempting to have her complete advance care planning documents like advance directives or a Physician Orders for Life-Sustaining Treatment (POLST) form was a futile endeavor. Ms. L was always vague and non-committal. She simply did not want to engage in those types of conversations. When asked why she declined to discuss these issues, Ms. L would reply that she was doing okay, the discussion was unnecessary, and she had family members to make those decisions for her.Caring for her during her hospital stays was a source of professional frustration for me. Her recurrent admissions made me feel like I was failing her. During each hospital stay, we would go over her medications. We repeatedly discussed how she should check her weights daily and monitor for lower extremity edema. We created multiple action plans for when to call her physicians so we could head off another hospital visit. We completed all the... (shrink)

We live in a market system with much economic inequality. This may not be an essential characteristic of market systems but seems historically inevitable. How we should evaluate it, on the other hand, is contentious. I propose that bleeding heart libertarianism provides the best diagnosis and prescription.

We live in a market system and witness much economic inequality. Although such inequality may not be an essential characteristic of market systems, it seems historically inevitable. How we should evaluate this inequality, on the other hand, is contentious. I propose that bleeding heart libertarians provide the best diagnosis and prescription.

This article focuses on blood donation as a form of bloodletting in a context where donation is commonly seen to alleviate the symptoms of `thick blood'. It deals with the gendered aspects of blood donation, and the parallels drawn between donating blood and menstruating. Women are seen not to need to donate blood as much as men, who, in the absence of menstruation, are more prone to thick blood and require a means to expunge the ensuing excess. While blood donation (...) professionals strive to reconstruct donation as a selfless and ungendered act, counterposing the `facts' of arterial blood circulation to local blood-lore and beliefs, lay understandings challenge this construction in the use they make of blood donation centres or by reiterating the personalistic and gendered dimensions of donation. The article explores cases of patients who use hormonal contraceptives which suppress menstruation and express concerns over the resulting accumulation of blood in the body. It considers how blood donation is adopted by some women as a means of dispelling both the perceived inconveniences of menstrual bleeding and its swelling effects. Such literalized engagements with medical technologies reveal a conception of the body as a permeable, malleable and recipient-like enclosure. These views are often characterized as `ignorance' by medical practitioners, where ignorance is seen to derive not only from the absence of knowledge, but from the presence of the wrong kind of knowledge. (shrink)

This article focuses on the theological journeying of women ordinands in the Church of England, who have had to negotiate their belonging in the ‘pathway’ to Priesthood in ordination training. Attention is given to the extent to which the personhood of women is enabled to truly flourish in a theological education system that is dominated by men and predominantly patriarchal and Western theologising. It suggests that a gendered politics of belonging has been used and maintained through the socio-religious construct of (...) ‘shame’ in order to maintain the boundaries of belonging within the formation process, and therefore calls for an en-gendered ‘pathway to the priesthood’. This is exemplified in a re-reading of the bleeding woman who dares to challenge the hegemonies of patriarchy and purity by touching the cloak of Christ in Luke 8:40-48. This research is part of an ongoing project with Common Awards at Durham University that explores barriers to belonging in theological education for those in training for ordination. It has therefore received ethical approval for interviews and participant observations. (shrink)

This article retells the story of Luke’s bleeding woman with insight from history, social reconstruction, the Jewish law, and medical detail. It argues that the woman did nothing wrong in touching Jesus’ ritual fringes, and in fact acted as a priest by doing so, breaking new ground for women. Her life was ebbing away as she continued to bleed, but she, as the active agent in the story, pleaded with God for mercy, and by her faith, she was healed.

A young woman called me to ask for a referral to a physician who provided hymen reconstruction surgery. She had had premarital intercourse and came from a cultural background in which it was very important to “prove virginity” on the wedding night. This article deals with my internal struggle whether or not to provide the referral. I felt that providing it would have made me complicit in supporting gender inequality, as men are not required to “prove virginity” to get married. (...) At the same time, I was concerned about the repercussions of not being able to “prove virginity” would have on the caller. I had no explicit guidance on what to do in such a situation—it was not covered by the professional responsibilities I had as a research assistant. (shrink)

As one tries to grasp love and its images within José Leonilson's production, a multiplicity of aspects and meanings are seen that also relate to Louise Bourgeois's oeuvre in regard to the interest in human relations. Through a comparative approach to both artists' poetics, an understanding is created that love is not a simplistic action and all the words read in or applied to their visual discourse must be considered within a wide range of love in visual and literary images. (...) Keywords: literature and visual arts / love / creativity / Bourgeois, Louise / Leonilson, José / word and image. (shrink)

