Ayahuasca is a psychoactive beverage that is mostly used in ritualized settings (Santo Daime rituals, neo-shamanic rituals, and even do-it-yourself-rituals). It is a common practice in the investigated socio-cultural field to call these settings “healing rituals.” For this study, 15 people who underwent ayahuasca (self-)therapy for a particular disease like chronic pain, cancer, asthma, depression, alcohol abuse, or Hepatitis C were interviewed twice about their subjective concepts and beliefs on ayahuasca and healing. Qualitative data analysis revealed a variety of motivational (...) patterns, subjective effects, and user types. Most participants were convinced that ayahuasca had influenced their illness positively or improved their coping with their illness. More importantly, it had enhanced their well being in general. As a result, we concluded that the effects of ayahuasca should not be reduced to a pharmacological model. The substance should be conceptualized as a psychological catalyst that unfolds within different fields of sociocultural ideas. (shrink)

ABSTRACT In this commentary I evaluate what McGowan’s project would conclude with respect to the treatment of professional Australian Football League player Adam Goodes, who was incessantly ‘booed’ by crowds for the final two years of his career. Analysing Goodes’ case in light of McGowan’s argument leads me to two observations. First, McGowan’s norm-enactment approach is incredibly useful because it explains how words like ‘boo’ (with unstable meaning) can constitute actionable discrimination. Second, however, I wonder if a narrow focus on (...) whether such speech is legally actionable might encourage an overestimation of the power of laws to shepherd new g-norms into social practices. (shrink)

The prominent call to legalise same-sex marriage in Australia raises questions concerning whether its achievement will result in amplified societal acceptance of lesbian, gay, bisexual, and transgender (LGBT) people, and on what grounds this acceptance will take place. Same-sex marriage may not challenge heteronormative and patriarchal features typically associated with marriage, and may serve to reinforce a hierarchy that promotes traditional marriage as the ideal relationship structure. This may result in only assimilationist acceptance of LGBT people. However, the consequence of (...) inclusion to marriage ought to reflect social acceptance of LGBTs as people worthy of equal treatment in dignity and in rights, regardless of perceived differences or similarities to a supposed majority standard. This article argues that justice would be best served by introducing and promoting a variety of State-sanctioned unions whilst simultaneously introducing same-sex marriage. This ‘pluralisation strategy’ would increase awareness and legitimacy of other relationship-recognition options, promoting respectful acceptance of LGBT and heterosexual people alike. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with (...) BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. (shrink)

The typical outcome measure in infertility treatment is the (cumulative) healthy live birth rate per patient or per cycle. This means that those who end the treatment trajectory with a healthy baby in their arms are considered to be successful and those who do not are considered to have failed. In this article, we argue that by adopting the healthy live birth standard as the outcome measure that defines a successful fertility treatment, it becomes an interpretative self-fulfilling prophecy: those who (...) achieve the goal consider themselves successful and those who do not consider themselves failures. This is regardless of the fact that having children is only one out of many ways to alleviate the suffering related to infertility and that stopping fertility treatment can also be a positive decision to move on to other goals, rather than a form of “giving up,” “dropping out,” “nonadherence,” or failure. We suggest that those seeking fertility treatment would be served better by an alternative outcome measure, which can be equally self-fulfilling, according to which a successful treatment is one in which people leave the clinic released from the suffering that accompanied their status as infertile when they first entered the clinic. This new outcome measure still implies that walking out with a healthy baby is a positive outcome. What changes is that walking out without a baby can also be a positive outcome, rather than being marked exclusively as a failure. (shrink)

Advances in neurobiological knowledge and neuroimaging technology have contributed greatly to our investigations into the nature of self-awareness.

