In acute inpatient mental health services, patients commonly demonstrate extreme behaviours. A number of coercive practices, such as locked doors, enforced medication and seclusion, are used in these settings to control such behaviours. The aim of this report is to explore briefly some of the contemporary debates pertaining to seclusion. A perusal of the literature reveals a clarion call to end the practice of seclusion, without consideration of feasible alternatives. It is hoped that this brief report will (...) encourage further evidence-based discussion and research initiatives on this important ethical topic. (shrink)

Since the mid-nineteenth century, women in Europe, North America and elsewhere have played an increasing role in the workforce. Women started pursuing jobs in factories, offices and businesses instead of being dependent on men for their livelihood. However, along with this significant improvement in the status of women, they still face obstacles, such as the gender pay gab and harassment in the workplace. Although both males and females experience harassment, the available literature clearly suggests that females are more likely to (...) be harassed. Much of the research concerning workplace harassment against women has been conducted in the West while little is known about this phenomenon in workplaces across the Arab and Muslim countries. In fact, gender relations and the nature of workplaces in Arab countries vary significantly from the Western workplace due to religious, social and cultural traditions. Muslim women live in the midst of patriarchal cultures where women’s honour is believed to be sacred. The ideology of women’s seclusion and subordination resulted in the restriction of their ability to participate in the labour force even where females are in urgent need of earned income. In this regard, harassment considers a crucial subject on various international agendas. The Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) for instance, reinforces the implementation of legislation that protects women against gender discrimination. Islam in a similar manner respects women and acknowledges their major role within a society. Therefore, as women living in Muslim communities where issues related to sexuality are sensitive, and people are reluctant to discuss such questions in public, this paper aims to discuss women seclusion, the situation of Muslim women with regard to harassment in the workplace, how international human rights deals with harassment as well as the relation between the Islamic jurisprudence and the international human rights with regard harassment in the workplace. (shrink)

The increased focus on issues of gender and schooling in India over the last decade has produced several gains that include more incentive schemes to make girls attend school, greater employment of women teachers and improved efforts to incorporate female protagonists in textbooks. However, a closer reading of this ‘gender’ focus reveals an inordinate concern with numbers, i.e. enrolment. The instrumentalism that underlies these efforts is revealed through a double-move effected by existing discourses. The first is to locate the reasons (...) why girls are out of school strictly within a reading of cultural and familial practices and (secondly) to therefore fail to recognize normative practices of schooling and State policies as already deeply ‘gendered’. This double-move is epitomized in the Indian State’s more recent efforts to set up residential elementary schools for girls (Kasturba Gandhi Vidyalayas) in each district of the country; an effort that has been publicly lauded as the most effective way to overcome cultural barriers to girls’ schooling. Through a focus on policy documents that discuss this scheme, the article will interrogate the existing conflation of ‘gender’ with a biological/culturalist reading of the ‘girl child’. In what ways does this narrow focus naturalize a binary frame of reference around the traditional family/community and the empowered girl child? Why have State efforts around educating the ‘girl child’ not been subject to greater critical analysis amongst feminist scholars in India? (shrink)

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The (...) participants believed that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent. (shrink)

This essay critically examines some classic philosophical and legal theories of privacy, organized into four categories: the nonintrusion, seclusion, limitation, and control theories of privacy. Although each theory includes one or more important insights regarding the concept of privacy, I argue that each falls short of providing an adequate account of privacy. I then examine and defend a theory of privacy that incorporates elements of the classic theories into one unified theory: the Restricted Access/Limited Control (RALC) theory of privacy. (...) Using an example involving data-mining technology on the Internet, I show how RALC can help us to frame an online privacy policy that is sufficiently comprehensive in scope to address a wide range of privacy concerns that arise in connection with computers and information technology. (shrink)

A programme of research into conflict (e.g. violence, absconding, medication refusal) and containment (e.g. seclusion, special observation, physical restraint) in inpatient psychiatry has been under way at City University, London, UK, for the past 10 years. Recent research findings, plus the challenges posed by ongoing projects, have made apparent the need for greater clarity about the overarching concepts of ‘conflict’ and ‘containment’. This paper pulls together research findings pertaining to this issue, and conducts a reasoned analysis of what common (...) characteristics might underlie ‘conflict’ and ‘containment’. It is concluded that these are patient threats to safety, and the staff maintenance of safety. Details are presented on the inclusions and exclusions that follow from taking such a position, and potential definitions offered. On the grounds of this conceptual analysis, plus evidence for moderate degrees of statistical association between behaviours and events in each domain, it is concluded that it is legitimate to conduct analyses at the level of total conflict and containment rates, as well as at the level of individual types of behaviours and events (e.g. verbal abuse, sedation). Some of the mathematical difficulties in the analysis of total conflict and containment are addressed, and results of a weighting exercise presented. This exercise challenges our perception of the severity of some containment measures that are becoming more commonly used in acute psychiatry. (shrink)

