In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 157-159 [Access article in PDF] Constructing Persons:The Psychopathology of Identity Stephen R. L. Clark Keywords identity, legal fictions, materialism, psychopathology. Steve Matthews argues that the criteria proposed by Stephen Behnke and Walter Sinnott-Armstrong for establishing personal identity in cases of Dissociative Identity Disorder (DID) are flawed. Neither brain identity nor memory convergence are adequate grounds for ascribing identity, even in the absence (...) of DID. Someone suffering from DID is no less responsible than a drunkard for the crimes she commits when not in her right—or at least her usual—mind, and perhaps no more responsible than someone suffering from some other mental disorder. We may decide to punish someone suffering from DID for her crimes only when she and her presumed alter both share a brain (as obviously they do) and might—at least after therapy—have memories in common, and only when the alternate personality that led to the crime is herself sane. But we should not pretend to ourselves that this judgment rests upon a clear and uncontentious notion of identity.It may be that Matthews still shares too much of his opponents' attitude: namely, that there is some matter of fact about identity, or at least some fact about the central principles by which we ascribe or recognize identity. This, at first sight, is the force of his counterexamples: that the Behnke/Sinnott-Armstrong criteria give counterintuitive results and so cannot exactly map the notion that we have in mind. Just so Socrates was able to prove that Justice did not consist in Paying One's Debts, because we would all at once acknowledge that it was not Just (or Right) to restore his sword to a homicidal maniac (or at least that there were real doubts about who it was that really owned the sword). But neither Socrates' nor Matthews' conclusion need be referred to any simple fact. It would not be sensible to say that the maniac had a right to have his sword, or that its keeper had a duty to return it, because we recognize implicitly that the very point of Justice is to do Good. Correspondingly, maybe the real effect of Matthews's counterexamples is to remind us what the point of Judgment is. Is there any matter of fact about identity, or is identity simply a way of saying who it is that should now be held responsible? Joe is not to be held responsible because he is the same person as the one who committed the crime: he is reckoned the same person because he is the one who is here now to be held responsible. That is what it is to be the same person: to be held responsible for what is personally done. [End Page 157]Someone who is not a person at all is not the same person as anyone (although they may be the same creature). And a person is a creature who holds herself responsible, or can do so: who has memories and anticipations to which she lays claim, appropriates as her own. This in turn is possible because (or so it seems) she has acquired the necessary words and customs: because she sees people being held responsible she can also hold herself responsible—or sometimes disclaim all responsibility. She will not always be allowed to escape all blame or credit, merely because her memories are of a self that no longer makes much sense to her, nor even because she has no memories at all of what was done. But this need not be because she is objectively the very same person as the sometime agent; rather, the person she is taken to be is constructed by the legal and moral attitudes of those who judge her. Those attitudes are not necessarily determinate: how exactly the ordinary rules apply in novel cases may be a matter of decision rather than discovery. The connections that ordinarily ground or specify identity are not robust enough to rely upon in DID patients (that, after all, is the trouble). We have to make... (shrink)

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering—that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The (...) claim articulated by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of “doctoring.” The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural “work” is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening. (shrink)

The purpose of this dissertation is to identify some of the most pressing problems in the dominant contemporary approach to research ethics, and to devise an alternative approach that avoids these problems. I contend that the fundamental ethical values invoked in human research are often appealed to in contradictory or ambiguous ways, or in ways that do not adequately capture or do not show an adequate understanding of the specific ethical concerns of human research. One significant problem in this domain (...) is that values for ethical research are often unreflectively imported from medical therapy, producing ill-suited guidelines that cannot capture the different ethical situations that arise in the context of research. Furthermore, ethical guidelines in this area are often not developed with a sufficient understanding of the deep philosophical issues that they invoke. I suggest that we can address these problems through examining the fundamental ethical concerns of research on a philosophical level. This method will reveal severe problems with the approach to two of the ethical values underlying research; beneficence and respect for autonomy (or respect for persons). Once the nature of these problems has been revealed, and with reference to ethical problems that typically arise in the domain of research, I construct a coherent philosophical foundation for research ethics, which both avoids these deep-seated problems and better captures the ethical issues that arise in the domain of human research. I argue that we need to radically depart from the values of beneficence and autonomy/respect for persons as they are currently understood in the guidelines. We need an idea of beneficence that is clearly distinct from that which is used in the therapeutic medical context from which this notion is currently drawn. I also contend that we need to move away from autonomy as a central value in research ethics. I posit an alternative choice-based approach to informed consent which is concerned both with respecting agents’ freedom of choice, and also with their wellbeing, as providing a good means of protecting and promoting the interests of the individual research subject. Although these two imperatives are often thought to clash on a fundamental level, I will show that, in research ethics, they can be reconciled with minimal conflict. Though this represents a departure from the ethics of medical therapy, this approach is far more suited to the context of research. This theoretical basis for informed consent can help to clarify the ethical problems that are specific to this domain and provide us with relevant ethical guidance in research ethics. (shrink)

