The distinction between distributive and non-distributive profiles figures prominently in current evaluations of the ethical and epistemological risks that are associated with automated profiling practices. The diagnosis that non-distributive profiles may coincidentally situate an individual in the wrong category is often perceived as the central shortcoming of such profiles. According to this diagnosis, most risks can be retraced to the use of non-universal generalisations and various other statistical associations. This article develops a top-down analysis of non-distributive profiles in (...) which this fallibility of non-distributive profiles is no longer central. Instead, it focuses on how profiling creates various asymmetries between an individual data-subject and a profiler. The emergence of informational, interest, and perspectival asymmetries between data-subject and profiler explains how non-distributive profiles weaken the epistemic position of a profiled individual. This alternative analysis provides a more balanced assessment of the epistemic risks associated with non-distributive profiles. (shrink)

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses (...) on the doubt about the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment as the critics presuppose, but a probabilistic judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences. (shrink)

In his classic essay “The phenomenological approach to psychopathology”, Karl Jaspers defended the irreducible reality of the “subjective” mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients’ abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of (...) their observable clinical indicators. The aim of this paper is to reassess Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis. (shrink)

This article assesses what standards of safety and certainty of diagnosis need to be met in the determination of brain death. Recent medical, legal, and philosophical developments on brain death are summarized. It is argued that epistemologically adequate standards require the finding of whole-brain death rather than destruction of the cortex. Because of the possibility of positive error in misdiagnosing death, a tutioristic approach of being on the safe side is advocated. Given uncertainties in diagnosis of so-called vegetative (...) states like the apallic syndrome, anything less than whole-brain death, especially given the present state of diagnostic capability, should not qualify as an argument for removing therapy specifically on grounds that the patient is dead. (shrink)

There is an as yet unacknowledged and incomparable contribution to the philosophical debates about know-how to be found in the writings of Ludwig Wittgenstein. It is sourced in his investigations into knowledge and certainty in On Certainty, though it is not limited to these late passages. Understanding the ramifications of this putative contribution (even if one does not agree with it) highlights the extent to which (i) there is now a new range of issues pertaining to know-how which no future (...) philosophical consideration of the topic can ignore, except on pain of failing to engage comprehensively with the subject; (ii) the topic of know-how has been inappropriately marginalised by naturalized epistemology, and may well be as central to epistemology as the propositional knowledge which currently dominates epistemology’s attention; and (iii) any engagement with these potential Wittgensteinian contributions will need to be conducted in tandem with a reflection on the meta-philosophy of epistemology, since their potential impact extends to epistemology’s main methodology, i.e., naturalized reflective equilibrium. These three conclusions, together with a diagnosis of where and why all the current intellectualist accounts of know-how are either internally inconsistent, or irreconcilably flawed on their own terms, provide the motivation and the opportunity for a New Epistemology of Know-How. These conclusions established, I offer one possible Wittgensteinian-orientated version of the New Epistemology of Know-How, providing the first example of a non-naturalized philosophical approach to the topic since Gilbert Ryle. (shrink)

For two reasons, physics occupies a preeminent position among the sciences. On the one hand, due to its recognized position as a fundamental science, and on the other hand, due to the characteristic of its obvious certainty of knowledge. For both reasons it is regarded as the paradigm of scientificity par excellence. With its focus on the issue of epistemic certainty, philosophy of science follows in the footsteps of classical epistemology, and this is also the basis of its 'judicial' (...) pretension vis-à-vis physics. Whereas physics is in a strong competitive relationship to philosophy and epistemology with respect to its position as a fundamental science - even on the subject of cognition, as the pretension of 'reductionism' shows. It is the thematic focus on epistemic certainty itself, however, that becomes the root of a profound epistemological misunderstanding of physics. The reason for this is twofold: first, the idea of epistemic certainty as a criterion of 'demarcation' between physics and metaphysics obscures the view of the much deeper heuristic differences between the two kinds of knowledge. The second, related, reason is that epistemology does not ask the question of the reason for the epistemic certainty of physics; instead, it sets itself the task of 'legitimating' physical knowledge, and this, crucially, with reference to the interpretation of the process of cognition. Thus, as a matter of course, all epistemological assumptions about this process – including the common descriptive understanding of knowledge and its ontological premises – flow into the interpretation of physics as a science. Consequently, this undertaking is not only doubtful from the ground up, because it presupposes for its meaningfulness nothing less than certainty of knowledge concerning (the interpretation of) the process of knowledge, thereby relying on mere convictions; moreover, by projecting the descriptive, 'metaphysical' concept of knowledge onto physics, it leads to unsolvable epistemological problems and corresponding resignative conclusions concerning the claim of knowledge of physics. In other words, epistemology itself builds, due to its basic assumptions, a major obstacle for an adequate understanding of physics. Physics' cross-object, deconstructive approach to knowledge implies a completely different, non-descriptive understanding of its concepts, with consequences that extend far beyond itself due to its status as a basic science. (shrink)

