The purpose is to identify common and distinctive features of concepts and methodology of the problem of subject within different discourses, implicitly or explicitly relevant to the definition of "clinical" mode of human existence. The research methodology combines techniques of discourse analysis and basic principles of historical and philosophical studies. Originality of the research lies in definition of the clinical philosophical discourse as a special communicative process, where utterances not only focus on disease syndromes, (...) and reveal phenomenology of inner experience of a pathological self, but also structure a certain type of sociality. Clinical discourse represents the space where the patient is treated not as a subject but as an object of disease. Ontology of clinical discourse prevails over ontology of disease, since its structures determine the notion of disease as such. Categorization of the disease, the idea of disease as a phenomenon subdued to professional authority leads to the idea of the need for patient’s isolation from the natural environment and removing him to special social institutions. The clinicist doctrines share the intention to reduce the patient’s self to its bodily dimension, while ignoring social determinants of psychological deviations. Conclusions of the study are summarized in the following positions: the current clinical discourse is based on the positivist-biological trend in humanitarian knowledge and it is the basis for the production and reproduction of medical and pharmaceutical repressive ideology; criticism of philosophical clinical discourse opens the possibility of overcoming the dominance of purely clinicist discourse; such a transformation is possible only after a paradigm shift in understanding the category of subject. (shrink)

This paper aims to show how clinical pragmatics can fruitfully inform the classical theoretical models proposed by philosophical pragmatics. In the first part of the paper I argue that theories proposed in the domain of philosophical pragmatics, as those elaborated by Austin and Grice, are not plausible from a cognitive point of view and that for this reason they cannot be useful to understand pragmatic deficits. In the second part, I show that Relevance Theory overcomes this limitation, (...) but I also argue that it offers a restricted view of human communication which has to be integrated with a model of language use that takes into account a central pragmatic property: coherence of discourse. (shrink)

This book moves away from the frameworks that have traditionally guided ethical decision-making in the Western clinical setting, towards an inclusive, non-coercive and, reflective dialogic approach to moral decision-making. Inspired in part by Jürgen Habermas's discourse theory of morality and principles of communicative action, the book offers a proportionist approach as a way of balancing out the wisdom in traditional frameworks, set in the actual reality of the clinical situation at hand. Putting this approach into practice requires (...) having a conversation, a dialogue or a discourse, with collaboration amongst all the stakeholders. The aim of the dialogue is to reach consensus in the decision, via mutual understanding of the values held by the patient and others whom they see as significant. This book aims to underscore the moral philosophical foundations for having a meaningful conversation. Life and Death Decision in the Clinical Setting is especially relevant in our contemporary era, characterised medically by an ever-increasing armamentarium of life-sustaining technology, but also by increasing multiculturalism, a multiplicity of faiths, and increasing value pluralism. (shrink)

This book critically assesses the implications of modern medicine's claim to be a natural science. Medicine models its scientific and clinical self-understanding on an obsolete positivist conception of science, reality, and consciousness. In this view, the body is modeled as a biological machine, disease as breakdown of the machine, and therapy as physical measures to fix the machine. The problems besetting medical science and practice are rooted in the inadequacy of the positivist philosophical assumptions regarding the nature of (...) science, reality and consciousness To base the diagnostic practices and therapeutic regimes purely on knowledge of physical processes in the human body is, in view of this analysis, at best grossly inadequate, at worst thoroughly dehumanizing (Anton van Niekerk: Editorial Foreword). This means that medicine's clinical method cannot be transformed without transforming the underlying view of science, of reality, and of the human person. The book proposes a broader model of science which overcomes the outdated dichotomy between human and natural sciences. Science is viewed as an interdisciplinary exercise generating multiple perspectives. The insights of the human sciences are essential for scientific clinical medicine. Utilizing evolutionary biology and complexity theory, the author proposes an alternative understanding of reality and human consciousness as a basis for a transformed clinical method. Reality is a hierarchy of systems of increasing complexity. Different levels can be distinguished, namely material systems, living material systems, conscious living material systems and self-conscious living material systems. Each level represents a new manner of being which requires a different scientific discourse of understanding. Using this model of reality the author argues against understanding human consciousness as a byproduct of physical processes in the brain. The human person is a self-conscious, complex, psycho-somatic system, whose well-being is conditioned by much more than physical processes. (shrink)