Logic-Based Therapy & Consultation (LBTC) is a popular modality of philosophical counseling developed by philosopher Elliot D. Cohen and the first one to have undergone a randomized, controlled efficacy study. Logic-Based Therapy and Consultation: Theory and Applications brings together leading LBTC researchers, trainers, and practitioners to provide the latest account of its theory and apply it to diverse populations including persons with mental health issues, children, athletes, persons with drug and alcohol addictions, persons in a detention center, human (...) services workers, and adolescents. Edited by Elliot D. Cohen, S Zinaich Jr., Himani Chaukar, and Florin Lobont, this collection shows how religious and philosophical traditions from East to West can be used with LBTC to inspire meaningful life change, tackle social issues such as civic conflict, and even attain romantic love. Spanning forty years of research and development, this book should interest instructors of philosophy, religion, psychotherapy, and related areas; social workers and human services/mental health providers; philosophical counselors and consultants; and anyone interested in learning about this versatile approach to coping constructively with problems of living. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Experiencing Assistive Technology:A Pragmatist Inflection for Occupational TherapyNate Whelan-Jacksonshortly after i wake up, I put braces on my legs. I wear them throughout the day. Often, I don't notice them. If I'm walking on a flat surface, they often fade into the background of my consciousness. I make allowances without thinking about how they structure my gait and the space they take up. Rarely, I misjudge this, and occasionally (...) fall. In those moments, their presence is apparent, coming to the foreground of my experience as a problem, something I need to accommodate as I collapse. When they need to be repaired, I notice them all of the time. As a user of assistive technology, the way in which I experience the technology can swing from regarding them as part of my body, to an external tool, to an object in my environment. This experience is fluid, weaving moments where a sense of my embodiment includes the devices with moments where they are alien to me. Even when they are alien to me, I use them successfully (most of the time). Reading reports of the experiences of other users of assistive equipment, especially prosthetics, I do not seem to be alone in experiencing this fluidity with respect to these devices. These experiences raise questions for me. Is "successful use" sufficient as a goal as I learn and re-learn how to walk with them? Often, I prefer the experience of braces as part of myself: How might that be cultivated? Perhaps the fluidity of encountering them at times as tools and at times as part of myself is a strength, one that I might reasonably seek to develop. How might education or therapy accommodate and prepare for this feature of experience with assistive technology?Phenomenological analyses of symptoms of "phantom limbs," use of prosthetics, and even of physical impairment more generally, highlight the fluidity of disability experience, emphasizing the experience of having to continually revise ways of navigating our environments. For many disabled people, this precarious character of experience might demand that we learn to use new [End Page 60] assistive technologies. This education often takes place in the context of occupational therapy (hereafter OT), a form of therapeutic intervention using "occupations," or purposive tasks, to facilitate independence. In this process, persons might not just learn to make use of a technology or perform a task, but also to experience the technology in a variety of ways—for instance, as an obstacle, as a tool, or as a part of their bodies. Thus, OT becomes not only a locus for developing new modes of coping and performing daily tasks, but a site at which relationships to assistive technologies come to the foreground.Those relationships, in various theoretical models underlying OT, are often analyzed in terms of task performance, and different elements modified in order to complete a given occupation. A person might make changes in their own habits of moving (for instance, learning to move their legs a certain way to facilitate walking), the environment (e.g., modify furniture or a configuration of a room), or some combination thereof. However, some experiences of disability call into question features of popular models underlying OT, like the person-environment-occupation model. In particular, features of the situation, like the equipment, can occupy multiple roles, or even change roles, from person to environment or vice versa, within the context of performing daily tasks. I suggest that John Dewey's work on education and analysis of habits with relationship to a creature's broader environment provide a useful framework for articulating models of experiencing assistive technologies that appreciate their fluidity within experiences of disability. This model offers a helpful orientation for OT, one that offers an expansive account of the potential "ends" of OT, from re-molding habits to complete tasks to supporting plasticity in an individual's relationship to different elements of the model itself.Occupational TherapyBroadly, occupational therapy fosters independence through a number of means. Occupational therapists can aid in re-training how to perform everyday activities, construct exercises to strengthen or re-habituate new uses of muscles, make recommendations for changing features of home or... (shrink)