The most important epistemological problem in psychiatry is the detection of malingering. This is a consequence of the fact that there is no objective way to confirm any psychiatric diagnosis. Psychiatric diagnosis is based on subjective complaints. The discovery of objective markers for psychiatric diagnosis is problematic because it presupposes we can tell valid from faked subjective symptoms. But this is the difficulty. If we use pervasive irrationality as a sign of mental illness, we encounter the problem (...) of identifying pervasive irrationality. To understand someone's behaviour, we have to assume it is largely rational. This precludes us from using behaviour to separate genuine from faked mental illness. There are a number of strategies used to solve any epistemological problem, and the most successful is the hypothetico-deductive method. If we use this, we can solve our epistemological problem. Genuine mental illness can be identified when it is the best explanation of the person's overall behaviour. Consilience of inductions is critical in supporting the validity of such explanations. This implies that it is merely a hypothesis that mental illness exists, and that we might discover that many mental illnesses, perhaps all, do not exist. We must embrace this possibility - only if we take a risk will we gain any knowledge. (shrink)

This thesis centers on two trends in epistemology: the dissatisfaction with the reductive analysis of knowledge, the project of explicating knowledge in terms of necessary and jointly sufficient conditions, and the popularity of virtue-theoretic epistemologies. The goal of this thesis is to endorse non-reductive virtue epistemology. Given that prominent renditions of virtue epistemology assume the reductive model, however, such a move is not straightforward—work needs to be done to elucidate what is wrong with the reductive model, in (...) general, and why reductive accounts of virtue epistemology, specifically, are lacking. The first part of this thesis involves diagnosing what is wrong with the reductive model and defending that diagnosis against objections. The problem with the reductive project is the Gettier Problem. In Chapter 1, I lend credence to Linda Zagzebski’s grim 1994 diagnosis of Gettier problems by examining the nature of luck, the key component of Gettier problems. In Chapter 2, I vindicate this diagnosis against a range of critiques from the contemporary literature. The second part involves applying this diagnosis to prominent versions of virtue epistemology. In Chapter 3, we consider the virtue epistemology of Alvin Plantinga. In Chapter 4, we consider the virtue epistemology of Ernest Sosa. Both are seminal and iconic; nevertheless, I argue that, in accord with our diagnosis, neither is able to viably surmount the Gettier Problem. Having diagnosed what is wrong with the reductive project and applied this diagnosis to prominent versions of virtue epistemology, the final part of this thesis explores the possibility of non-reductive virtue epistemology. In Chapter 5, I argue that there are three strategies that can be used to develop non-reductive virtue epistemologies, strategies that are compatible with seminal non-reductive accounts of knowledge and preserve our favorite virtue-theoretic concepts. (shrink)

A substantial step in The Claim of Reason, Stanley Cavell's critique of the modern epistemological tradition is a unique and intricate endeavor, supported by different intuitions and strategies. In light of this, the central aim of this paper is to articulate the main theoretical and methodological basis that govern such reading of traditional epistemology’s procedures, and, indeed, the entire Cavellian philosophical project, aiming to provide an indispensable groundwork for those who intend to delve into the American’s work. Thus, the (...) following are presented: the foundations and methods of ordinary language philosophy, primarily inherited from Austin, and sophisticated by Cavell in Must We Mean What We Say?; the innovative theses concerning the modern skeptical problem proposed by Thompson Clarke in The Legacy of Skepticism; and the principles of Cavell's unorthodox interpretation of Wittgenstein's Philosophical Investigations, supported by the analysis of grammatical criteria. Placed side by side, these three ideas help clarify the inaugural hypothesis of The Claim of Reason, that the classical notion of knowledge as certainty must be mistaken. Finally, Cavell's alternative suggestion of knowledge as acknowledgement is briefly addressed and situated within the broader landscape of the theories of knowledge. With that, the intent is to show that the Cavellian criticism aims not only to diagnose an epistemological concern born in modernity, but to also argue that it cannot be eliminated with a refutation of skepticism, but only recognized through the acceptance of its truth. (shrink)