In some popular and political discourse, ‘compassion’ is commonly conceived as a simple or ‘given’ aspect of the world. And yet public discussion also focusses on whether ‘compassion' has gone wrong in some way, suggesting that there might be various more or less satisfactory versions of compassion. At the same time, some thinkers doubt whether compassion should any longer be expected of those working in healthcare. This article draws on philosophical and theological resources to argue that the conceptual (...) context which forms compassion is crucial for determining the ethos of healthcare. The discussion explores three themes – politics, suffering and responsibility – which must be addressed in order to understand what is wrong with compassion, to identify lines of future investigation and to develop possible remedies. (shrink)

BackgroundPrevious empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice ‘on its own terms’ by turning to the experience of patients.MethodsPhenomenological analysis of in-depth individual interviews with 8 patients.ResultsWe describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point (...) provided by an engaged physician. We draw on Heidegger’s notion of solicitude to show that patients are actively ascertaining the physician’s engagement in their care.ConclusionsThese findings lead us to question the classical “dual discourse” of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician’s solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient. (shrink)

The purpose is to identify common and distinctive features of concepts and methodology of the problem of subject within different discourses, implicitly or explicitly relevant to the definition of "clinical" mode of human existence. The research methodology combines techniques of discourse analysis and basic principles of historical and philosophical studies. Scientific novelty of the research lies in definition of the clinical philosophical discourse as a special communicative process, where utterances not only focus on disease (...) syndromes, and reveal phenomenology of inner experience of a pathological self, but also structure a certain type of sociality. Clinical discourse represents the space where the patient is treated not as a subject but as an object of disease. Ontology of clinical discourse prevails over ontology of disease, since its structures determine the notion of disease as such. Categorization of the disease, the idea of disease as a phenomenon subdued to professional authority leads to the idea of the need for patient's isolation from the natural environment and removing him to special social institutions. A great while authenticity of the individual had been determined through the testimony of others and manifestation of one's connection to others; then authenticity begun to establish trough the discourse, which individual was able or obliged to deliver about himself/herself. The clinicist doctrines share the intention to reduce the patient's self to its bodily dimension, while ignoring social determinants of psychological deviations. Conclusions of the study are summarized in the following positions: the current clinical discourse is based on the positivist-biological trend in humanitarian knowledge and it is the basis for the production and reproduction of medical and pharmaceutical repressive ideology; philosophical clinical discourse opens the possibility of overcoming the dominance of purely clinicist discourse; such a transformation is possible only after a paradigm shift in understanding the category of subject. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, sensory, affective, (...) and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing amultidimensional phenomenal spacefor pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whosestructurereflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes aprimitivephenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses theutilityof continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

The article presents a philosophical understanding and real interpretation of the existence and evolution of pedagogical (educational) discourse in the postmodern space. The results of scientific research are analyzed and the structural-semantic relationship of the concepts, terms and categories associated with the terminological field “discourse” is defined. The authors raise the problem of the postmodern significance of discourse in the period of the global transformation of the educational environment, caused by the pandemic COVID-19, which has put (...) humanity before the fact of actualization of remote communication and receipt of educational services. The authors believe that distance learning should be provided with strong technical and technological support on the one hand and the use of this vector set of educational, pedagogical, learning and development technologies in the preparation of future specialists in the system of higher education on the other. The article deals with new approaches to the application of discourse-supporting technologies and methods. Thus, the emphasis is placed on the relevance of an open informational and educational environment of higher education institutions in the postmodern space where the role of discourse as a constructive tool of postmodernism is determined by the new interpretation, and the teacher becomes a generator of innovations in this context. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, sensory, affective, (...) and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing a multidimensional phenomenal space for pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whose structure reflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes a primitive phenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses the utility of continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

The once animated efforts in medical phenomenology to integrate the art and science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based (...) medicine has refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine. (shrink)