Introduction: Resilience is a multidimensional and dynamic construct associated with positive growth and the capacity to transform stressful and negative factors into opportunities of personal development and self-improvement when faced with difficult experiences. The resilience process of each individual integrates multiple analysis levels, which range from genetic-environmental interactions to a complex process of adaptation between the individual and his/her family, friends, co-workers, society, and culture.Objective: To determine whether resilience improves in students of occupational therapy when exposed for (...) the first time to practice placement education.Methodology: Quasi-experimental, prospective, observational, multi-center study with a sample composed of students from the Degree of Occupational Therapy of the public universities of Málaga and Castilla-La Mancha. Two weeks prior to the beginning of the practice education period, the participants completed a questionnaire that included sociodemographic data and the area of their internships. They were also given the Spanish version of the Connor-Davidson's resilience scale. All these instruments were also completed 1 week after the end of the clinical practice.Results: There were statistically significant differences between the variables that make up resilience and the different internship areas. On the other hand, there was a significant improvement of global resilience after the clinical practice period, in both women and men, when the internship area was not considered.Conclusions: The results show that resilient students are more optimistic and work to improve a situation beyond doing simply what is expected of them, knowing how to control their feelings. This is beneficial for students in practice education, since, during these, they face difficult situations that require a resilient pattern, which helps reduce stress and the burnout syndrome. (shrink)

Virtual reality constitutes an alternative, effective, and increasingly utilized treatment option for people suffering from psychiatric and neurological illnesses. However, the currently available VR simulations provide a predetermined simulative framework that does not take into account the unique personality traits of each individual; this could result in inaccurate, extreme, or unpredictable responses driven by patients who may be overly exposed and in an abrupt manner to the predetermined stimuli, or result in indifferent, almost non-existing, reactions when the stimuli do not (...) affect the patients adequately and thus stronger stimuli are recommended. In this study, we present a VR system that can recognize the individual differences and readjust the VR scenarios during the simulation according to the treatment aims. To investigate and present this dynamically adaptive VR system we employ an Anxiety Disorder condition as a case study, namely arachnophobia. This system consists of distinct anxiety states, aiming to dynamically modify the VR environment in such a way that it can keep the individual within a controlled, and appropriate for the therapy needs, anxiety state, which will be called “desired states” for the study. This happens by adjusting the VR stimulus, in real-time, according to the electrophysiological responses of each individual. These electrophysiological responses are collected by an external electrodermal activity biosensor that serves as a tracker of physiological changes. Thirty-six diagnosed arachnophobic individuals participated in a one-session trial. Participants were divided into two groups, the Experimental Group which was exposed to the proposed real-time adaptive virtual simulation, and the Control Group which was exposed to a pre-recorded static virtual simulation as proposed in the literature. These results demonstrate the proposed system’s ability to continuously construct an updated and adapted virtual environment that keeps the users within the appropriately chosen state for approximately twice the time compared to the pre-recorded static virtual simulation. Thus, such a system can increase the efficiency of VR stimulations for the treatment of central nervous system dysfunctions, as it provides numerically more controlled sessions without unexpected variations. (shrink)

Crises in therapist-patient relationship can also become a challenge in clinical supervision. However, success and failure in establishing and maintaining constructive relationships in therapy and supervision is not only subject to a lucky fit of personal characteristics (therapist A gets along well/badly with client B; supervisee A gets along well/badly with supervisor C). Rather, we can identify determining field conditions in the overall therapeutic and supervisory situation for this outcome. We do not only focus on the persons involved, (...) but also on their environment, the task to be accomplished together, further framework conditions and the power relations resulting from their mutual influence-in the supervised case of therapy as well as in supervision itself. We want to examine the structure and dynamics of these relationships from a genuine Gestalt psychological perspective. What contributes to a cooperative atmosphere? When do goals get out of sight? What can make the atmosphere hostile? How do such developments become accessible in supervision? (shrink)