We present a multiscale integrationist interpretation of the boundaries of cognitive systems, using the Markov blanket formalism of the variational free energy principle. This interpretation is intended as a corrective for the philosophical debate over internalist and externalist interpretations of cognitive boundaries; we stake out a compromise position. We first survey key principles of new radical views of cognition. We then describe an internalist interpretation premised on the Markov blanket formalism. Having reviewed these accounts, we develop our positive multiscale account. (...) We argue that the statistical seclusion of internal from external states of the system—entailed by the existence of a Markov boundary—can coexist happily with the multiscale integration of the system through its dynamics. Our approach does not privilege any given boundary, nor does it argue that all boundaries are equally prescient. We argue that the relevant boundaries of cognition depend on the level being characterised and the explanatory interests that guide investigation. We approach the issue of how and where to draw the boundaries of cognitive systems through a multiscale ontology of cognitive systems, which offers a multidisciplinary research heuristic for cognitive science. (shrink)

A largely qualitative body of literature has contributed to understanding the contradictory dimensions of community gardening as a social justice tool. Building on this literature through a city-wide, quantitative intervention, this paper focuses on community gardening as a facilitator of ecological gentrification in St. Louis, Missouri. Combining the analytical lenses of spatial justice, urban political ecology, and the rent gap theory of gentrification, I deploy spatial regression analysis to show that community gardening was positively associated with gentrification in St. Louis (...) between the years 2000 and 2010, as measured by the growth of high socioeconomic status residents in each neighborhood. This result suggests that a sociospatial dialectic exists in which the implementation of a community garden, a change in the use of urban space, leads to unintended social outcomes. Contextualizing this finding within the broader literature, I conclude that the potential of community gardening as an instrument for spatial justice is contingent on institutional support against larger-scale processes, like gentrification, that lead to spatially unjust outcomes. (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics (...) and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics (...) and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

From the Qur'an, Surah Maryam: -/- (21) So she conceived him, and went in seclusion with him to a remote place. (22) And the pains of childbirth drove her to the trunk of a palm tree: she cried (in her anguish): "Ah! would that I had died before this! Would that I had been a thing forgotten and out of sight!" (23) But (a voice) cried to her from beneath the (palm tree): "Grieve not! for thy Lord hath provided (...) a rivulet beneath thee;" (24) "And shake towards thyself the trunk of the palm tree: it will let fall fresh ripe dates upon thee." (25) "So eat and drink and cool (thine) eye. And if thou dost see any man say 'I have vowed a fast to (Allah) Most Gracious, and this day will I enter into no talk with any human being.'" -/- This Surah depicts a human being in unbearable pain. What makes the pain tolerable is the sympathy that God shows for Mary. Hearing her inner voice, understanding her suffering and her grief, God is moved to provide her with practical and substantive support to help her bear her agony. For me this story portrays a God who is active in the world, hears the supplications of humanity, and has empathy with the needy, the oppressed, and those who are suffering. -/- Yet I am concerned that our theological traditions in the Islamic world (as also in Christendom) have developed through the centuries such that God is now seen, by overwhelming theological consensus, as an immutable being, a being outside time who has determined our providence from the standpoint of eternity, who has foreknowledge of every free action of his creations and has designed all according to His plan for past and future events; who knows in advance even the timings and contents of our petitionary prayers and has decided already whether to answer them. (shrink)

The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. We (...) argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach. The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures. (shrink)

In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes are tailored (...) to the interests and context, and the type of impact stakeholders envisage. There is an emphasis on realizing social change through the conduct of the research, and it is believed that the engagement of stakeholders in the research process will promote their intrinsic motivation to change their practice. Another distinctive feature of participatory bioethics research is that its central normative commitment is to reflection and dialogue, not to a particular substantive ethical approach. In reflection and dialogue there is an emphasis on inclusion and the co-production of knowledge. Furthermore, empirical and normative research are combined, and there is a deliberate attempt to give voice to otherwise marginalized positions. This provides a model of social impact which is relevant not only for bioethics research, but also for other areas of health care research. We will show the merits of a participatory approach to bioethics research with a case example. It concerns the reduction of coercion and in particular seclusion in Dutch mental healthcare. (shrink)

Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

In the closed wards of mental health institutions, moral decisions are made concerning the use of forced seclusion. In this article we focus on how these moral decisions are made and can be improved. We present a case study concerning moral deliberations on the use of seclusion and its prevention among nurses of a closed mental health ward. Moral psychology provides an explanation of how moral judgments are developed through processes of interaction. We will make use of the (...) Social Intuitionist Model of Jonathan Haidt that emphasizes the role of emotions, intuitions and the social context in moral judgments and reasoning. We argue that this model can help to explain social dynamics in the context of enforced seclusion. In the discussion we explore how moral psychology can be complemented with the normative perspective of dialogical ethics to develop strategies for improving psychiatric practices. We conclude that social processes play an important role in moral deliberations and that moral development can be fostered by bringing in new perspectives in the dialogue. Moral case deliberation provides a practical tool to systematically organize moral reflections among nurses on the work floor. (shrink)

In recent years, the international commons movement has increasingly joined forces with the global movement of municipalities, putting common ideas on the political agenda in many western countries. Commons have been widely discussed in literature. Broadly understood, commons refers to the practices for collective development, ownership, management, and fair access to resources and artifacts (social, cultural, economic, political, environmental, and technological). However, the concept remains vague, complex, and unclear, especially when it comes to different contexts in which new definitions are (...) needed to better understand the societal and cultural dimensions of urban commons. Decolonizing the notion of urban commons brings into visibility the unseen cultures, infrastructural systems, and communities showing where de-growth and separation can take place. Therefore, this analysis can provide new insights, opportunities, and the need for new theoretical, methodological, and shared approaches. There is a gap in transnational research and cultural understanding within the field of urban commons. This research opens new lines of inquiry relating to the definitions of commons in non-European countries. This may include longitudinal research on the decolonization and potential fragmenting of the commons and in particular 'commoning' mindset, more detailed empirical evidence of the cultural and communal concepts, and how these cultural diversities and new interpretations can be implemented in collaborative governance in a wider variety of non-western contexts. By challenging existing frameworks, this study facilitates the emergence of differentiated, dynamic, and non-linear forms of social and political subjectivity within various sociospatial domains. (shrink)

The voluminous writings of Ludwig Wittgenstein contain some of the most profound reflections of recent times on the nature of the human subject and self-understanding - the human condition, philosophically speaking. Describing Ourselves mines those extensive writings for a conception of the self that stands in striking contrast to its predecessors as well as its more recent alternatives. More specifically, the book offers a detailed discussion of Wittgenstein's later writings on language and mind as they hold special significance for the (...) understanding and clarification of the distinctive character of self-descriptive or autobiographical language. Garry L. Hagberg undertakes a ground-breaking philosophical investigation of selected autobiographical writings - among the best examples we have of human selves exploring themselves - as they cast new and special light on the critique of mind-body dualism and its undercurrents in particular and on the nature of autobiographical consciousness more generally. The chapters take up in turn the topics of self-consciousness, what Wittgenstein calls 'the inner picture', mental privacy and the picture of metaphysical seclusion, the very idea of our observation of the contents of consciousness, first-person expressive speech, reflexive or self-directed thought and competing pictures of introspection, the nuances of retrospective self-understanding, person-perception and the corollary issues of self-perception (itself an interestingly dangerous phrase), self-defining memory, and the therapeutic conception of philosophical progress as it applies to all of these issues. The cast of characters interwoven throughout this rich discussion include, in addition to Wittgenstein centrally, Augustine, Goethe, Dostoevsky, Kierkegaard, Iris Murdoch, Donald Davidson, and Stanley Cavell, among others. Throughout, conceptual clarifications concerning mind and language are put to work in the investigation of issues relating to self-description and in novel philosophical readings of autobiographical texts. (shrink)

This paper examines the nature of “asceticism” (rīyāḍat) in Sufism, revolving around the works of the 13th century Persian Sufi Mawlānā Jalāl al-Dīn Muḥammad Rūmī Balkī and exploring two critical inquiries: Firstly, it seeks to determine whether Rūmī’s mystical perspective on asceticism is world-rejecting or world-affirming. Secondly, it investigates potential parallels and divergences between Rūmī and Meister Eckhart’s stances—specifically, through the Dominican’s Sermons and Treatises—and assesses the implications for the two figures. In examining Rūmī’s works, the current research primarily relies (...) on secondary sources within the Persian intellectual tradition to provide an intracultural context. Utilizing horizontal and vertical interpretations, this study examines critical themes in Rūmī’s works, such as love, detachment (zuhd), the world’s deceptive nature, and seclusion. The findings reveal that Rūmī’s asceticism is not “monastic” (ruhbānī); instead, it balances moderate abstinence and worldly engagement, underpinned by the Quran and the ḥadīth teachings. Rūmī and Eckhart underscore asceticism as an inner transformation rather than mere physical austerity, emphasizing inner purification, self-transcendence, and spiritual detachment as routes to divine unity. The two thinkers’ teachings are catalysts for profound personal transformation and a more fulfilling life in today’s world. (shrink)