BackgroundThe prognosis of patients undergoing lung cancer treatment might be influenced by mental health status. Resilience is one of the important predictors to reflect the mental health status. It has been shown that patients with higher levels of social support, self-care self-efficacy, and positive coping have greater resilience. This study aimed to determine the mediating role of self-efficacy and positive coping in the relationship between social support and psychological resilience in patients with lung cancer.MethodThis is a cross-sectional study that was (...) conducted in in the oncology departments and thoracic surgical wards of four tertiary hospitals in Hunan Province, China, between November 2016 and November 2017. Three hundred and three patients who were undergoing treatment for lung cancer volunteered their participation in the study. Participants completed questionnaires, including the Chinese version of the Perceived Social Support Seale Scale, the Chinese version of Strategies Used by People to Promote Health Scale, and the Chinese version of the Connor-Davidson Resilience Scale.ResultsMediation analysis indicated that self-care self-efficacy and social support partially mediate the effect of social support on resilience. Direct paths from social support to self-efficacy, self-efficacy to positive coping, positive coping to psychological resilience, self-efficacy to psychological resilience, and social support to psychological resilience were significant. The indirect paths from social support to self-efficacy and self-efficacy to psychological resilience were also significant. The chain mediation from social support to self-efficacy, self-efficacy to positive coping, and positive coping to resilience were significant.ConclusionSelf-efficacy and positive coping play an important role in the relationship between social support and resilience in patients receiving cancer treatment. Social support not only directly influenced psychological resilience but also indirectly influenced psychological resilience through self-efficacy and positive coping. (shrink)

The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding (...) patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? (shrink)

Background: Newer “closed-loop” neurostimulation devices in development could, in theory, induce changes to patients’ personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment. Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program (...) and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception. Results: Participants generally did not attribute changes in patients’ personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients’ experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians .Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients’ illness experiences and social circumstances. (shrink)

The increasing awareness of personal health responsibility had led to the claim that patients with ‘self-inflicted’ conditions have less of a right to treatment at the public's expense than patients whose conditions arose from ‘uncontrollable’ causes. This paper suggests that regardless of any social decision as to the limits and scope of individual responsibility for health, the moral framework for discussing this issue is equality. In order to reach a consensus, discourse should be according to the common basis of all (...) theories of justice, Aristotle's formal principle of justice: ‘equals must be treated equally and unequals must be treated unequally, in proportion to the relevant inequality’. This paper deals with the question of whether and under what circumstances risk-taking behaviour could be regarded as a ‘relevant inequality’ with respect to the right to health care. Following a discussion of the relevant inequalities in health care, the conclusion is reached that the fact that the condition was avoidably caused by the patient and is therefore his or her fault can not be regarded necessarily as a relevant inequality. Therefore, the issue is one of societal support for health care; after defining relevant inequalities in this respect, the paper attempts to apply them to self-inflicted conditions. This analysis reveals that, in theory, it may be just to restrict societal support in such cases. However, the application of this conclusion requires proof of many factual claims—for which there is often very limited evidence. (shrink)

The commentaries by Warren Kinghorn and Giuseppe Butera provide me with the welcome opportunity to reaffirm and briefly address a concern that lies at the core of my work in recent years. It regards the lack of a metaphysical perspective and consequently metaphysically informed interventions, or what I recently came to term 'metaphysical care', in psychological and medical treatments when there are identifiable metaphysical assumptions at work both in clinicians and treated persons that affect the treatment and the well-being of (...) both. In the original article, this is exemplified in the failure of both psychotherapists and people affected by violence to operate with a metaphysically grounded... (shrink)

Studies have reported high rates of childhood maltreatment among individuals with drug addiction problems; however, investigation about the potentially protective factors to mitigate the effects of maltreatment experiences on motivation to engage in addiction treatment has received less attention. This study aims at exploring the mediating effects of forgiveness and self-efficacy on the association between childhood maltreatment and treatment motivation among drug addicts. A total of 360 male drug addicts were recruited from three mandatory inpatient rehabilitation centers in Malaysia. Participants (...) completed a package of self-report questionnaires including measures of childhood maltreatment experiences, forgiveness, self-efficacy, and motivation for treatment. The analysis conducted using the structural equation model revealed that childhood maltreatment significantly predicted lower treatment motivation, while forgiveness and self-efficacy played a fully mediating role regarding the effect of childhood maltreatment on treatment motivation. In conclusion, these findings suggest that combining the element of forgiveness and self-efficacy in treatment programs appears to benefit the drug addicts with childhood maltreatment history. (shrink)

Foucauldian analyses of civil society depart from classical approaches in that they don´t consider civil society to be a site of societal change or resistance as classical analyses do, but rather one of society’s multiple locations where so-called governmentality hits the ground. Although Foucauldian investigations have provided the prevailing discussion with a necessary departure from excessively idealistic images of civil society organizations as sites of resistance and societal transformation, what may have resulted in turn are overly pessimistic analyses that have (...) overlooked the emancipatory aspects of civil society organizations as sites where Foucauldian “care of the self” becomes possible. This article provides the reader with an analysis of these kind of aspects in civil society organizations’ work and, more importantly, of the conditions of their existence. The study contributes to the prevailing discussion by offering examples of the possibilities that civil society organizations have to act as a counterbalance and addition to states institutions. The context is Finnish drug treatment policies that took a client-centered and user-friendly approach at the turn of 21st century. Since then new kinds of methods to work with drug users have been initiated, which have helped the users to recast their identities and find new ways of living as a drug user. (shrink)