During the last few years forgiveness has been seen as an important element in psychological health. The development of forgiveness therapy and its application by psychotherapists to areas like family therapy attests to its growing significance. As a consequence it is important to investigate what people understand by forgiveness and in what circumstances this knowledge structure is retrieved. The present study forms part of ongoing research to access and measure a person's construct of forgiveness. Two studies are (...) compared across three dimensions: semantics, questionnaire instructions and five methods of accessing a forgiveness knowledge structure. In the first study, 49 students from the University of Glasgow were presented with descriptions or videoed scenarios of an act of infidelity. After each presentation they completed the Scobie Forgiveness Scale . In the second study, 315 students from the University of Glasgow completed four measures, only the SFS is used in the current study. A comparison of the studies suggests that minor word changes and questionnaire instructions may not exert a significant influence on participants' responses. However, different methods of accessing knowledge structures may have an effect on an individual's construct of forgiveness. The results suggest that different methodologies , affect participants' responses in both the forgiver and the forgiven mode. The findings may have implications for the general accessing of knowledge systems and for the measurement of forgiveness. (shrink)

Despite recognition as an important, potentially unifying construct within the social sciences and humanities, value lacks an overarching theoretical framework. One theory within the social sciences, personal construct theory, is suggested as a theoretical foundation for human values, and an attempt to situate values within this theory is presented. It is argued that human values are core constructs in the language of personal construct theory, while ordinary beliefs are peripheral constructs. Various implications and applications of (...) this formulation are discussed. (shrink)

Couples therapy has long been regarded as one of the most demanding forms of psychotherapy because of the way it challenges therapists to combine the insights of dynamic psychology with the power and clarity of systems dynamics. In this exciting new volume, Gordon Wheeler and Stephanie Backman, couples therapists with broad training and long years of experience, present dramatic new approaches that at last integrate the dynamic/self-organizational and the systemic/behavioral schools of thought. Building on the insights of Gestalt psychology (...) and psychotherapy, the authors show us how a truly phenomenological approach, based on the clients' own experience and goals, holds the key to a dramatic increase in therapeutic power and flexibility. The fifteen engaging chapters demonstrate the application of this approach to issues of intimacy, self-construction, power and abuse, "resistance," growth, and shame - and to such diverse and challenging populations as abuse survivors and their partners, remarried couples, gay and lesbian couples, and couples with "personality" or "character" disorders. In the process, the authors offer a fresh perspective that will serve to re-energize the couples therapist's work in this challenging area. _On Intimate Ground_ contributes new insights to many of the most timely and provocative questions in the field today. (shrink)

This chapter examines the control capacities of individuals with certain mental disorders and how, specifically, their reasons-responsiveness improves with treatment. Successful talk therapy, in particular, can bring individuals with disorders of agency closer to full-blown agency. The discussion focuses, first, on Agoraphobia and Exposure Therapy and, second, on Borderline Personality Disorder and Dialectical Behavior Therapy. We can see effective techniques of talk therapy, such as gradual exposure or radical acceptance exercises, as operating on the ability of (...) patients to respond appropriately to reasons. In this way, reasons-responsiveness is a lens through which both to better appreciate the flourishing of patients, via improved control in both moral and nonmoral contexts. The chapter bridges philosophical concepts of reasons-responsiveness with key psychiatric constructs, such as distress tolerance and experiential avoidance. (shrink)

For Sigmund Freud, founder of psychoanalysis, the Unconscious is characterized by the fact that it is born from the repression of impulses. For Carl Jung, on the other hand, the Unconscious is made up of everything that is not conscious. According to Jung: “It is inherent to reality and to the communication of the conscious with the Unconscious, and allows the becoming of the individual”. He called it “collective” because its pictorial manifestations, the archetypes, were common to all human beings. (...) For 20 years he searched, with the physicist Wolfgang Pauli, for an extra-personal origin of the Unconscious, called “synchronicity”. The study of near-death experiences sheds new light on this question: the last image the dying man/woman sees would be himself a few weeks before his birth. The ego is believed to be built in the fetal stage around the discovery of the body, and to remain unchanged until brain death. Personalism would describe the fetus’ access to self-consciousness by discovering his body. (shrink)