I argue that Tomasi’s most fundamental “bleeding heart libertarian” insights are not adequately served by Rawls’s lexical framework and his idealized theory of institutional choice. Perhaps paradoxically, using Rawls’s lexical framework to articulate Tomasi’s declared concerns for both economic liberty and “social justice” gives the latter concern very little weight. For that reason, Tomasi’s own objections against classical liberalism would ultimately apply to his own positive contribution as well: the satisfaction of a distributional adequacy condition is secured on purely (...) contingent grounds. Furthermore, Tomasi’s endorsement of Rawls’ conception of the first tasks of political philosophy might render his case for laissez-faire forms of capitalism immaterial. This is because Rawls fails to appreciate the very narrow theoretical relevance of identifying institutional arrangements purely as a matter of “ideal theory”. Feasibility concerns have always been an important element in the classical liberal critique of interventionist and redistributive politics. Yet they have invariably failed to be featured, in any theoretically prominent way, within the most philosophically oriented defenses of the classical liberal order. A formulation of bleeding heart libertarianism along Rawlsian lines would be equally wanting in this regard. (shrink)

The gastrointestinal tract is normally investigated using reductionism methods in human studies, where the focus is on each segment of the gastrointestinal system and the specific links between various parts of it. This helps researchers and clinicians to produce a simple relationship between the elements of the gastrointestinal tract based on clinical diagnosis and treatment. However, there is evidence indicating that the gastrointestinal tract has properties that are beyond function of the simple systems, such as, multiplicity (...) of elements, network communication, emergence, self-organization, sudden transition, nonlinearity, and adaptation, all of which are attributes of complex systems. It seems that the gastrointestinal tract is an appropriate candidate for complexity research. If the gastrointestinal tract is assumed as a complex system, then it would be more fitting to study the tract using holistic methods through interdisciplinary perspective. In the present paper, the features of the gastrointestinal that correlate to complex systems have been explained using physiological examples from studies done on human subjects. (shrink)

In September 2013, images of bruised, bleeding and battered Hindu goddesses went viral on social media networks. Saraswati (the goddess of knowledge), Lakshmi (the goddess of wealth) and Durga (the goddess of strength and power) appear as victims of domestic abuse in the Abused Goddesses advertising campaign against domestic violence. In this article, I analyse the Abused Goddesses campaign and the conversations it generated. I argue that it reiterates both a form of Hindu nationalistic discourse as well as longstanding (...) patriarchal, orientalist and neocolonialist perspectives about sexual violence in India. I examine the discourse generated by the Abused Goddesses campaign on social and mainstream media in order to trace how these images were circulated, perceived and engaged with by Indian and international audiences. While the campaign went viral on social media, I argue that its virality offers insufficient conditions for substantial social change around gender violence, including consciousness raising. Through analysis of the campaign and the ways in which it has been commented on, I demonstrate how the representation of domestic violence through the calendar art imagery of abused goddesses ultimately reaffirms classist, casteist, racist, sexist and orientalist discourses about Indian women and the violence they face. (shrink)

Microbes in the gastrointestinal tract are under selective pressure to manipulate host eating behavior to increase their fitness, sometimes at the expense of host fitness. Microbes may do this through two potential strategies: (i) generating cravings for foods that they specialize on or foods that suppress their competitors, or (ii) inducing dysphoria until we eat foods that enhance their fitness. We review several potential mechanisms for microbial control over eating behavior including microbial influence on reward and satiety pathways, production (...) of toxins that alter mood, changes to receptors including taste receptors, and hijacking of the vagus nerve, the neural axis between the gut and the brain. We also review the evidence for alternative explanations for cravings and unhealthy eating behavior. Because microbiota are easily manipulatable by prebiotics, probiotics, antibiotics, fecal transplants, and dietary changes, altering our microbiota offers a tractable approach to otherwise intractable problems of obesity and unhealthy eating. (shrink)

Introducing the concept of Crisis Solution Marketing, this research explores how metaphor pre-packages information, proposing “solutions” to “problems” they discursively construct in the media. These conceptual frameworks are capable of influencing how readers perceive and interpret news events, ultimately influencing their behavior as consumers and the financial decisions they make. This article explores the relationship between editorial positioning and ideology in financial news and the types or ontologies of metaphors used to describe the nature of the stock market via reporting (...) on the stock market crash of 2008 in online news media. Results indicate a statistically significant preference for The New York Times and The Wall Street Journal, liberally positioned newspapers, for animate-biological metaphors which promote understanding of the stock market in terms of a living being that must be ‘nurtured’ through intervention as opposed to being ‘left alone’, which is more consistent with laissez-faire approaches to economic crisis scenarios. (shrink)