I explicate and defend Kant's analysis of “skepticism” as a single, metaphilosophically unified rational phenomenon (at A756–764/B784–797, for instance). Kant anticipates one of the defining trends of contemporary epistemology's approach to radical philosophical skepticism: the thought that skepticism cannot be directly refuted, by demonstrating its falsity, but must be diagnosed, to show that its premises are unnatural, and consequently fail to be rationally compelling from within our own nonskeptical standpoint. Kant's most ambitious claim here is that he will develop (...) this diagnosis in a unitary fashion, by demonstrating that Cartesian, Humean, Pyrrhonian, and Agrippan skepticism are essentially interrelated as so many means to “the skeptic's” defining philosophical end. This “unity thesis” comes in both weak and strong variations. First, and more weakly, Kant argues that apparently distinct skeptical problematics share certain crucial metaphilosophical assumptions about the nature of reason, and the role of philosophical self-knowledge. More strongly, he also claims that the four problematics just mentioned are related hierarchically, in that the more fundamental skeptical worries constitute the essential dialectical context for the less fundamental ones, such that the more superficial problematics only arise if a logically prior worry is first acceded to. By showing how deeply these two unity theses structure Kant's Critical methodology, I argue that the Kantian view of philosophy as a “doctrine of wisdom” incorporates, and arguably surpasses, a number of key insights found in more recent work. The final result is that the transcendental philosopher may hope to co-opt the attractions of skepticism without making any unnecessary concessions along the way. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that (...) the practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

The complexity of cognitive emulation of human diagnostic reasoning is the major challenge in the implementation of computer-based programs for diagnostic advice in medicine. We here present an epistemological model of diagnosis with the ultimate goal of defining a high-level language for cognitive and computational primitives. The diagnostic task proceeds through three different phases: hypotheses generation, hypotheses testing and hypotheses closure. Hypotheses generation has the inferential form of abduction (from findings to hypotheses) constrained under the criterion of plausibility. Hypotheses (...) testing is achieved by a deductive inference (from generated hypotheses to expected findings), followed by an eliminative induction, constrained under the criterion of covering, which matches expected findings against patient''s findings to select the best explanation. Hypotheses closure is a deductive-inductive type of inference very similar to the inferences operating in hypotheses testing. In this case induction matches the consequences of the generated hypotheses against the patient''s characteristics or preferences under the criterion of utility. By using the language exploited in this epistemological model, it is possible to describe the cognitive tasks underlying the most influential knowledge-based diagnostic systems. (shrink)

This paper aims to show how some of Wittgenstein's considerations in the Philosophical Investigations speak to the neo-empiricist tendency to give sensation a purely causal, non-epistemic role. As the foil for Wittgenstein's criticisms, I outline the way Wilfred Sellars rehabilitates sensory impressions from his own diagnosis of the Myth of the Given by construing them as purely causal episodes. Sellars' work shows how it is possible to have a keen appreciation of the incoherence of the empiricist model yet to (...) believe that we ought to maintain that model by modifying our account of the role that sensations play in perception. Sellars and Wittgenstein have the same understanding of what a non-epistemic conception of sensations must involve. Wittgenstein articulates the way this conception manifests itself in ordinary thinking while Sellars gives it a sophisticated theoretical elaboration designed to retain what is key for sensory episodes while avoiding traditional problems of givenness. The instructive difference between Sellars and Wittgenstein is that while Sellars believes we can develop a coherent non-epistemic conception, Wittgenstein’s work suggests that we cannot. (shrink)

This article discusses the use of Bayes’ Theorem in medical diagnosis with a view to examining the epistemological problems of interpreting the concept of pre-test probability value. It is generally maintained that pre-test probability values are determined subjectively. Accordingly, this paper investigates three main philosophical interpretations of probability (the “classic” one, based on the principle of non-sufficient reason, the frequentist one, and the personalistic one). This study argues that using Bayes’ Theorem in medical diagnosis does not require accepting (...) the radical personalistic interpretation. It will be shown that what distinguishes radical and moderate personalist interpretations is the criterion of conditional inter-subjectivity which applies only to the moderate account of personalist interpretation. (shrink)

In The Anticipatory Corpse, Jeffrey Bishop claims that modern medicine has lost formal and final causality as the dead body has become epistemologically normative, and that a singular focus on efficient and material causality has thoroughly distorted modern medical practice. Bishop implies that the renewal of medicine will require its housing in alternate social spaces. This essay critiques both Bishop’s diagnosis and therapy by arguing, first, that alternate social imaginaries, though perhaps marginalized, are already present within the practice of (...) medicine. And second, the essay argues that alternate social imaginaries in medicine can be reclaimed not through separatist communities but in the re-narration of conceptually underdetermined practices. Given Bishop’s invitation for theology to engage medicine, this essay then draws from theologian Dietrich Bonhoeffer for the kind of diagnosis and therapy currently needed, concluding with a contemporary example of how an alternate social imaginary is being instantiated in modern medicine. (shrink)