Demosthenes' client Euxitheos is attempting to defend his claim to citizenship, and finds himself obliged to counteract the prejudice raised by his opponent Euboulides from the fact that his mother works, and has worked, in menial wage labour. The implication is that no citizen woman would sink so low; therefore, she is no citizen, and so neither is he. His response is defensive: he acknowledges that such labour is a source of prejudice , but argues that people often find themselves (...) obliged to undertake such demeaning work through poverty, which is deserving of the jury's sympathy, and in any case has no bearing on questions of citizenship . He does not challenge the assumptions behind the prejudice, suggesting that he expects the jury to share them, and this might encourage us to extrapolate from the passage to a set of common values held by Athenian citizens, namely that paid work by women is degrading, embarrassing and only acceptable as a temporary expedient under the compulsion of poverty. If we then align these attitudes with the implications elsewhere in the orators that women led lives of seclusion, usually confined indoors and largely separated from the exterior male world, we might be inclined to conclude that the labour of women was also confined to the oikos and almost entirely distinct from the labour of males, not least in having little or no monetary aspect, a point which the usual view of the economic capacity of Athenian women appears to confirm. (shrink)

The article delves into the enduring ramifications of historical and contemporary processes of racialization, the delineation of societal divisions, the forsaking of marginalized communities, and the coerced isolation or seclusion of specific populations. Within the realm of necropolitical afterlives, these terms indicate the manners in which these persistent predicaments have molded and persist in molding the realms of life and death for diverse groups. Analysis encompassing necro-lives holds significance in comprehending the sway of necropolitics, unearthing systemic injustices, and amplifying (...) the voices silenced. The bodies of necro-lives amalgamate in communal endeavors for justice, parity, and human rights. Necro-lives call for mobilization and advocacy to deconstruct necropolitical frameworks and forge more just and impartial societies. Necropolitics, entailing dominion over life and death by influential necro-entities, can be contextualized through these themes, spotlighting how certain populations endure violence, disregard, or isolation beyond their corporeal existence, thereby perpetuating cycles of injustice and suffering. (shrink)

Little is known about how farms and markets are connected. Identifying critical gaps and central hubs in food systems is of importance in addressing a variety of concerns, such as navigating rapid shifts in marketing practices as seen during the COVID-19 pandemic and related food shortages. The constellation of growers and markets can also reinforce opportunities to shift growing and eating policies and practices with attention to addressing racial and income inequities in food system ownership and access. With this research, (...) we compare network methods for measuring centrality and sociospatial orientations in food systems using two of America’s most high-producing agricultural counties. Though the counties are adjacent, we demonstrate that their community food systems have little overlap in contributing farms and markets. Our findings show that the community food system for Yolo County is tightly interwoven with Bay Area restaurants and farmers’ markets. The adjacent county, Sacramento, branded itself as America’s Farm-to-Fork capital in 2012 and possesses network hubs focused more on grocery stores and restaurants. In both counties, the most central actors differ and have been involved with the community food system for decades. Such findings have implications beyond the case studies, and we conclude with considerations for how our methods could be standardized in the national agricultural census. (shrink)

The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

Although there is a high degree of consensus in the existing literature regarding the importance of respect in mental health care, a realistic appraisal suggests that there is something of a disconnect between what is espoused in policy documents and what actually occurs in practice. As a result, this article seeks to explore and advance our understanding of the phenomenon of respect in mental health care and draws on real practice situations to illustrate this schism. To this end, the authors (...) present three case studies that focus on the following: “use of seclusion,” “respecting professional boundaries,” and “horizontal workplace violence.” The authors advance the, perhaps for some, provocative argument that it is relatively easy to write/speak about respect, while the reality of communicating respect to others is more difficult, challenging, and makes significant demands on the individual psychiatric/mental health nurse. (shrink)

The analogous unity between God and creature, which Eckhart assumes in his doctrine of the analogy of the communissima 'Being', 'One', 'True', 'Good' does not consist in a causal relation ('analogous causality'), as understood in recent studies, but in a sign relation: The creature functions as a medium, which indicates and manifests the being, one, true, good, which is God. This relation, however, is based on a causal relation which Eckhart interprets as participation. His understanding of participation differs fundamentally from (...) that of Aquinas. Eckhart unfolds the practical consequences of his doctrine of analogy in his reflections on the ethos of seclusion. Keywords: doctrine of analogy, analogous unity (of God and creature), analogy of the transcendentals, participation (Eckart versus Thomas Aquinas), creature as sign, ethos of seclusion. (shrink)