BackgroundAt present, adherence to antipsychotic treatment is often poor, leading to the recurrence of symptoms. This increases the likelihood of the patient experiencing disability and thus increases the disease burden for the patient, their family, and society as a whole. However, to date, there is no clear evidence regarding the effect of medication adherence interventions on outcomes for patients with schizophrenia. Moreover, the traditional intervention methods are limited by manpower and resources in low- and middle-income countries. Recent studies have demonstrated (...) that increasing a patient’s level of self-compassion may improve their treatment adherence. Online mental health care interventions have advantages in terms of feasibility and acceptability for patients with schizophrenia. In this regard, a WeChat-based self-compassion training protocol to improve patient treatment adherence was designed in this study and will be evaluated in the future to determine its impact on patients with schizophrenia.MethodsThe protocol for the randomized controlled trial is based on the SPIRIT 2013 statement. This parallel RCT will aim to recruit 392 patients with schizophrenia who will be randomized at a 1:1 ratio into a 3-week intervention or control group. Both groups will receive routine care. The intervention group will also receive WeChat-based self-compassion training, which requires participants to complete three tasks every day, including a reading task, a meditation task, and a self-compassion journal task. The control group will receive WeChat-based psychological health education, which will only require participants to read positive articles about psychological health every day. Medication adherence, self-compassion, stigma, and social support will be measured at baseline, immediately after the intervention, and 3 weeks after the intervention. Program feasibility will be evaluated throughout the course of the study, and acceptability will be measured immediately after the intervention.Expected results:The intervention described here will address the barriers to accessing mental health care for people with schizophrenia, including patients’ desire for independent management, difficulty accessing providers, and concerns about privacy and stigma. The current study provides guidance for clinical nurses to carry out psychological intervention, with the ultimate aim of addressing the problems associated with a shortage of psychological professionals in low- and middle-income countries. (shrink)

Volume 20, Issue 8, August 2020, Page 119-120.

IntroductionA symptom cluster is very common among oncological patients: cancer-related fatigue, emotional distress, sleep difficulties, pain, and cognitive difficulties. Clinical applications of interventions based on non-ordinary states of consciousness, mostly hypnosis and meditation, are starting to be investigated in oncology settings. They revealed encouraging results in terms of improvements of these symptoms. However, these studies often focused on breast cancer patients, with methodological limitations. Another non-ordinary state of consciousness may also have therapeutic applications in oncology: self-induced cognitive trance. It seems (...) to differ from hypnosis and meditation, as it involves the body more directly. Thus, investigating its clinical applications, along with hypnosis and meditation interventions, could improve available therapeutic options in oncology. This article details the study protocol of a preference-based longitudinal controlled superiority trial aiming to assess the effectiveness of 3 group interventions to improve oncological patients’ quality of life, and more specifically CRF, emotional distress, sleep, pain, and cognitive difficulties.Methods and analysisA power analysis required a total sample of 160 patients. Main inclusion criteria are: cancer diagnosis, active treatments completed for less than a year, no practice of hypnosis, meditation, or SICT, and presence of at least one of these four symptoms: fatigue, sleep difficulties, depression, or anxiety. Each participant will choose the intervention in which they want to participate. To test the effectiveness of the interventions, data will be collected by questionnaires and neurobiological measures and directly from the medical record at four time points: before inclusion in the study ; immediately after the intervention; and at 3- and 12-month follow-up. The longitudinal data in each group will then be measured.DiscussionIn addition to standard cancer therapies, there is a growing interest from patients in complementary approaches, such as hypnosis, meditation, and SICT. The results of this study will be useful to increase knowledge about short- and long-term effectiveness of 3 group interventions for CRF, emotional distress, sleep, pain, and cognitive difficulties in patients with different cancers.Clinical Trial RegistrationClinicalTrials.gov/. Retrospectively registered on the 29th of April 2021. url: https://clinicaltrials.gov/ct2/show/NCT04873661. (shrink)