Radical skepticism about the external implies that no belief about the external is even prima facie justified. A theoretical reply to skepticism has four stages. First, show which theories of epistemic justification support skeptical doubts (show which theories, given other reasonable assumptions, entail skepticism). Second, show which theories undermine skeptical doubts (show which theories, given other reasonable assumptions, do not support the skeptic’s conclusion). Third, show which of the latter theories (which non-skeptical theory) is correct, and in so doing show (...) that all of the rival theories of justification, skeptical and non-skeptical alike, are mistaken. Fourth, explain why skeptical doubts are sometimes (or sometimes merely seem) intuitive, and thereby accommodate skeptical doubts without capitulation. Michael Williams has pioneered the very idea of a theoretical reply. A theoretical diagnosis consists in just the first two stages. An adequate reply, which is correct at each stage, would rebut the skeptic entirely. Williams’ own reply, I argue, is inadequate. I offer in its place an exhaustive and accurate diagnosis of skepticism. I distinguish four kinds of skepticism and five theories of justification. I then show which theories do, and which theories do not, support which kinds of skepticism. (shrink)

Health and illness are key concepts of medicine but they also have essential significance for each and every one of our lives. For this reason, social value systems are inevitably integrated into medicine through the concept of health and illness. In turn, medical knowledge and medico-scientific notions are perpetually incorporated into societal perceptions of health and illness. Generally, such integration usually occurs via an extended concept of health and illness, which is to be discussed in the following. To a certain (...) extent, medical and societal notions of health are mutually co-determined. The underlying dynamics deserve a closer look because if health and illness are societal and medical concepts alike this fundamentally impacts on the epistemological and the practical dimension of diagnosis and prognosis as discussed in this volume of Medicine Studies. (shrink)

The history of medical and professional ethics has largely been a history of attempts to identify, articulate, and defend principles that explain when and why certain actions, institutions, health care professionals, and particular decisions count as right or wrong, just or unjust, virtuous or vicious. Medical ethics has been dominated by principlism. However, so-called moral particularists have forcefully attacked the dominance of principle-based normative theories. The particularist critique of traditional moral theory derives from the rejection of the claim that the (...) normative content of ethics and medical... (shrink)

The recent literature on the theory of knowledge has taken a distinctive turn by focusing on the role of the cognitive and intellectual virtues in the acquisition of knowledge. The main contours and motivations for such virtue-theoretic accounts of knowledge are here sketched and it is argued that virtue epistemology in its most plausible form can be regarded as a refined form of reliabilism, and thus a variety of epistemic externalism. Moreover, it is claimed that there is strong empirical (...) support in favour of the virtue epistemic position so understood, and an empirical study regarding the cognitive processes employed by medical experts in their diagnosis and treatment of epilepsy is cited in this regard. In general, it is argued that one can best account for 'expert' knowledge in terms of a virtue-theoretic epistemology that retains key reliabilist features. It is thus shown that understanding knowledge along virtue-theoretic lines has important implications for our understanding of how knowledge is acquired, and thus for the philosophy of education. (shrink)

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial (...) that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship. (shrink)

Michael Williams believes that scepticism about the externalworld seems compelling only because the considerations that underpin it are thoughtto be ``mere platitudes'' about e.g., the nature and source of human knowledge, and hence,that if it shown through a ``theoretical diagnosis'' that it does not rest upon suchplatitudes, but contentious theoretical considerations that we are no means bound toaccept, we can simply dismiss the absurd sceptical conclusion. Williams argues thatscepticism does presuppose two extremely contentious doctrines, however, he admits thatif these (...) doctrines are themselves motivated by ``platitudes'' then scepticism follows. Iaddress Williams's arguments for thinking scepticism must presuppose these doctrines,and argue that he overlooks a way that they can be seen as motivated by mere platitudes.Thus, I conclude that William's novel rejection of scepticism fails. (shrink)

The article analyses the meta- epistemological problem of the justification of a theory of knowledge. The first section is dedicated to the morphological reconstruction of the problem, the second presents a diagnosis of the problem in terms of a metatheoretical and logically non- contradictory "petitio principii" and the third delineates the limits within which strategies for the treatment of the problem could be elaborated.