ABSTRACT When melancholy is mentioned in connection with pietism, it is usually associated with self-ordained contrition and castigation which, according to the opponents of this religious movement, is prone to drive the believers into pathological dejection or even suicide. The example of the radical pietist Frankfurt physician Johann Christian Senckenberg, however, demonstrates the need for a more differentiated approach. As Senckenberg attained his medical knowledge primarily through physical and mental self-observation, he experienced the sadness of his own soul as absence (...) of divine grace and increased irritability resulting from his own wilfulness and lack of faith in God. Similarly, he interpreted his hypochondriac affliction as a divine punishment for his lustfulness and culinary debauchery. Concluding that both ailments could be remedied by dietetic moderation, steadfastness against temptations and withdrawal from the company of sinners, temporary seclusion and abstinence to him did not at all serve the crucifixion of the flesh, but rather functioned as part of a dietary cure, from which the sufferer could emerge cheerfully and strengthened. In this way, he could not only identify melancholy as a pathological yet treatable condition, but also solve the seeming contradiction between pious humility and independent self-preservation. (shrink)

The definition above nicely encapsulates two of the intertwined meanings of ‘privacy’. In the first sense— physical seclusion —the level of privacy in modern developed societies is extraordinarily high by historical standards. We take it for granted that a bed in a hotel will be occupied by either one person or a couple—not by several strangers. At home, few of us expect to share either bed or bedroom with our children. In these and a variety of other ways, increased (...) physical privacy has come as a byproduct of increased wealth. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Memoriam:Brother Wayne TeasdaleJennifer HarrisOn 20 October 2004, Wayne Teasdale died at age 59. After his second battle with cancer, he passed on, leaving numerous friends, loved ones, and students. Wayne was a world-renowned spiritual teacher and scholar who worked tirelessly to create dialogue and understanding among the world's religions. Wayne was the leading voice in the Christian contemplative movement.In particular, Wayne Teasdale met often with His Holiness the (...) Dalai Lama to discuss their faiths. In his own words, "I am convinced that Christianity and Buddhism together have a unique opportunity and responsibility to enter into a sustained dialogue on all matters.... If the two traditions work together on resolving the critical issues facing the planet, and if they commit themselves to an open-ended dialogue process in which mutual influence on each other occurs in the areas of belief or view, prayer, and social engagement, they will make an enormously precious contribution towards the communication of a new consciousness all around the world."For more than ten years, Brother Wayne Teasdale studied, prayed, and meditated in the seclusion of Hundred Acres Monastery in New Hampshire. In 1986, Father Bede Griffiths, an English Benedictine monk living in India, invited Wayne to his ashram to take sannyasa (Indian monkhood) from him as a Christian. Sannyasa formally means to renounce the world. This event began Wayne's work as an interreligious monk and mystic. Through his writings, Wayne has helped thousands of individuals to understand their own true paths and explored the idea of renunciation and spirituality in daily life.Wayne Teasdale served on the board of trustees of the Parliament of the World's Religions and was the coordinator of the Bede Griffiths International Trust. Wayne dedicated himself to helping people discover their true spiritual nature and was a passionate activist who worked throughout his life to create dialogue and mutual understanding among the world's religions. He is the author of many seminal books, most notably The Mystic Heart: Discovering a Universal Spirituality in the World's Religions and A Monk in the World: Cultivating a Spiritual Life. His other books include Catholicism in Dialogue: Conversations Across Traditions; Come and Sit: A Week Inside Meditation Centers; Hermitage of the Heart: Contemplative Practices from Hundred Acres Monastery; Community of Religions: Voices and Images of the Parliament of the World's Religions; Essays in Mysticism; Yoga of Sound: Healing and Enlightenment through the Sacred Practice of Mantra (with Russill Paul); Bede Griffiths: An Introduction to His Interspiritual Thought (with Bede Griffiths); Awakening the Spirit, Inspiring the Soul: 30 Stories of Interspiritual Discovery in the Community of Faiths (with Martha Howard, MD), and Mystic Hours: A Daybook of Inspirational Wisdom and Devotion. [End Page 163]Wayne was the leader of the Interfaith Call for Freedom of Worship and Human Rights in Tibet. He was a member of the Monastic Interreligous Dialogue and helped draft their Universal Declaration on Nonviolence. He was an adjunct professor at DePaul University, Columbia College, and the Catholic Theological Union, and lectured throughout the world.In his life and teachings, Wayne always promoted the concepts of community, service, and faith. He said, "We now know that each one of us inhabits, rather than possesses, what can be called local awareness. It makes our life tangible by filtering it through parameters of knowing and being that allow for this local type of consciousness, this knowing person here and now who is self-aware. When someone has a mystical experience, he or she is propelled into a cosmic kind of perception. The enlightened are those who have broken out of their local and regional, or individual and species awareness and have discovered other realms of consciousness beyond this sphere."Jennifer HarrisFriends of Drepung Gomang MonasteryCopyright © 2005 The University of Hawai'i Press... (shrink)