As evaluation of practitioners’ competence is largely based on self-report, accuracy in practitioners’ self-assessment is essential for ensuring high quality treatment-delivery. The aim of this study was to assess the relationship between independent observers’ ratings and practitioners’ self-reported treatment integrity ratings of Motivational interviewing. Practitioners were randomized to two types of supervision [i.e., regular institutional group supervision, or individual telephone supervision based on the MI Treatment Integrity code]. The mean age was 43.2 years, and 62.7 percent were females. All sessions (...) were recorded and evaluated with the MITI, and the MI skills were self-assessed with a questionnaire over a period of 12 months. The associations between self-reported and objectively assessed MI skills were overall weak, but increased slightly from baseline to the 12-months assessment. However, the self-ratings from the group that received monthly objective feedback were not more accurate than those participating in regular group supervision. These results expand findings from previous studies and have important implications for assessment of practitioners’ treatment fidelity: Practitioners may learn to improve the accuracy of self-assessment of competence, but to ensure that patients receive intended care, adherence and competence should be assessed objectively. (shrink)

Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation in patients with Major Depressive Disorder.Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory. Associations between depression changes on BDI13 domains, treatment arm, (...) time, and clinical variables were tested in a mixed linear model.Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI13 were personality disorders, a past history of suicide attempt, age under 65 years old, and female sex.Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt. (shrink)

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

Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors’ decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed (...) ought to make such decisions, and whether the relatives’ preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors’ decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious , because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death. (shrink)

When a Jehovah’s Witness patient is traumatically injured, the lack of uniform professional consensus guidelines and the cultural knowledge deficit of many clinicians adds an additional layer of legal and ethical complexity to the inherent difficulty of managing a critically ill patient. We present here the case of an incapacitated Jehovah's Witness patient with severe traumatic hemorrhagic shock. We go on to discuss the historical and contemporary case law on proxy refusal of blood transfusion for the incapacitated adult, as well (...) as the ethics of self-determination and the application of the principle of proportionate reason in the management of the critically injured Jehovah's Witness patient. (shrink)

The aim of the study was to confirm the mediation effects of the task-specific self-efficacy on the relationship between the general self-efficacy and intention and planning considering treatment. The study comprised 265 subjects, of which 165 were post-mastectomy women and 100 patients hospitalized due to acute coronary syndrome. The variables were assessed using the Generalized Self-Efficacy Scale and tools developed to examine the context of treatment. The data were analyzed using the bootstrapping procedure. The results confirmed the indirect effects of (...) task-specific self-efficacy, both in women making a decision to undergo breast reconstruction, and in patients after ACS formulating intention to change risk behaviours. As smoking was considered to be a moderator in the post-ACS group, the obtained associations were observed only among the patients declaring quitting smoking. In view of the fact that taskspecific self-efficacy is susceptible to context, it is useful to assess it in order to increase treatment effectiveness. (shrink)

Self and World is an exploration of the nature of self-awareness. Quassim Cassam challenges the widespread and influential view that we cannot be introspectively aware of ourselves as objects in the world. In opposition to the views of many empiricist and idealistic philosophers, including Hume, Kant and Wittgenstein, he argues that the self is not systematically elusive from the perspective of self-consciousness, and that consciousness of our thoughts and experiences requires a sense of our thinking, experiencing selves as shaped, located, (...) and solid physical objects in a world of such objects. Awareness of oneself as a physical object involves forms of bodily self-awareness whose importance has seldom been properly acknowledged in philosophical accounts of the self and self-awareness. The conception of self-awareness defended in this book helps to undermins the idealist thesis that the self does not belong to the world, and also the claim that the existence of subjects or persons is only a derivative feature of reality. In the final part of the book, Cassam argues that the existence of persons is a substantial fact about the world, and that it is not possible to give a complete description of reality without claiming that persons exist. This clear, original, and challenging treatment of one of the deepest intellectual problems will demand the attention of all philosophers and cognitive scientists who are concerned with the self. (shrink)

We investigate how social comparison processes in leader treatment quality impact group members’ self-worth, affect, and behavior. Evidences from the field and the laboratory suggest that employees who are treated kinder and more considerate than their fellow group members experience more self-worth and positive affect. Moreover, the greater positive self-implications of preferentially treated group members motivate them more strongly to comply with norms and to engage in tasks that benefit the group. These findings suggest that leaders face an ethical trade-off (...) between satisfying the moral standard of treating everybody equally well and satisfying individual group members’ desire to be treated better than others. (shrink)