We argue that the causal theory of memory and the simulation theory of memory are not as straightforwardly incompatible as they are usually taken to be. Following a brief review of the theories, we describe alternative normative and descriptive perspectives on memory, arguing that the causal theory aligns better with the normative perspective and the simulation theory with the descriptive perspective. Taking explanatory contextualism about perception as our starting point, we then develop a form of explanatory contextualism about memory, arguing (...) that, depending on the context in which we find ourselves, either the normative perspective or the descriptive perspective may be appropriate. It follows that, while the causal theory and the simulation theory cannot both be right with respect to a given perspective, and while it is necessary to choose one perspective or the other in a given context, there an important sense in which we need not choose between causalism and simulationism. We conclude by differentiating our position from and critiquing a related position developed by Craver (2020) and defending our position against objections. (shrink)

The modern editions of the Diagnostic and Statistical Manual of Mental Disorders, beginning with DSM-III in 1980, emerged in response to notable challenges to psychiatry’s practices and ways of knowing in the early 1970s. Because these challenges threatened psychiatry’s scientific self-understanding and moral authority, they exemplify what Alasdair MacIntyre has termed “epistemological crisis.” As a response to crisis, the modern DSM has been a stunning political achievement, providing the central diagnostic constructs around which psychiatric research, practice, and reimbursement has been (...) organized for four decades. Indeed, the DSM’s authority survives in the face of ongoing trenchant scientific and philosophical critique. But if psychiatry is to be healthy, it must be epistemologically humble, reckoning honestly with the limits of the DSM before a future epistemological crisis destabilizes it entirely. (shrink)

Gender Identity Disorder is classified as a mental illness and included in the DSM-IV and ICD-10. It will also be included in the DSM-V. The psychiatric diagnosis, in spite of some apparent advantages, has significant psychological and social adverse implications. This paper discusses some of the main epistemological reasons to consider gender variance as a mental disorder. It will also evaluate whether reasons of other kinds may justify the inclusion of gender variance amongst mental illnesses.

It is argued that the common definition of diagnosis as the determination of the nature of a disease is misleading. Many diagnoses are not the names of disease entities. This finding reflects the integral relation of the diagnostic task to the rest of clinical reasoning. Diagnosis has no separate goal of its own, in particular it does not have the goal of determining the nature of a disease. Instead, diagnosis contributes to the general goals of clinical medicine. (...) Any attempt to model diagnostic reasoning abstracted from the rest of clinical reasoning will yield an inadequate representation of diagnosis. Such a distortion of medical reasoning will blind us to whatever implications an adequate epistemology of medicine may have for an understanding of the relation between theoretical and practical knowledge in other contexts. (shrink)

Somatic cell count is a diagnostic test of milk for mastitis in cows. Its specificity and sensitivity are less than 1.0, making test results uncertain. I discuss epistemological problems of the test such as underdetermination, undercalibration and underdiscrimination, in the solution of which biomedical and economic factors may play a role. Diagnostics of the SCC should be considered as an epistemological network, functioning in a network in which farmers, veterinarians, epidemiologists and milk industry shift their position following biomedical, technological and (...) economic changes, which is described as an actor-network to understand how human and non-human agents in mastitis may be associated. (shrink)

The view that the basic statements in some areas of language are never true or false absolutely, but only relative to an assessment-perspective, has been advanced by several philosophers in the last few years. This paper offers a critique of that position, understood first as a claim about our everyday concept of truth, and second as a claim about the key theoretical concept of an adequate empirical semantics. Central to this pair of critical discussions will be an argument that the (...) appeal of truth-relativism derives from a specific misconception: namely, that our ordinary concept of absolute truth is substantive — a form of metaphysical or epistemological determination. Building on this argument, the present paper aims to undercut relativism about truth both as a purely philosophical thesis and as an approach to the science of meaning. (shrink)

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person’s health. This study investigates how advancements in science (...) and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics. (shrink)

The purpose of this paper is to offer a diagnosis and a resolution to generality problem. I state the generality problem and suggest a distinction between criteria of relevance and what I call a theory of determination. The generality problem may concern either of these. While plausible criteria of relevance would be convenient for the externalist, he does not need them. I discuss various theories of determination, and argue that no existing theory of determination is plausible. This provides a (...) case for the no determination view: there are no facts that determine relevant types. This is the diagnosis of the generality problem. The externalist, however, may embrace the no determination view. This is what provides a resolution to the generality problem. (shrink)

This paper argues that just as full beliefs can constitute knowledge, so can properties of your credence distribution. The resulting notion of probabilistic knowledge helps us give a natural account of knowledge ascriptions embedding language of subjective uncertainty, and a simple diagnosis of probabilistic analogs of Gettier cases. Just like propositional knowledge, probabilistic knowledge is factive, safe, and sensitive. And it helps us build knowledge-based norms of action without accepting implausible semantic assumptions or endorsing the claim that knowledge is (...) interest-relative. (shrink)