In the field of psychology, filial piety is usually defined in terms of traditional Chinese culture-specific family traditions. The problem with this approach is that it tends to emphasize identification of behavioral rules or norms, which limits its potential for application in other cultural contexts. Due to the global trend of population aging, governments are searching for solutions to the accompanying financial burden so greater attention is being focused on the issue of elder care and its relevance to filial practices. (...) We contend that the psychological investigation of filial piety in Chinese societies has progressed to the point that it can now provide a solid structure for research targeting intergenerational relations in other cultures. We describe an indigenous psychology approach that integrated Chinese historical, philosophical, and social trends to construct a model of filial piety in terms of the dual reciprocal and authoritarian filial aspects underlying parent-child relations: the dual filial piety model (DFPM). We use this model to re-conceptualize filial piety from its usual definition as a set of Chinese culture-specific norms to a contextualized personality construct represented by a pair of culturally-sensitive psychological schemas of parent-child interaction. We then describe how the DFPM can provide a framework for research on filial relations on individual, structural, societal, and cross-cultural levels. We conclude with a discussion of how the model may be able to integrate and extend Western research on intergenerational relations and contribute to the issue of elder care beyond Chinese societies. (shrink)

This book traces the philosophical history of Personal Construct Psychology through the broad and complex tradition of phenomenology and thinkers such as Spinoza, Hegel and Heidegger.

Kelly’s work was formed and developed in the context of the American philosophical movement known as pragmatism. The major figures to which this tradition is attributed are Charles S. Peirce, William James and John Dewey. In Personal Construct Psychology, Dewey was acknowledged by Kelly and by subsequent writers as perhaps his most important influence. It has recently become increasingly apparent, however that Peirce was a much more pervasive and crucial influence on James and Dewey than has previously been (...) recognized. Kelly did not mention Peirce but a close reading of the two writers reveals a remarkable correspondence and relationship between their two bodies of work. To set these two thinkers side by side proves to be an interesting and productive exercise. In this paper, after introducing Peirce and examining the relationship between him and Dewey, Kelly’s basic philosophical assumptions, as outlined at the beginning of Volume 1 of the Psychology of Personal Constructs, are used as a framework for exploring their similarities and differences. The result is an enrichment of our understanding of Kelly’s philosophy which allows us to make links with many different subsequent thinkers’ ideas and provides a basis for exploring the psychological aspects of the two men’s work. The latter forms the subject of Part II of this series which is in preparation. (shrink)