Psychoanalysis has traditionally had difficulty in accounting for the existence of evil. Freud saw it as a direct expression of unconscious forces, whereas more recent theorists have examined the links between early traumatic experiences and later ‘evil’ behaviour. _Humanizing Evil: Psychoanalytic, Philosophical and Clinical Perspectives _explores the controversies surrounding definitions of evil, and examines its various forms, from the destructive forces contained within the normal mind to the most horrific expressions observed in contemporary life. Ronald Naso and _Jon (...) Mills_ bring together an international group of experts to explore how more subtle factors can play a part, such as conformity pressures, or the morally destabilizing effects of anonymity, and show how analysts can understand and work with such factors in clinical practice._ _Each chapter is unified by the view that evil is intrinsically linked to human freedom, regardless of the gap experienced by perpetrators between their intentions and consequences. While some forms of evil follow seamlessly from psychopathology, others call this relationship into question. Rape, murder, serial killing, and psychopathy show very clear links to psychopathology and character whereas the horrors of war, religious fundamentalism, and political extremism resist such reductionism. Humanizing _Evil_ is unique in the diversity of perspectives it brings to bear on the problem of evil. It will be essential reading for psychoanalysts, psychotherapists, philosophers, and Jungians. Because it is an integrative depth-psychological effort, it will interest general readers as well as scholars from a variety of disciplines including the humanities, philosophy, religion, mental health, criminal justice, political science, sociology, and interdisciplinary studies. Ronald Naso, Ph.D., ABPP is psychoanalyst and clinical psychologist in independent practice in Stamford, CT. The author of numerous papers on psychoanalytic topics, he is an associate editor of _Contemporary Psychoanalytic Studies_, and contributing editor of _Division/Review _and _Journal of Psychology and Clinical Psychiatry_. His book, _Hypocrisy Unmasked: Dissociation, Shame, and the Ethics of Inauthenticity_, was published by Aronson in 2010. Jon Mills, Psy.D., Ph.D., ABPP is a philosopher, psychoanalyst, and clinical psychologist. He is Professor of Psychology & Psychoanalysis at Adler Graduate Professional School, Toronto. A 2006, 2011, and 2013 Gradiva Award winner, he is Editor of two book series in psychoanalysis, on the Editorial Board for _Psychoanalytic Psychology_, and is the author and/or editor of thirteen books including his most recent works, _Underworlds: Philosophies of the Unconscious from Psychoanalysis to Metaphysics_, and _Conundrums: A Critique of Contemporary Psychoanalysis_, which won the Goethe Award for best book in 2013. (shrink)

The once animated efforts in medical phenomenology to integrate the art and

science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based medicine (...) has refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine. (shrink)

A book exploring the relationship between post-Cartesian philosophy and psychoanalysis.

Health is a value-laden concept. The state of being that it designates is a fundamental human goal. As a value, the concept is normative, governing both clinical practice and the therapeutic treatment developed by medical research. Also, the promise of health plays a pivotal role in health-policy discourse. Almut Caspary considers philosophical and theological concepts of health in the context of its practical significance, both in the past and today. This conceptual analysis culminates in a preliminary sketch (...) of a concept of health; focusing on the stem-cell debate, it offers a discriminating approach to contemporary ethical problems in medicine. "Gesundheit" ist ein wertgeladener Begriff. Er bezeichnet einen grundsatzlich wunschenswerten Zustand menschlicher Existenz, der das arztliche Handeln im klinischen Alltag leitet. Daruber hinaus werden (gesundheits-)politische Debatten mit Verweis auf den Nutzen fur die Gesundheit entschieden. Vor diesem Hintergrund setzt sich Almut Caspary epochenubergreifend mit philosophischen und theologischen Uberlegungen zur Gesundheit auseinander. Die konzeptuelle Diskussion erlaubt die Skizzierung eines Gesundheitsverstandnisses, das - wie am Beispiel der Stammzelldebatte gezeigt wird - ein differenziertes Abwagen in medizinethischen Konfliktfallen zulasst. (shrink)

Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published (...) a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as “homelike being-in-the-world”. Unhealth, illness, consequently should be understood as a situation where a person’s “being-in-the-world” in characterized by that lack of the rhythm, balance and “tune” of everyday living that characterizes not “being at home”. In this article, Svenaeus’ position is briefly outlined. Questions are raised whether “unhomelikeness” is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus’ assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky. (shrink)

Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} The constructionist approach of philosophy includes an epistemic dimension and a pragmatic emphasis on the interdependence between knowledge and action in the social areas. Appreciative approach to philosophy is based on the work of David Cooperrider on “Appreciative Inquiry”, which is a form of pragmatic discourse that substitutes the (...) focus on the problem with the focus on successful elements of previous experience of individuals, groups, organizations or communities. This experience can be integrated in the philosophical discourse starting from Plato's dialogues and maieutic method promoted by Socrates. Hermeneutic of the real seen as a philosophical reflection on the daily positive experiences falls into tradition of philosophical search of the ultimate meaning of reality. The appreciative speech starts from a postmodern view by a constructivist and constructionist approach, through which reality itself is a social construction generated by successive negotiations on accepted interpretations. Appreciative philosophy is centered on a semiotics grid that seeks positive qualities of existence and its strengths. Appreciative theology reveals a collaborative process between humanity and divine that catalyzes transformations in human being giving them life including eternal life. The communion human-Divinity is seen as a divine-human co-creation. (shrink)

"This book integrates a thinking about dilemmas faced in the context of the clinical practice of psychoanalysis today, with contemporary social and political concerns specific to the age of the global consumer marketplace. Beginning with an analysis of the fate of the concept of sublimation in Freud’s work, and its relationship to the elaboration of the concept of the superego in 1923, the book examines how these concepts provide a lever for integrating psychoanalytic thinking with topics of urgent social (...) concern, beyond the critique of ideology. Taking up topics such as the experience of time, addiction to consumption, and the general consequences of the insinuation of digital technologies at increasingly earlier stages in human development-and thinking these through the lens of what the clinical practice of psychoanalysis teaches us about intimate human relatedness-the book addresses how a philosophically oriented approach to psychoanalysis can illuminate our response to the problems of everyday life under conditions of late capitalism. Drawing on a diverse range of authors such as Freud, Heidegger, Hans Loewald, Christopher Bollas, Lacan, Deleuze and Bernard Stiegler, it is argued that the concepts of sublimation and of the superego must be reinvented with regard to both clinical and critical discourse today if psychoanalysis is to remain relevant to the major issues we face, both individually and collectively, in the twenty-first century. The book stages a unique encounter between philosophy, critical theory and clinical practice that will be of interest to psychoanalysts, scholars of twentieth century Continental philosophy, critical social theorists and mental health practitioners"–. (shrink)

Introduction: Play, Power, and the Western Mentality Whereas play has always had an important, if sometimes unthemat- ized, role in Western literary ...

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are (...) justified. I address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Modern medical ethics developed in America after mid-century chiefly at theological schools, but discourse on bioethics soon moved to the pluralist-secular settings of the academy and the clinic, where it acquired a philosophical and intentionally non-religious cast. An effort was made, on the grounds of ‘liberal culture’ and ‘late Enlightenment rationality’ to find a framework for inquiry which aspired to the universal. Today, while that language persists, it coexists with, challenges, and is challenged by forms of ethical analysis (...) and advocacy which take into consideration the ‘thickness’ of complicating narrative and reasoning based in the many religious traditions. It has become incumbent upon advocates of those traditions to propose ‘publicly accessible’ argument. Keywords: bioethics, church, religion, theology CiteULike Connotea Del.icio.us What's this? (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been (...) at the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

The meaningful consideration of cultural practices, values and beliefs is a necessary component in the effective translation of advancements in neuroscience to clinical practice and public discourse. Society’s immense investment in biomedical science and technology, in conjunction with an increasingly diverse socio-cultural landscape, necessitates the study of how potential discoveries in neurodegenerative diseases such as Alzheimer disease are perceived and utilized across cultures. Building on the work of neuroscientists, ethicists and philosophers, we argue that the growing field of (...) neuroethics provides a pragmatic and constructive pathway to guide advancements in neuroscience in a manner that is culturally nuanced and relevant. Here we review a case study of one issue in culturally oriented neuroscience research where it is evident that traditional research ethics must be broadened and the values and needs of diverse populations considered for meaningful and relevant research practices. A global approach to neuroethics has the potential to furnish critical engagement with cultural considerations of advancements in neuroscience. (shrink)