The aim of this study was to validate the Polish adaptation of the Treatment Self-Regulation Questionnaire, which measures the degree of self-determination in risk behaviour changes. The study comprised 219 patients, beginning to undergo treatment. The Global Motivation Scale was used to test a convergent validity. The confirmatory factor analysis did not support the theoretical four-factor model, thus an exploratory analysis was conducted to determine an optimal model across risk behaviours. The adopted two-factor model matched original TSRQ subscales: autonomous motivation (...) and external regulation. The internal consistency of factors ranging from.78 to.89. Structural equation modeling revealed the impact of global motivation on contextual motivation, limited to the equivalent type of regulation. The action aimed at supporting patient’s autonomy should consider the particular behaviour and the global motivation as a resource in disease. (shrink)

In the philosophical literature, self-deception is mainly approached through the analysis of paradoxes. Yet, it is agreed that self-deception is motivated by protection from distress. In this paper, we argue, with the help of findings from cognitive neuroscience and psychology, that self-deception is a type of affective coping. First, we criticize the main solutions to the paradoxes of self-deception. We then present a new approach to self-deception. Self-deception, we argue, involves three appraisals of the distressing evidence: (a) appraisal of the (...) strength of evidence as uncertain, (b) low coping potential and (c) negative anticipation along the lines of Damasio’s somatic marker hypothesis. At the same time, desire impacts the treatment of flattering evidence via dopamine. Our main proposal is that self-deception involves emotional mechanisms provoking a preference for immediate reward despite possible long-term negative repercussions. In the last part, we use this emotional model to revisit the philosophical paradoxes. (shrink)

This paper defends Lewis’ influential treatment of de se attitudes from recent criticism to the effect that a key explanatory notion—self-ascription—goes unexplained. It is shown that Lewis’ treatment can be reconstructed in a way which provides clear responses. This sheds light on the explanatory ambitions of those engaged in Lewis’ project.

Moral treatment refers to a psychological approach to treating mental disorder that arose across Europe and North America around the turn of the eighteenth century. It is mostly associated with the French physician Philippe Pinel (1745–1826) and the English Quaker philanthropist William Tuke (1732–1819). Pinel and Tuke each independently developed their own distinct models of the once popular therapy known as moral treatment. Although moral treatment is often considered to have been a successful therapy in its early years, it was (...) eventually replaced by custodial care on a mass scale and became a travesty of its earlier self. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

본 논문은 의료기술이 발달하면서 등장하게 된 다양한 도덕적 문제 가운데 하나로, 회복 불가능한 환자에 대한 심폐소생술 결정 문제 및 최근 제정된 연명의료결정법 의 자기결정권에 대해 살펴보고자 한다. 연명의료결정법 이 제정되기 이전 한국사회에서는 회복불가능한 환자의 심폐소생술 시행 여부를 가족이 결정하는 특징을 보였으며, 이는 한국사회 특유의 유교적 정서로 논의되곤 했다. 연명의료결정법 의 등장 이후, 연명의료결정의 주요 주체는 환자 자신으로 전환되었으며 그 주요 근거는 자기결정권이다. 본 논문에서는 이러한 한국사회에서 가족결정 중심의 심폐소생술 금지 논의에서 자기결정권 중심의 연명의료결정법 으로의 전환을 살펴보고, 자기결정권과 관련하여 보충되어야 할 (...) 논의들과 연명의료결정법 의 철학적 근거가 되어야 할 生의 문제, 죽음에 대한 관점 등을 『周易』을 통해 살펴보고자 한다. 특히 주역의 연대적 生철학, 죽음이 아닌 마무리지어가는 과정을 중시하는 終始에 기반 한 死生觀을 통해, 연명의료결정법 에 보완되어야 할 사유를 논의해 보고자 한다. (shrink)

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. Understanding (...) the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)

Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event. Frailty is most frequently assessed in the old using the Clinical Frailty Scale (CSF) which ranks frailty from 1 to 9. This assessment typically takes less than one minute and is not validated in patients with learning difficulties or those under 65 years old. The National Institute for Health and Care Excellence (NICE) developed guidelines that use “frailty” as one of the priority-setting criteria for (...) how scarce, but potentially lifesaving, health care resources should be allocated during the COVID-19 pandemic. Similar guidelines have been developed elsewhere. This paper discusses the ethical implications of such rationing and argues that this is an unproven and ethically problematic form of health care rationing. It specifically discusses: (1) how the frailty ascription becomes a self-fulfilling prophecy, (2) the problematic use of “frailty” in COVID-19 “triage,” (3) the circularity of the link between age and frailty, (4) indirect discrimination because of the use of a seemingly neutral criterion in health care rationing, and (5) the difficult link between comorbidities and frailty. It is found that there was no research into the use of global frailty scores as a criterion for access to acute treatment before January 2020 and so it is concerning how readily frailty scoring has been adopted to ration access to potentially lifesaving treatments. Existing gerontological frailty scoring systems have not been developed for this purpose, and repurposing them creates significant ethical issues. (shrink)

The concept of a relational self has been prominent in feminism, communitarianism, narrative self theories, and social network theories, and has been important to theorizing about practical dimensions of selfhood. However, it has been largely ignored in traditional philosophical theories of personal identity, which have been dominated by psychological and animal theories of the self. This book offers a systematic treatment of the notion of the self as constituted by social, cultural, political, and biological relations. The author's account incorporates practical (...) concerns and addresses how a relational self has agency, autonomy, responsibility, and continuity through time in the face of change and impairments. This cumulative network model of the self incorporates concepts from work in the American pragmatist and naturalist tradition. The ultimate aim of the book is to bridge traditions that are often disconnected from one another--feminism, personal identity theory, and pragmatism--to develop a unified theory of the self. (shrink)

This paper develops the Diachronic Self-Making View, the view that we are the non-accidentally best candidate referents of our ‘I’-beliefs. A formulation and defence of DSV is followed by an overview of its treatment of familiar puzzle cases about personal identity. The rest of the paper focuses on a challenge to DSV, the Puzzle of Inconstant ‘I’-beliefs: the view appears to force on us inconsistent verdicts about personal identity in cases that we would naturally describe as changes in one’s de (...) se beliefs. To solve this problem, the paper defends the possibility of overlapping people, and addresses a number of objections to this idea. (shrink)

The Self-Intimation thesis has it that whatever justificatory status a proposition has, i.e., whether or not we are justified in believing it, we are justified in believing that it has that status. The Infallibility thesis has it that whatever justificatory status we are justified in believing that a proposition has, the proposition in fact has that status. Jointly, Self-Intimation and Infallibility imply that the justificatory status of a proposition closely aligns with the justification we have about that justificatory status. Self-Intimation (...) has two noteworthy implications. First, assuming that we never have sufficient justification for a proposition and for its negation, we can derive Infallibility from Self-Intimation. Interestingly, there seems to be no equivalently simple way to derive Self-Intimation from Infallibility. This asymmetry provides reason for thinking that bottom-level justification rather than top-level justification drives the explanation for why the levels of justification align. Second, Self-Intimation suggests a counterintuitive treatment of information concerning what justificatory status a proposition has. It follows from Self-Intimation that we always have justification for the truth about whether a proposition is justified for us, and therefore, that higher-order evidence could change what we should believe on this matter only by misleading us. This permits forming beliefs about whether a proposition is justified for us without regard to higher-order evidence, and thus reveals a reason for thinking that top-level justification is evidentially inert. (shrink)

A currently popular view traces autistic cognitive abnormalities to a defective capacity for theorizing about other minds. Two prominent researchers, Uta Frith and Francesca Happé, extend this account by tracing further autistic abnormalities to impaired self-consciousness. This paper argues that Frith and Happé's account requires a treatment of autistic self-report that is problematic on both methodological and philosophical grounds. However, the philosophical problems point to an alternative account of self-awareness and self-report in normal individuals; and this account gives us a (...) methodologically more attractive approach to explaining autistic abnormalities. (shrink)

A 'self-refutation argument' is any argument which aims at showing that a certain thesis is self-refuting. This study was the first book-length treatment of ancient self-refutation and provides a unified account of what is distinctive in the ancient approach to the self-refutation argument, on the basis of close philological, logical and historical analysis of a variety of sources. It examines the logic, force and prospects of this original style of argumentation within the context of ancient philosophical debates, dispelling various misconceptions (...) concerning its nature and purpose and elucidating some important differences which exist both within the ancient approach to self-refutation and between that approach, as a whole, and some modern counterparts of it. In providing a comprehensive account of ancient self-refutation, the book advances our understanding of influential and debated texts and arguments from philosophers like Democritus, Plato, Aristotle, Epicurus, the Stoics, the Academic sceptics, the Pyrrhonists and Augustine. (shrink)