When it comes to fulfilling our basic duties to distant others, we in the affluent world face a motivation gap; we consistently fall short of bearing even moderate costs for the sake of helping others secure basic minimums to which they are entitled. One response to the motivation gap is to cultivate in affluent populations a greater concern for distant others; cultivating such concern is the goal of ‘sentimental cosmopolitanism’. Two approaches to sentimental cosmopolitanism currently dominate the literature, a compassion-based (...) and a complicity-based approach, respectively. In this paper, I argue for the promise of reciprocity as an alternative motivator of cosmopolitan concern. I further argue that a sense of obligation to distant others, grounded in our participation in an ongoing system of reciprocal exchange, can be cultivated within a thus-far overlooked sphere of cosmopolitan sensitization, namely the market. I make the case for the market as an appropriate site for cosmopolitan sensitization, and further argue that multinational corporations are, for several reasons, well-positioned to bear the political responsibility of sensitizing affluent populations to the significance of their participation in a cooperative economic scheme shared with distant others. This paper, then, makes a novel contribution to debates on cosmopolitan sentiment, as well as to the emerging literature on corporations’ political responsibilities. Keywords: multinational corporations; political responsibility; reciprocity; sentimental cosmopolitanism; trade. (shrink)

This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the “gastrointestinal woman,” who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman (...) is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions. (shrink)

Phase I clinical trials are the first stage of testing new pharmaceuticals in humans. The majority of these studies are conducted under controlled, inpatient conditions using healthy volunteers who are paid for their participation. This article draws on an ethnographic study of six phase I clinics in the United States, including 268 semistructured interviews with research staff and healthy volunteers. In it, I argue that an institutional banalization of risk structures the perceptions of research staff and healthy volunteers participating in (...) the studies. For research staff, there are three mechanisms by which risk becomes banal: a perceived homogeneity of studies, Fordist work regimes, and data-centric discourse. For healthy volunteers, repeat study participation contributes to the institutional banalization of risk both through the process of desensitization to risk and the formation of trust in the clinics. I argue that the institutional banalization of risk also renders invisible ethical concerns about exploitation of underprivileged groups in pharmaceutical research. (shrink)

The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 (...) patients were identified. The most common primary ethical issue was the DNR order, followed by medical futility. The most common contextual issues were dispute/conflict between staff and family, dispute/conflict intra-family, and cultural/ethnic/religious issues. The majority of ethical issues leading to consultation were resolved ; i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning. (shrink)

The gut microbiota is an important component of the human body and its immune‐modulating and metabolic activities are critical to maintain good health. Gut microbes, however, are sensitive to changes in diet, exposure to antibiotics, or infections, all of which cause transient disruptions in the microbial composition, a phenomenon known as dysbiosis. It is now recognized that microbial dysbiosis is at the root of many gastrointestinal disorders. However, the mechanisms through which bacterial dysbiosis initiates disease are not fully understood. (...) Microbially‐derived metabolites and their role in disease have also attracted significant attention. Identification of cancer‐associated bacteria and understanding the contributions of microbial metabolism in health and disease are exciting but challenging areas that will allow defining microbial biomarkers for predicting gastrointestinal disorders. Understanding the complex interactions between gut microbiota, diet, host immune system and host genetics will be critical to developing more personalized therapies and approaches to treat disease. (shrink)

Two years ago, Indonesian Foreign Minister Ali Alatas said that his government faced an important choice on East Timor, which had become "like a sharp piece of gravel in our shoes." Benedict Anderson, a leading specialist on Indonesia, took this to be one of many signs of second thoughts: "Alatas doesn't spell out what the choice is," Anderson commented, "but he's implying you should take your shoe off and get rid of the gravel.".