Several studies have found a robust effect of truth on epistemic evaluation of belief, decision, action and assertion. Thus, truth has a significant effect on normative participant evaluations. Some theorists take this truth effect to motivate factive epistemic norms of belief, action, assertion etc. In contrast, I argue that the truth effect is best understood as an epistemic instance of the familiar and ubiquitous phenomenon of outcome bias. I support this diagnosis from three interrelating perspectives: (1) by epistemological theorizing, (...) (2) by considerations from cognitive psychology and (3) by methodological reflections on the relationship between folk epistemology and epistemological theorizing. (shrink)

The anti-metaphysical intentions of naturalism can be respected without abandoning the project of a normative epistemology. The central assumptions of naturalism imply that (1.) the distinction between action and behaviour is spurious, and (2.) epistemology cannot continue to be a normative project. Difficulties with the second implication have been adressed by Normative Naturalism, but without violating the naturalistic consensus, it can only appreciate means-end-rationality. However, this does not suffice to justify its own implicit normative pretensions. According to our (...) diagnosis, naturalism succumbs to the lure of an absolute observer's stance and thereby neglects the need for participation in communal practice. By contrast, methodical culturalism ties down the concepts of epistemology to the success of such practice. Only from this perspective, the normative force of epistemology can be appreciated. Also, the mind-body problem loosens its hold and the distinction between action and behaviour is reestablished. In the last section, the mutual relation between philosophy andscience is reconsidered. (shrink)

The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic evidence (...) as defeasible as well. It argues that metaphors might be effective communicative devices to let the patients understand the relevant defeasors in the diagnostic reasoning process, helping to improve effective diagnosis communication, and also encouraging a change in patients’ beliefs and attitudes on their own experience of illness and illness’ management. (shrink)

Biomedical science suffered a loss of trust during the Covid‐19 pandemic. Why? One reason is a crisis fueled by confusion over the epistemology of science. Attacks on biomedical expertise rest on a mistaken view of what the justification is for crediting scientific information. The ideas that science is characterized by universal agreement and that any evolution or change of beliefs about facts and theories undermines trustworthiness in science are simply false. Biomedical science is trustworthy precisely because it is fallible, (...) admits error, adjusts to new information, and, most importantly, is practical. Successful diagnosis and cure demarcate the boundaries of warranted knowledge. The other reason is sociological. As the pandemic made all too clear, the loss of faith in scientific experts was due to the failure of most of them to engage in regular public dialogue, reflecting a failure to recognize the obligation that science has to bolster trust in its work and findings by concerted public engagement. (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to be (...) fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

This paper has two objectives 1) to study the influence of digital and new technology on COVID-19 diagnosis and healthcare 2) To propose the integral guideline solutions of the infectious disease for the future. COVID-19 stands for corona (CO), virus (VI), disease (D), or SARS-CoV-2, is a respiratory virus first identified in December 2019 in Wuhan, China(WHO, 2019). It is an epidemiological crisis that caused the deaths and sudden destruction of wealth and health of people around the world. Many (...) countries responded to the crisis with what could only be called urgent prevention and treatment. In the 21st century, our society is based on digital and new technology that can control and prevent the COVID-19 pandemics. However, these ways for solving the problem of COVID-19 pandemics are rising an epistemological crisis too. There are some problems with the COVID-19 diagnosis. From Buddhist philosophy perspective, COVID-19 teaches us the coronavirus is causing us to experience some heightened forms of the three marks of our existence which are the impermanence (aniccā), the suffering (duḥkha), and the non-self (anatta). The establishment of scientific expertise and innovation has shown its value and educating the public about testing, diagnosis, communication, treatment, and vaccine development technology for prevention the of infectious diseases in the future. (shrink)

In this paper I will discuss Michael Williamss inferential contextualism – a position that must be carefully distinguished from the currently more fashionable attributer contextualism. I will argue that Williamss contextualism is not stable, though it avoids some of the shortcomings of simple inferential contextualism. In particular, his criticism of epistemological realism cannot be supported on the basis of his own account. I will also argue that we need not give up epistemological realism in order to provide a successful (...) class='Hi'>diagnosis of scepticism. (shrink)

Virtue epistemology has it that knowledge is a kind of success through ability, and explains the value of knowledge in terms of the general value of success through ability. However, Duncan Pritchard, in a series of recent writings, argues that knowledge is not merely a success through ability, and the virtue-theoretic explanation of the value of knowledge fails. He derives general claims about what he calls ‘environmental luck’ from certain examples, and uses them against virtue epistemology. First, I (...) propose counterexamples to Pritchard’s general claims about environmental luck. Second, I offer a diagnosis of both Pritchard’s and my examples, according to which they differ as to how many abilities are responsible for the performance in question. Different structures of performance make for different conditions for success to be fully creditable to a subject. Once this is taken account of, virtue epistemology can deal with all the examples, while maintaining its main tenet that the value of knowledge is explained in terms of the value of success through ability. Third, I show that my response to Pritchard’s argument against virtue epistemology is more plausible then the ones offered by John Greco and Ernest Sosa. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” (...) in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