Self-generation of knowledge can activate deeper cognitive processing and improve long-term retention compared to the passive reception of information. It plays a distinctive role within the concept of inquiry-based learning, which is an activity-oriented, student-centered collaborative learning approach in which students become actively involved in knowledge construction. This approach allows students to not only acquire content knowledge, but also an understanding of investigative procedures/inquiry skills – in particular the control-of-variables strategy (CVS). From the perspective of cognitive load theory, generating answers (...) and solutions during inquiry-based learning is inefficient as it imposes an intrinsic and extraneous load on learners. Previous research on self-generation of content knowledge in inquiry-based learning has demonstrated that (1) a high cognitive load impairs retention of the generated information, (2) feedback is a fundamental requirement for self-generation of complex content knowledge, (3) self-generation success is key to long-term retention and (4) generating and rereading place different demands on learners. However, there is still no research on the self-generation of scientific reasoning skills and the interaction between the retention of these skills with prior knowledge, feedback and self-generation success. That is why this experiment was conducted. The focus of this research is to analyze the distinctive role of self-generation of scientific reasoning skills within the concept of inquiry-based learning and to identify the influence of prior knowledge and self-generation success on short-term and long-term retention. For this purpose, an experiment involving 133 6th and 7th graders was conducted. An inquiry activity that included the self-generation of scientific reasoning skills was compared to an inquiry task that had students simply read information about the experimental design. We used both an immediate and a delayed test to examine which treatment better developed a deeper understanding of CVS and an ability to apply this knowledge to novel problems (transfer). Direct instruction was clearly superior to self-generation in facilitating students’ acquisition of CVS immediately after the inquiry task. However, after a period of one week had elapsed, both treatment conditions turned out to be equally effective. A generation effect was only found among students with high self-generation success after a 1-week delay. (shrink)

While issues of efficacy and specificity are crucial for the future of neurofeedback training, there may be alternative designs and control analyses to circumvent the methodological and ethical problems associated with double-blind placebo studies. Surprisingly, most NF studies do not report the most immediate result of their NF training, i.e. whether or not children with ADHD gain control over their brain activity during the training sessions. For the investigation of specificity, however, it seems essential to analyze the learning and adaptation (...) processes that take place in the course of the training and to relate improvements in self-regulated brain activity across training sessions to behavioral, neuropsychological and electrophysiological outcomes. To this aim, a review of studies on neurofeedback training with ADHD patients, which include the analysis of learning across training sessions or relate training performance to outcome, is presented. Methods on how to evaluate and quantify learning of EEG regulation over time are discussed. “Non-learning” has been reported in a small number of ADHD-studies, but has not been a focus of general methodological discussion so far. For this reason, selected results from the brain-computer interface (BCI) research on the so-called “brain-computer illiteracy”, the inability to gain control over one’s brain activity, are also included. It is concluded that in the discussion on specificity, more attention should be devoted to the analysis of EEG regulation performance in the course of the training and its impact on clinical outcome. It is necessary to improve the knowledge on characteristic cross-session and within-session learning trajectories in ADHD and to provide the best conditions for learning. (shrink)

According to one tradition in the philosophy of language and mind, the content of a psychological attitude can be characterized by a set of possibilities. On the classic version of this account, advocated by Hintikka (1962) and Stalnaker (1984) among others, the possibilities in question are possible worlds, ways the universe might be. Lewis (1979, 1983a) proposed an alternative to this account, according to which the possibilities in question are possible individuals or centered worlds, ways an individual might be. The (...) motivation for the centered worlds theory has primarily to do with self-locating – or de se – attitudes. The focus of this paper is on the less-discussed question of how other-locating – or de re – attitudes ought to be treated within this framework. Most advocates of what we might call the modal approach to attitudes, Stalnaker and Lewis included, offer some kind of descriptivist solution to the well-known problems that other-locating attitudes raise. There are intramural differences between Stalnaker, Lewis, and other modal theorists (e.g. two-dimensionalists) on a number of issues: on the precise nature of the descriptivism involved, how attitude content relates to the asserted content of the sentences we utter, and on the proper semantic treatment of attitude reports. I pass over these differences to focus on a problem common to these various approaches: all face a problem when it comes to characterizing the contents of counterfactual attitudes like imagining, dreaming, and wishing. (shrink)