This paper is predicated on the understanding that clinical encounters between clinicians and patients should be seen primarily as inter-relations among persons and, as such, are necessarily moral encounters. It aims to relocate the discussion to be had in challenging medical decision-making situations, including, for example, as the end of life comes into view, onto a more robust moral philosophical footing than is currently commonplace. In our contemporary era, those making moral decisions must be cognizant of the existence (...) of perspectives other than their own, and be attuned to the demands of inter-subjectivity. Applicable to clinical practice, we propose and justify a Habermasian approach as one useful means of achieving what can be described as dialogic consensus. The Habermasian approach builds around, first, his discourse theory of morality as universalizable to all and, second, communicative action as a cooperative search for truth. It is a concrete way to ground the discourse which must be held in complex medical decision-making situations, in its actual reality. Considerations about the theoretical underpinnings of the application of dialogic consensus to clinical practice, and potential difficulties, are explored. (shrink)

Language, Ideology, and the Human: New Interventions redefines the critical picture of language as a system of signs and ideological tropes inextricably linked to human existence. Offering reflections on the status, discursive possibilities, and political, ideological and practical uses of oral or written word in both contemporary society and the work of previous thinkers, this book traverses South African courts, British clinics, language schools in East Timor, prison cells, cinemas, literary criticism textbooks and philosophical treatises in order to forge (...) a new, diversified perspective on language, ideology, and what it means to be human. This truly international and interdisciplinary collection explores the implications that language, always materialising in the form of a historically and ideologically identifiable discourse, as well as the concept of ideology itself, have for the construction, definition and ways of speaking about 'the human'. Thematically arranged and drawing together the latest research from experts around the world, Language, Ideology, and the Human offers a view of language, ideology and the human subject that eschews simplifications and binary definitions. With contributions from across the social sciences and humanities, this book will appeal to scholars from a range of disciplines, including sociology, cultural studies, anthropology, law, linguistics, literary studies, philosophy and political science. © Sanja Bahun, Dušan Radunović and the contributors 2012. All rights reserved. (shrink)

Critical Rationalism has become an influential philosophy in many areas including a great number of scientific disciplines. Yet only few studies have been devoted to the role of the philosophy of Sir Karl Popper in the vast field of education. This volume undertakes to fill this gap. Leading scholars in the educational science and in the philosophy of education have critically written for this volume in an attempt to elaborate Popper's methodological and socio-political views and confront them with a globally (...) relevant spectrum of scientific objectives and cultural values. Among the topics discussed are moral values, education for freedom and its consequences for the student, and the critical attitude in political education. Attention is also paid to the historiography of this significant philosophical movement. Regarding pedagogical research, the empirical paradigm, the falsificatory approach to educational research, the complex relationship between educational theory and practice as well as the problem of value-neutrality in educational science are objects of critical analysis. (shrink)

Cet article est une explication suivie et presque complète du chapitre III, 12 des Entretiens d’Épictète intitulé « Sur l’exercice » et en particulier de l’opposition qu’il propose entre les exercices des acrobates et ceux du philosophe. On analyse la discussion sous-jacente avec Diogène de Sinope et la critique de la dimension spectaculaire des exercices cyniques, à laquelle Epictète oppose un entraînement philosophique essentiellement privé et même invisible.