A central element of constitutivist accounts of categorical normativity is the claim that the ultimate foundation of the relevant kind of practical authority is sourced in certain tasks, features, and aims that every person inevitably possesses and inescapably has to deal with. We have no choice but to be agents and this fact is responsible for the norms and principles that condition our agency-related activities to have anunconditional normative grip on us. Critics of constitutivism argue that it is exactly because (...) of itsinescapability that agency is a powerless source of normative authority. I investigate why our intuitionsconcerning the appeal to inescapability point into such contrary directions. Why do we feel the attraction ofgrounding categorical normativity in phenomena that not even the skeptic can ignore, on the one hand, butseem to hold dear the principle that “ought implies need not,” on the other? Instead of fully developing thethird, neutral, way of conceptualizing the relationship between inescapability and normativity that theimpasse between constitutivists and their critics suggests, this paper diagnoses the disagreement at hand.That agency is inescapable does neither guarantee nor rule out its status qua source of categoricalnormativity. Both camps of the debate overlook this option and depict their opponents as adhering to animplausible perspective of how appeals to inescapability and unconditional normativity are related. Sincethe debate relies on a false dichotomy it is not surprising that its participants so often talk past each other. (shrink)

My title may suggest that I will address the activities of medical professionals as they go about their daily business of diagnosis, prescription and treatment. Certainly, that deserves attention, but it is not my target here. My concern is, on the one hand, with typical consumers of health and medical information, and, on the other, with the problems such consumers face in understanding, interpreting and applying the information available to them.

psychiatric diagnoses such as attention deficit hyperactivity disorder is a rapidly growing and globally increasing phenomenon, not least in different educational contexts such as in family and in school. Children and youths labelled as ADHD are challenging normative claims in terms of nurturing and education, whereas those labelled as ADHD are considered a risk for society to handle. The dominant paradigm regarding ADHD is biomedical, where different levels of attention and activity-impulsivity are perceived as neurobiological dys/functions within the brain best (...) managed by means of an individual diagnosis and instrumental pedagogy. The majority of those labelled as having ADHD encounter a dominant educational model in the form of what is referred to in this article as neurobehaviorism, which is based on onto-epistemological violence. As opposed to this act of violence against being—and against the psychiatrized subject—a less violent educational model is proposed, based on French philosopher Alain Badiou’s ontological examination of being and his concept of love as a truth procedure. In terms of the latter, the focus is on the potential of the encounter as a ‘Two scene of love’. Here, the encounter is a place where it is possible to create new truths and subjects, instead of taking the individual diagnosis as an axiom which only leads to individuals having fixed identities codified in a hierarchical order. This argument is drawn from the ‘mathematical’ formula 1 + 1 = ♥, which originates from an online forum for people who have come into contact with ADHD in one way or another. (shrink)

"In Learning from Our Mistakes: Epistemology for the Real World, Talbott provides a new framework for understanding the history of Western epistemology and uses that framework to propose a new way of understanding rational belief. His proposal makes epistemology relevant to the real world, which he illustrates with a new theory of racial, gender and other kinds of prejudice, a new diagnosis of the sources of the inequity in the U.S. criminal justice system, and insight into (...) the proliferation of tribal and fascist epistemologies based on alt-facts and alt-truth. Talbott's new model of rational belief is not a model of a theorem prover in mathematics. It is a model of a good learner. Being a good learner requires sensitivity to clues, the maginative ability to generate alternative explanatory narratives that fit the clues, and the ability to select the most coherent explanatory narrative. Sensitivity to clues requires sensitivity not only to evidence that supports one's own beliefs, but also to evidence that casts doubt on them. One of the most important characteristics of a good learner is the ability to correct mistakes. Talbott articulates nine principles that help to explain the difference between rational and irrational belief. Talbott contrasts his approach with the approach of historically important philosophers, including Socrates, Plato, Aristotle, Hume, Kant, Wittgenstein, and Kuhn. He also contrasts his approach with a variety of contemporary approaches, including pragmatism, Bayesianism, and naturalism. He responds to the main criticisms of his method from the experimental philosophy literature"--. (shrink)

Although Williams’ contextual thesis is above all a critique of one way of interpreting contextualism in epistemology, viz., simple conversational contextualisam, I will argue that this thesis has also been a very successful means for the critique of a standpoint on which that interpretation, and the entire traditional epistemology rests - epistemological realism. Accordingly, in spite of certain weaknesses in Williams’ position pointed out by his critiques, in this paper I will try to show that, by interpreting the (...) problem of scepticism as first and foremost a methodological necessity of epistemological realism, Williams succeeds in offering an enlightening diagnosis of the sceptical paradox problem which is at the centre of epistemology traditionally construed. (shrink)