The present article analyzes a fifteenth-century debate over the value and significance of enclosure in monastic contemplative life. The controversy arose as a consequence of the vow of seclusion taken by the canons regular in the convent of Bethlehem near Louvain and centered on the legitimacy of enclosure as an object of monastic professio as well as on its compatibility with Augustine’s rule. The article surveys the sources of this debate clarifying its historical circumstances and its theoretical boundaries and (...) focuses on the contribution of the Albertistic theologian Heymericus de Campo. The dossier of this querelle is mainly handed down in the manuscript Brussel, Koninklijke Bibliotheek, 11752-64, with the integration of the codex Wien, Österreichische Nationalbibliothek, Series Nova 12835 containing Heymericus’ Epistola de laude religiose solitudinis. (shrink)

"During the last months of the war, Josef Pieper saw the realization of a long-cherished plan to escape from the "lethal chaos" that was the Germany of that time, "plucked," he writes, "as was Habakkuk, by the hair of his head... to be planted into a realm of the most peaceful seclusion, whose borders and exists were, of course, controlled by armed sentries." There he made contact with a friend close-by, who possessed an amazing library, and Pieper hit upon (...) the idea of reading the letters of Goethe from that library. Soon, however, he decided to read the entire Weimar edition of fifty volumes, which were brought to him in sequence, two or three at a time." "It was precisely in the seclusion, the limitation, the silence of Goethe that made the strongest impact on Pieper. Here was modern Germany's quintessential conversationalist intellectual, but the strength of his words came from the restraint behind them, even to the point of purposeful forgetting." --Book Jacket. (shrink)

The Sera Jey Monastery, reestablished near Mysore, India, houses 5,000 Buddhist monks living in exile -- including survivors of the destruction of the Tibetan monastery in 1959. Sheila Rock's moving portraits are a celebration of the everyday simplicity and subtle beauty of the ascetic life. More than a hundred duotone photographs document the compassionate expressions, emotional openness, and aura of serenity inspired by lives of renunciation and seclusion. A percentage of the royalties from this book go to the Sera (...) Jhe Health Care Committee in aid of various humanitarian projects. (shrink)

We look on Fernán Pérez de Guzmán as an exile not only because he lived out the last thirty years of his life in the relative seclusion of his estate in Batres; he is an exile, too, because as a poet he has long been banished from critical acclaim. For an enthusiastic view, one has to go back to the 1860s and the eulogy of the literary historian José Amador de los Ríos, according to whom Fernán Pérez's graceful didacticism (...) deserved “[el] aprecio de la verdadera crítica.” Since then, “the appreciation of true critics” has been reserved for what is now considered a canonical work of prose history, the Generaciones y semblanzas, whereas most of his poetry has been condemned for stylistic inelegance — ironically, as we shall see, one of the very qualities he seems deliberately to have cultivated. (shrink)

Abstract The article sketches a theoretical model which explains how it is possible that fundamentalist beliefs can emerge as a result of an individual rational adaptation to the context of special living conditions. The model is based on the insight that most of our knowledge is acquired by trusting the testimony of some kind of authority. If a social group is characterized by a high degree of mistrust towards the outer society or other groups, then the members of this group (...) will rely solely on the authorities of their own group for their acquisition of knowledge. In this way they can adopt a corpus of beliefs which may seem absurd from an external point of view. However, they may be locked in a “fundamentalist equilibrium” in which particularistic trust, common sense plausibility, epistemic seclusion, social isolation and fundamentalist beliefs are mutually reinforcing - and in which individuals who adopt the “fundamentalist truths” of their group do not behave more irrationally than individuals in an open society who accept the “enlightened” worldview of their culture. (shrink)