When I was a 7 months pregnant medical student, an attending surgeon asked me to which specialty I would be applying. When I replied that I was hoping to match in general surgery, he touched my pregnant abdomen and said, “Not with that you’re not.” I am not alone. Gender bias and discrimination have been shown to negatively impact women surgeons throughout their careers and deter women from even applying in surgical fields.1 Bias against female surgical trainees leads to less (...) operative autonomy and higher dropout rates.2 3 Once faculty, women surgeons are less likely to reach leadership roles.4 Recent studies confirm the author’s assertion that implicit biases create substantial harm. The author has undertaken an important study, conducting in-depth interviews with 46 women surgeons in Australia that identifies four distinct types of bias causing cumulative harm. In all four types of biases: Workplace factors including leave policies and mentorship. Epistemic injustices, or unfair assessments of women surgeons’ credibility by patients and colleagues. Stereotyped expectations. Objectification, implicit biases were seen. While many of the broad factors impeding women in surgery are well known, the author argues that these subtler factors, including both implicit bias and epistemic injustice, have a large impact. The …. (shrink)

Clarice Lispector has been studied thoroughly against the backdrop of Western ontology and feminism, but she has not often been read in relation to postcolonial theory and Black studies. Yet, their critique of coloniality and the radicality with which they conceive of a different world, can provide a fitting frame for understanding what is at stake in Lispector’s thought. When put in dialogue with the work of Édouard Glissant and Denise Ferreira da Silva, Lispector makes a key contribution to the (...) reconfiguration of the relation between the subject and the world that can be understood as an attempt to, echoing Sylvia Wynter, “unsettle the coloniality of being.” Where Glissant effectuates “creolization” and Silva a “hacking” of the subject, Lispector attempts to transgress our colonial relation to the world through a reconfiguration of fertility. In our study of The Passion According to G.H., supported by fragments from the Chronicles, we show: (1) how the passion of G.H., is the passion of a specifically colonial subject; (2) how fertility is an essential link between subjectivity and coloniality, ensuring an atavistic chain of filiation and hence the continuation of a colonially dominated world; and (3) how Lispector reconfigures fertility as a possibility of being deeply affected by the world, so much so that the colonial subject perishes and the chain of filiation is disrupted. As a consequence, we argue that Lispector’s project must not primarily be understood as ontological or in search of pre-discursivity, but as concerned with the revolutionary question of dismantling the colonial subject and its world in order to open up a potential of life otherwise. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug (...) treatment. Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

Regulators of G protein signaling (RGS) proteins provide timely termination of G protein‐coupled receptor (GPCR) responses. Serving as a central control point in GPCR signaling cascades, RGS proteins are promising targets for drug development. In this review, we discuss the involvement of RGS proteins in the pathophysiology of the gastrointestinal inflammation and their potential to become a target for anti‐inflammatory drugs. Specifically, we evaluate the emerging evidence for modulation of selected receptor families: opioid, cannabinoid and serotonin by RGS proteins. (...) We discuss how the regulation of RGS protein level and activity may modulate immunological pathways involved in the development of intestinal inflammation. Finally, we propose that RGS proteins may serve as a prognostic factor for survival rate in colorectal cancer. The ideas introduced in this review set a novel conceptual framework for the utilization of RGS proteins in the treatment of gastrointestinal inflammation, a growing major concern worldwide. (shrink)

The gastrointestinal tract is an asymmetrically patterned organ system. The signals which initiate left‐right asymmetry in the developing embryo have been extensively studied, but the downstream steps required to confer asymmetric morphogenesis on the gut organ primordia are less well understood. In this paper we outline key findings on the tissue mechanics underlying gut asymmetry, across a range of species, and use these to synthesise a conserved model for asymmetric gut morphogenesis. We also discuss the importance of correct establishment (...) of left‐right asymmetry for gut development and the consequences of perturbations in this process. (shrink)

Palliative laser therapy for gastrointestinal tumors is now well established. Its use however may be associated with complications not directly attributable to the laser therapy. These complications potentially decrease the quality of life which opposes the aim of treatment.

‘If it bleeds, it leads’, events characterised by fatalities, are likely to attract high levels of media coverage. This study adopts a multidisciplinary approach to investigate public discourses on the MH17 tragedy in Malaysia and the United Kingdom. First, corpus-based discourse analysis was employed to explore the construction of the Malaysian Airlines tragedy MH17 in four selected Malaysian and British newspapers. In addition, an attitudinal study examining 50 Malaysian and 50 UK nationals’ perceptions of the tragedy was conducted. Keywords analysis (...) revealed an overall tendency for the news media to construct the air tragedy through classifications between ‘us’ and ‘others’. Specifically, important ‘Us’ and non-important ‘Other’ in the Malaysian newspapers, versus good ‘Us’ and evil ‘Others’ in the British newspapers. The attitudinal analysis shows, for both the Malaysian and the UK respondents, the most salient associations with the MH17 tragedy related to ‘conflicts’. (shrink)