It is now broadly accepted that disability is a concept infused with both descriptive and evaluative meaning, such that invoking the concept of disability necessarily involves making judgements of moral value as well as describing certain facts about individuals. This paper aims to map the complex terrain that shapes our current understandings of disability by outlining five distinct ‘discourses of disability’. It is shown how the similarities and differences between the discourses hinge on different ways of making sense of the (...) descriptive and evaluative dimensions of the concept, and the relationships between these dimensions. The paper concludes by considering the specific implications that these different ways of elucidating the concept of disability might have for the provision of clinical ethics support, both in terms of shaping ethical decision-making relating to people with disabilities and in terms of framing the process of providing clinical ethics support itself. (shrink)

Understanding Eating Disorders is an original contribution to the field of healthcare ethics. It develops a new theory concerning the moral basis of eating disorders, and places such disorders for the first time at the centre of philosophical discourse. The book explores the relationship that people have with food and their own body by looking at genetics and neuro-physiology, sociology and family studies, clinical psychology and psychiatry, and frames abnormal eating at the extreme of a spectrum of (...) normal behaviours, directed by moral values. Giordano argues that abnormal eating is not a psycho-pathological phenomenon, but the coherent implementation of ordinary moral values with a long tradition in Western culture. The book also contains a detailed analysis of UK legislation, accompanied by a timely critique of the law on treatment of mental disorders in general and of eating disorders in particular. (shrink)

Setting the terms of praise‐ and blameworthiness has long dominated philosophers’ discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise ‘the mentally ill’? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to (...) appraise a person as (morally) praise‐ or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold ‘the mentally ill’ responsible for their actions? If not, can it in any way be reasonable to expect them to ‘take responsibility’ for their actions and/or characters? The expectation that ‘the mentally ill’ will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of ‘the mentally ill’. It would seem that such treatment approaches are coherent only to the degree ‘the mentally ill’ can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of ‘mental illness’ and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame. (shrink)

Any attempt to describe a "best health service' must make political assumptions. For example, should it help everyone? Do different people have different entitlements to its support? Should its help be offered according to need, value for money or ability to benefit? These assumptions are not always clear to health service decision-makers immersed in clinical and economic technicalities, so HCA invited two philosophers --John Shand and David Seedhouse -- to engage in conversation about the political philosophy of health care.

Spariosu, a professor of Comparative Literature at the University of Georgia, is really a philosopher of culture. In this book, in his earlier Literature, Mimesis, and Play: Essays in Literary Theory, and in different articles, he outlines a theory influenced by Eric Havelock, E. R. Dodds, Werner Jaeger, and Rene Girard, but which in fact is quite original. The author argues in the first half of his book that in the nineteenth and twentieth centuries, Western culture accommodates two opposing concepts (...) of play. The first, the aesthetically moderated view of Kant and Schiller, is more rational and mediated. While this model of play is a reaction against the repression of the play instinct by the rationalist and post-Aristotelian tradition, it stops short of a full return to Dionysus. According to Spariosu this type of moderation merely intends to provide some flexibility to the empirical-rationalist mainstream of Western thought and to enrich it. (shrink)

This book is the result of a long-standing clinical and educational cooperation between a medical psychologist (Bergsma) and a medical ethicist/philosopher (Thomasma). It is thoroughly interdisciplinary in its examination of the difficulties of honoring the patient's and the physician's autonomy, especially in light of the changes in health care worldwide today. Although autonomy has become the primary standard of bioethics, little has been done to link it to the ways people actually behave, nor to its roots in the healing (...) relationship. Combining as it does the disciplines of psychology and philosophy, this book is a step in that direction. (shrink)

The scientific and philosophical approach to pain must be supplemented by a hermeneutics studying how racism has complicated the communication of pain. Such an investigation reveals that not only are non-white people seen as credibly speaking their pain, but also pain “science” is one of the ways races have historically been constructed. I illustrate this through a study of Frantz Fanon’s clinical writings, along with eighteenth- and nineteenth-century slave-owners’ medical manuals and related documents. I suggest that, with this (...) history, what philosophers understand as the problem of pain is best framed as the problem of colonial violence. (shrink)