In this thesis, I present an account of the development of early Greek epistemology, according to which Protagoras' measure doctrine, and his argument from conflicting appearances, was the starting point for work on perception and knowledge by Plato in the Theaetetus, Aristotle in Metaphysics IV and Democritus. In Chapter One, I argue against the assumption that Protagoras' Aletheia contained a philosophical theory. It was probably not a treatise, but a virtuoso show-piece, with the aim of "knocking down" views according (...) to which truth is only known by gods, and, with difficulty, by privileged humans--namely, philosophers. For this, it need not have contained more than some well-chosen examples of perceptual and value beliefs, and arguments that one cannot decide which are true. In Chapter Two, I argue that Democritus should be seen as Protagoras' heir. Democritus argued Protagoras' general claim is self-refuting, but thought he was right about perceptual appearances. In Confirmations, he defended the senses, attributing to them knowledge and "power of proof." However, his theory led to an ancestor of the primary/secondary quality distinction, and this threatened to undermine the theory itself because of implications--that one can only know how things appear and not how things are by nature--which were later taken up in Pyrrhonist skepticism. In Chapter Three, I present a reading of the Secret Doctrine in Plato's Theaetetus as a defense and diagnosis of Protagoras' claim, in particular, an explanation of the global relativization which Protagoras' claim seems to recommend. This reading is meant to avoid the well-known difficulties concerning the prevailing interpretation of Protagoras' "Secret Doctrine" as a flux doctrine. I also argue that Plato developed the Secret Doctrine with Democritus in mind. In Chapter Four, I argue that Plato's "self-refutation argument" is aimed at relativism, but not relativism about truth. The latter, which Aristotle dismisses as eristical, is a position Protagoras can take, but Plato's argument works against it as well. In Chapter Five, I examine why Aristotle seems to treat Protagoras in Metaphysics IV as being committed to a denial of the principle of non-contradiction. (shrink)

This project is concerned with the attempt to diagnose certain types of deductive inferences as exhibiting failure of transmission of justification. The canonical example of alleged transmission failure is G. E. Moore’s infamous ‘proof’ of the external world, in which Moore reasoned here is a hand, therefore the external world exists. If the transmission failure diagnosis is correct, then this inference is incapable of providing a route to learning of its conclusion on the grounds that it is only if (...) one already has some justification to believe its conclusion that one can acquire justification for its premise. The thesis presents two novel problems for the transmission failure diagnosis. Firstly, this diagnosis is only appealing if it is able to safeguard epistemic closure, but it is unclear whether it is able to do this once we distinguish between propositional and doxastic justification. Secondly, a dilemma is presented for entitlement theory, the traditional framework for understanding how there could be justification for believing the conclusions at issue. The dilemma arises once we consider the question of what the apposite degree of confidence is that is licenced by an entitlement, the upshot of which is that either entitlement theory is unmotivated, or it leads to irrational doxastic attitudes. In light of these problems, an alternative framework for understanding the phenomenon of transmission failure is presented. This framework rejects a common assumption in the literature that we can only accommodate the phenomenon by appealing to internalist notions of justification. The resulting externalist framework is defended against two potentially devastating objections. Finally, implications for how these views regarding the structure of justification bear on issues in the epistemology of testimony are considered, and it is argued that a certain family of views in the literature on testimony are committed to certain problematic views regarding the structure of justification. (shrink)

This article elaborates on the relationship between structuralism (and to some extent post-structuralism), hermeneutics and pragmatism, starting from what I comprehend as the inherent dilemma articulated in the policy documents concerning the emerging knowledge economy: the tension between innovation and adaptation. In the first section, I delineate a horizon of understanding for my presentation by defining the particular societal transformations in the historical context where the question of creativity and innovation has become of strategic importance. Then, in the second section, (...) I suggest a diagnosis of the new and predominant flexible organization of knowledge within the context of the new creative economy. The third section is a short interlude, where the philosophical implications of these societal transformations are being disclosed, together with the challenges that influence the agenda for a discussion about a constructive philosophical contribution. In the last two sections, I introduce a particular kind of hermeneutical perspective into the discussion by a close reading of one of Paul Ricoeur’s major works from the mid 1970s, here distinctively interpreted as a profound investigation into the micro-mechanisms of the epistemology of creativity. Thus, by the configuration of a hermeneutics of creativity and innovation from these philosophical resources, my intention is to disclose the ontological implications of innovation as well as the anthropological prerequisites for a conception of creativity “with a human face.”. (shrink)