This article is concerned with the deprivation of patients’ liberty while undergoing psychiatric treatment, with special reference to the situation in Finland. It is based on a review of Finnish law, health care statistics, and empirical and theoretical studies. Relevant research findings from other countries are also discussed. In Finland, it is required that patients are cared for by mutual understanding with themselves; coercive measures may be applied only if they are necessary for the treatment of the illness, or for (...) safeguarding patients’ safety or the safety of others. Involuntary psychiatric hospitalization is closely regulated by the Mental Health Act. However, the rules concerning the deprivation of liberty during inpatient treatment (by seclusion, restraint and restricted leave) are formulated in very general terms. Therefore, Finnish psychiatric hospitals have their own policies concerning when and how seclusion may be used. The practice of seclusion and the use of restraint therefore vary among the psychiatric hospitals in Finland. (shrink)

Han Kang's 2007 novel The Vegetarian, published in English translation in 2015, tells a story of one woman's refusal to eat meat. Yeong-hye's refusal comes from her desire to eschew the intersecting violence of patriarchy and carnism, which gradually reveals an underlying psychosis and drive towards self-attrition. Because of the central motifs of bodily transgression and self-abnegation in the novel, critics have compered Han Kang's Yeong-hye to Frantz Kafka's Gregor Samsa or the hunger artist. Just as the hunger artist seeks (...) seclusion from human sociality in the space of his vacuous interiority, so does Yeong-hye sequester herself from the gaze of others in her visions of... (shrink)

Veiling is one of the sources of seclusion of women from and within society. _Ghūnghat_ (_avagunṭhana, purdāh_) or veiling is primarily associated with covering one’s face which performs various functions. The rationale for veiling could be that it becomes a source of refuge to women from the gaze of others, sometimes providing them with a place of their own, without any interference from others, maintains their respectability and _mān_ or _izzat_ (honour), and becomes a sign of their modesty in (...) society. On the other hand, on analysis, it turns out to be a source of concealment of one’s identity, suppression of one’s sexuality, and a life without any agency. This paper, in the context of the dominant caste of the North Indian Hindu community, will bring out the cultural, social, and gendered aspects of the practice of veiling to show how the acceptance and deference to this practice is the byproduct of women’s conditioning in a patriarchal society. By bringing in the physical and symbolic aspects of veiling, this paper attempts to show how this discussion is significant for the attainment of a ‘good quality of life’ as mentioned by Martha Nussbaum and to come out of the state of an internalised sense of oppression. (shrink)

This article is part of a symposium on property-owning democracy. In A Theory of Justice John Rawls argued that people in a just society would have rights to some forms of personal property, whatever the best way to organise the economy. Without being explicit about it, he also seems to have believed that protection for at least some forms of privacy are included in the Basic Liberties, to which all are entitled. Thus, Rawls assumes that people are entitled to form (...) families, as well as personal associations which reflect their tastes as well as their beliefs and interests. He seems also to have assumed that people are entitled to seclude themselves, as well as to associate with others, and to keep some of their beliefs, knowledge, feelings and ideas to themselves, rather than having to share them with others. So, thinking of privacy as an amalgam of claims to seclusion, solitude, anonymity and intimate association, we can say that Rawls appears to include at least some forms of privacy in his account of the liberties protected by the first principle of justice. -/- However, Rawls did not say very much about how he understands people’s claims to privacy, or how those claims relate to his ideas about property-ownership. This is unfortunate, because two familiar objections to privacy seem particularly pertinent to his conception of the basic liberties. The first was articulated with customary panache by Judith Thomson, in a famous article on the moral right to privacy, in which she argued that talk of a moral right to privacy is confused and confusing, because privacy rights are really just property rights in disguise. The second objection has long been a staple of leftist politics, and is that the association of privacy with private property means that privacy rights are just a mask for coercive and exploitative relationships, and therefore at odds with democratic freedom, equality and solidarity. If the first objection implies that Rawls is wrong to think that protection for privacy can be distinguished from protection of personal property, the second objection implies that Rawls cannot hope to protect privacy without thereby committing himself to the grossest forms of capitalist inequality. -/- In this paper I will not discuss Rawls’ views of property-owning democracy. However, by clarifying the relationship between claims to privacy and claims to property-ownership, I hope to illuminate some of the conceptual, moral and political issues raised by Rawls’ ideas, and by work on the concept of a property-owning democracy, which he inspired. As we will see, privacy-based justifications of private ownership are not always unappealing, and privacy is sometimes promoted, rather than threatened, by collective ownership. The conclusion draws out the significance of these claims for the idea of a property-owning democracy. (shrink)