If each of the subtypes of autism is defined simply as constituted by a set of symptoms, then the criteria for its observation are straightforward, although, of course, some of those symptoms themselves might be hard to observe definitively. Compare with telling whether or not someone is bleeding: while it might be hard to tell if someone is bleeding internally, we know what it takes to find out, and when we have the right access and instruments we can (...) settle the issue. But matters are not so simple for the autism subtypes. For one thing, how do we settle which symptoms to group together under one heading? One key difference between “autism disorder” and “Asperger’s disorder” is that the former exhibit language delays (sometimes extreme), whereas the latter do not. But is that a sign of genuinely distinct conditions or is that an artifact of the distinct groups of subjects that Leo Kanner and Hans Asperger worked with? And in general, although there are certainly types of behavior that are taken to be indicative of autism, none by itself is taken by diagnosticians to be either necessary or sufficient for a definitive diagnosis for any of the autism subtypes. What is the diagnostician to do? This is not merely an academic issue, as many parents can attest. Are we in a situation, then, that each practitioner has his or her own “pet” signs that are the “real keys” to the diagnosis? That would suggest that the term “autistic” might meet the fate of the outdated term “neurotic,” which turned out to be a pseudo-scientific term for an inexact clumping together of unrelated phenomena. The assumption amongst specialists seems to be that we will reach the point with "autism" that we have with "water": there will be a root essence to autism whose presence or absence settles a diagnosis. If that is to be the case, however, we have to settle the level of application of the concept. Does the term apply to people who exhibit particular behaviors? Or is it possible to exhibit “autistic” behaviors without actually being autistic, because autism is instead a particular feature of the mind (as, for example, in Baron-Cohen’s “impaired theory of mind module” theory, discussed below) which usually but not necessarily has behavioral effects? Or is autism located instead in the brain, perhaps in damage to key areas, which in turn would typically have an effect on modules of the mind? Or perhaps autism is located in genetics or biology, so that some people with damage to the brain caused by accidents so that they exhibit autistic symptoms would not actually be autistic. Conversely, supposing one had an “autistic brain” but showed none of (or not a sufficient number of) the symptoms, would one not be autistic? The assumption is that the genotypes and phenotypes will line up neatly, but if they do not, what happens to the concept “autistic?” (There is an analogy in the philosophy of sex and gender: androgen insensitive individuals tend to self-identify as female and have outward female traits, but have XY chromosomes—should we go with chromosomes or self-identity in assigning sex category?) Finally, the implications for these complications for diagnosis and categorization, with the attendant social and medical implications is discussed. The typical assumption of the medical profession is that autism cannot be “cured.” That assumes that autism is not simply the symptoms. However, at the same time, the tests used to diagnose ASDs work simply from the symptoms (for example, Baron-Cohen’s Sally/Anne test, which ASD children of a certain age almost all fail, but which practically no ASD adult fails). This implies an inherent confusion over the status of the concept. I conclude that attempts to make sense of some true or accurate summary of what it is to be autistic (such as one would find in the DSM) are almost certainly misguided and will vanish into history along with “neurotic.” But as with racial terms, which are similarly shifting and perverse, the term has already passed into the public sphere and will have a lasting and dangerous influence beyond its short scientific shelf-life. (shrink)

While gender and race often are considered socially constructed, this book argues that they are physiologically constituted through the biopsychosocial effects of sexism and racism. This means that to be fully successful, critical philosophy of race and feminist philosophy need to examine not only the financial, legal, political and other forms of racist and sexism oppression, but also their physiological operations. Examining a complex tangle of affects, emotions, knowledge, and privilege, The Physiology of Sexist and Racist Oppression develops an understanding (...) of the human body whose unconscious habits are biological. On this account, affect and emotion are thoroughly somatic, not something "mental" or extra-biological layered on top of the body. They also are interpersonal, social, and can be transactionally transmitted between people.Ranging from the stomach and the gut to the hips and the heart, from autoimmune diseases to epigenetic markers, Sullivan demonstrates the gastrointestinal effects of sexual abuse that disproportionately affect women, often manifesting as IBS, Crohn's disease, or similar functional disorders. She also explores the transgenerational effects of racism via epigenetic changes in African American women, who experience much higher pre-term birth rates than white women do, and she reveals the unjust benefits for heart health experienced by white people as a result of their racial privilege. Finally, developing the notion of a physiological therapy that doesn't prioritize bringing unconscious habits to conscious awareness, Sullivan closes with a double-barreled approach for both working for institutional change and transforming biologically unconscious habits. The Physiology of Sexist and Racist Oppression skillfully combines feminist and critical philosophy of race with the biological and health sciences. The result is a critical physiology of race and gender that offers new strategies for fighting male and white privilege. (shrink)