Although psychoanalysis and Zen Buddhism derive from theoretical and philosophical assumptions worlds apart, both experientially-based traditions share at their heart a desire for the understanding, development, and growth of the human experience. Paul Cooper utilizes detailed clinical vignettes to contextualize the implications of Zen Buddhism in the therapeutic setting to demonstrate how its practices and beliefs inform, relate to, and enhance transformative psychoanalytic practice. The basic concepts of Zen, such as the identity of the relative and the absolute (...) and the foundational principles of emptiness and dependent-arising, are given special attention as they relate to the psychoanalytic concepts of the unconscious and its processes, transference and countertransference, formulations of self, and more. In addition, through an analysis of apophasis, a unique style of discourse that serves as a basic structure for mystical languages, he provides insight into the structure of the seemingly irrational Zen koan in order to demonstrate its function as a pedagogical and psychological tool. Though mindful of their differences, Cooper’s intent throughout is to illustrate how the practices of both Zen and psychoanalysis become internalized by the individual who engages in them and can, in turn, inform one another in mutually beneficial ways in an effort to comprehend the ramifications of an individual or collective expanding vision. (shrink)

Intersubjectivity, the existing way of humans in discourse, is the speakers’ concern over the hearers. A framework for the dynamic construction of discourse intersubjectivity by integrating philosophical and cognitive perspectives was proposed to reveal the essential philosophical and cognitive attributes of discourse intersubjectivity. Qualitative analysis and speculative methods were employed. Intersubjectivity in discourse and its dynamic construction process were investigated from speaker orientation, hearer orientation and social interaction orientation. The results show the following: (1) (...) the proposed framework clarifies the dynamic construction of discourse meaning from objectivity to subjectivity and intersubjectivity; (2) speaker orientation focuses on the dynamic construction of discourse meaning from objectivity to subjectivity; (3) hearer orientation emphasises the dynamic construction of discourse meaning from subjectivity to intersubjectivity; (4) social interaction orientation concerns the interaction between speakers and hearers in social discursive practices. The study broadens the research perspective of intersubjectivity, provides a feasible analysis framework to deeply explore intersubjectivity, helps dig up the role of humans as communicative subjects in discourse and communication, and explores the implicit interaction between speakers and hearers. (shrink)

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

The final work of the late philosopher Gilles Deleuze includes essays on such diverse literary figures as Herman Melville, Walt Whitman, D.H. Lawrence, Lewis Carroll, and others, along with philosophers Plato, Spinoza, Kant, and others. Taken together, these 18 essays--all newly revised or published here for the first time--present a profoundly new approach to literature.

One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability is (...) a complex, multi-perspective and multi-layered concept, which implies the vulnerability of different stakeholders involved in EAS practices and vulnerability in different aspects of being human (i.e., physical, mental, moral, social and spiritual). A comprehensive understanding of the notion of vulnerability, which balances as well as complements the concept of autonomy, seems to be an indispensable element of the discourse on EAS. (shrink)

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons “wise.” Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle’s intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis (...) and psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the Other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

Slavoj Žižek is one of the most influential philosophers of our current age. His work as a whole largely draws from Platonic, Cartesian, Hegelian and Lacanian thought, and has been applied to the analysis of empirical sciences, political-economic theory, as well as contemporary spirituality and theology. Jordan Peterson is a well respected clinical psychologist and has recently become one of the most influential public intellectuals of our current age. His work as a whole largely draws from Christian, Nietzschean, Jungian (...) and Piagettian thought, and has been antagonistically situated in contemporary debates on the nature of gender identity, sexual expression, communist ideology, and the importance of responsibility for a meaningful life. During Peterson’s rise to global fame these two thinkers have often been symbolically positioned by those familiar with their work as figures in an oppositional determination : Žižek standing for the future of the progressive left and revolutionary communist values, and Peterson standing for the future of the conservative right and traditional patriarchal values. In this work it is argued that the difference internal to this antagonistic positioning can be put to a productive utility. Towards this end I first attempt to use Christianity, Postmodernism and Psychoanalysis as thematic structures to focus on their core differences. Secondly, I attempt to summarize the major points of agreement that emerged from their public debate/dialogue/discussion. These two goals are established to demonstrate the importance of higher order dialogue capable of reconciling opposed figures of consciousness. Such reconciliation would not represent a synthesis to erase all differences, but rather a reconciliation that would open new spaces of productive discourse capable of approaching the nature of psychology and society. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)