The essay discusses a significant shift in conceptualizing the notion of representation found in Alain Badiou’s ontology and Jacques Rancière’s aesthetics. From Heidegger to Deleuze, the artwork was able to express an ontological truth about the world on the condition that it does not represent it. Badiou’s ‘subtractive’ approach to ontology and Rancière’s redefinition of the modern aesthetic break with representation, however, suggest that there is nothing to express beyond the veil of representation. Instead, representation can only be counteracted by (...) the occurrence of surplus representations that subvert the principles of the dominant regime of representation. The essay provides an understanding of this shift by reversing the Leibnizian conceptual metaphor Adorno used to describe the modern artwork. Unlike ‘windowless monads’, whose seclusion from the world enables them to convey an ontological truth, artworks as ‘monadless windows’ reframe the parameters of what is perceived as reality. (shrink)

Those who live in retirement, whose lives have fallen amid the seclusion of schools and other walled-in and guarded dwellings, are liable to be suddenly and for a long while dropped out of the memory of their friends, the denizens of a freer world … there falls a stilly pause, a wordless silence, a long blank of oblivion. Unbroken always is this blank, alike entire and unexplained. The letter, the message once frequent, are cut off, the visit, formerly periodical, (...) ceases to occur; the book, paper, or other token that indicates remembrance, comes no more. Always there are excellent reasons for these lapses if the hermit but knew them. Though he is stagnant in his cell, his connections without are whorling in the very vortex of life … The hermit – if he be a sensible hermit – will swallow his own thoughts, and lock up his own emotions during these weeks of inward winter… (Charlotte Brontë, Villette, 1979: 348). (shrink)

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility (...) of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (shrink)

This paper presents a social-theologically informed interpretation of the term integrity, as it occurs in fundamental law. It explores the manifestations of integrity violations and proceeds to draw an inference: an integrity violation can directly emanate from a misconception regarding integrity itself, as well as the implementation of protective measures that follow it. Integrity in its wholeness dimension is understood as open-endedness and non-seclusion rather than as a substantial, clearly definable characteristic of a person. This open-endedness and non-seclusion (...) results from the relational constitution of an individual. Consequently, it follows that a violation of integrity occurs when the open-endedness and non-seclusion of a person and their relational Becoming is hindered. The new definition of integrity is particularly important when it comes to the governance of new health technologies, especially Digital Twins that can become representatives of a person. Human integrity is non-violated only when it is understood as open to relational Becoming and this Becoming shows its expression in the mutual enabling and support of self-articulation. (shrink)

Georg Lukács wrote that "there is autonomy and 'autonomy.' The one is a moment of life itself, the elevation of its richness and contradictory unity; the other is a rigidification, a barren self-seclusion, a self-imposed banishment from the dynamic overall connection." Though Lukács' concern was with the conditions for the possibility of art, his distinction also serves as an apt description of the way that Hegel and Hegelians have contrasted their own interpretations of self-determination with that of Kant. But (...) it has always been difficult to see how elevation is possible without seclusion, or how rigidification can be avoided without making the boundaries of the self so malleable that its autonomy looks like a mere cover for the power of external forces. Yeomans explores Hegel's own attempts to grapple with this problem against the background of Kant's attempts, in his theory of virtue, to understand the way that morally autonomous agents can be robust individuals with qualitatively different projects, personal relations, and commitments that are nonetheless infused with a value that demands respect. In a reading that disentangles a number of different threads in Kant's approach, Yeomans shows how Hegel reweaves these threads around the central notions of talent and interest to produce a tapestry of self-determination. Yeomans argues that the result is a striking pluralism that identifies three qualitatively distinct forms of agency or accountability and sees each of these forms of agency as being embodied in different social groups in different ways. But there is nonetheless a dynamic unity to the forms because they can all be understood as practical attempts to solve the problem of autonomy, and each is thus worthy of respect even from the perspective of other solutions."Everyone recognizes the importance of Hegel's critique of Kantian morality as empty, but until now there has not been a fully worked out presentation of how Hegel's views in his discussion of Sittlichkeit actually provide the missing content. Yeomans has finally provided us with a reconstruction of Hegel's mature position that makes good on all the promissory notes that Hegel gives in his famous descriptions of his alternative to Kantian ethics. Yeomans offers a compelling account of Hegel's view of individuality, societal differentiation and its roots in Kantian and Fichtean moral theory. The book will be a major contribution to the scholarship on Hegel's practical philosophy." - Dean Moyar, Associate Professor of Philosophy, Johns Hopkins University -/- "Yeomans' book is a subtle, detailed and original explication of some key ideas having to do with how Hegel's general philosophy of action relates to his social and political philosophy. It is attentive to Hegel's texts, and it ties its discussions into all the relevant contemporary themes in philosophy. It is very ambitious in its attempt to make Hegel's theory into a real competitor to other views that are currently in wide play in the philosophical world. It will very likely become one of the key texts in the secondary literature on Hegel." - Terry Pinkard, University Professor of Philosophy, Georgetown University. (shrink)