In these seven letters, practising psychiatrist Vincenzo Di Nicola offers wisdom to a young therapist from 25 years of experience conducting relational therapy. Ranging from what to read and how to begin therapy, the letters cover therapeutic temperaments and technique, how to create a relational dialogue, the myths of individual psychology and the need for relational psychology, the evolution of therapy in the past century and when therapy is over-all the while looking forward to the relational (...) practices of the coming community. This book complements Di Nicola's model of working with families presented in A Stranger in the Family: Culture, Families, and Therapy (New York and London: W.W. Norton). -/- Awarded the prestigious Prix Camille-Laurin of the Association des médecins psychiatres du Québec - the Camille Laurin Prize of the Quebec Psychiatric Association. -/- From the Foreword: -/- "It's a beautiful idea, this project of turning to young people... The relational dialogue offers an important new direction of study to discover the deep basis of the therapeutic alliance, in order to understand the still too-little known phenomenon of 'change'... This is what you have brought together in your book: the search for the whole regarding the person and, at the same time, the network of primary affective relationships that we call the family and of social relationships ..." --from the Foreword by Maurizio Andolfi, M.D. Director of the Academy of Family Psychotherapy Professor of Psychology, University of Rome -/- Advance Review: -/- "Di Nicola is a true master of constructive inquiry, synthesis, and brilliant creativity. Memorable aphorisms leap from every page of this very wise, thoughtful, and beautifully written book in which the healing process of discovering and making meaning to help reorder the lives of troubled persons is clarified. I highly recommend this book for all who are or would be therapists!" --Armando Favazza, M.D., M.P.H. Emeritus Professor of Psychiatry University of Missouri-Columbia Author of Bodies Under Siege. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 1-7 [Access article in PDF] Clinical Practice, Science, and the Unconscious Douglas McConnell Neil Pickering Keywords psychotherapy, cognitive science, neuroscience, computational view of mind. This volume of Philosophy, Psychiatry, & Psychology is devoted to questions about the unconscious mind. The philosophical complexities and difficulties associated with the unconscious are many and, despite widespread confusion and disagreement as to the nature of the unconscious (...) mind, it is used as a concept informing psychotherapy. It is therefore not surprising that papers in a special edition on the unconscious might be weighted heavily toward uncovering a justifiable conceptual niche for the unconscious and elaborating on some of the main conceptual connections. Although this makes for a slightly more philosophical edition of PPP than usual, those perhaps less interested in philosophy and more interested in actual psychiatric practice can incorporate the concepts and insights developed in these papers into their practice as they see fit.The three main articles take three quite distinct approaches to the unconscious. Schechtman (2005) addresses the need for a theory of personal identity to incorporate the unconscious and presents one that does so by developing some central Lockian intuitions. Church (2005) investigates whether the kinds of things happening in the unconscious can be explained by cognitive operations not normally associated with consciousness, specifically, spatial structuring of experience. McConnell and Gillett (2005) clarify some of Lacan's ontology of the mind where the language encountered and used by the subject provides the structure for their unconscious.The aim of this introduction is to ask and try to answer a question that logically precedes those raised in the articles in the light of the therapeutic use of the unconscious. When dealing with psychoanalysis or psychoanalytic concepts in an Anglo-American context, the struggle that psychoanalysis has had and continues to have in a psychiatric domain ruled by science is never far from the spotlight. Indeed Hinshelwood (2005) also picks up the importance of this conflict when replying to McConnell and Gillett. It seems to be historically true that the unconscious has fallen out of favor in scientific and psychiatric circles (it is no surprise that psychiatric training is largely based in "hard," that is, biological and biochemical science) particularly over the last 50 years or so. But is the scientific skepticism to be found about the use of the unconscious well-founded? And how does the continued utilization [End Page 1] of the unconscious by the therapist fit into current practice given this skepticism? Psychotherapy and the Unconscious In psychotherapy, the therapist and the client together construct a story that explains why the client is having some form of difficulty in his or her life. The stated aim is to enable the client to overcome this difficulty by gaining an understanding of what has generated it. Doing so may be a first step to dealing with that conflict. For example, an office worker who is scared of the boss and whose life at work is a misery as result may come to think that the boss is a reminder of some threatening figure from childhood and that the reaction is a regression to infantile behavior. Knowing this, the fear of the boss can be revisited—perhaps reconfigured, perhaps overcome—and life may improve. In the process of therapy, the relation of the figure from childhood to the boss is made conscious. But it was still operative before it was made explicit, even though the client did not realize it and some would say that the client's unconscious had somehow buried the memory from childhood or hidden from the client the relation of this memory of a threatening figure to the boss.A description of the content of the unconscious is, then, an intentional description involving the client's thought life, one made to help an individual understand otherwise unintelligible (to that individual) feelings, beliefs, desires, actions, and so on. Subjects' intentions are their normatively structured mental representations of, and attitudes toward, the world (e.g., "He is my boss"; "I am afraid of him"). An intentional unconscious description then takes an intentional form... (shrink)

Two recurring ideologies are used to explore and explain differences in approach to media coverage and problems, both by those within the media and by critics outside the media. Models of Left (individualism, liberty, human happiness) and Right (achievement, maintenance of norms) are used to map three contemporary journalism issues: professionalism, journalist as Good Samaritan, and objective reporting. Each readily lends itself to ideological and para-ideological analysis. Ideological constructs made a significant contribution to the mapping and assessing of ethical and (...) professional media problems. (shrink)

Tan and Moghaddam’s ‘reflexive positioning’ expansion of Harré’s positioning theory provokes consideration of psychological factors underlying the discursive production of selves. However, it understates the issue, why do people appropriate particular positions, hearable in utterances, as applicable to themselves. Some of the theoretical ambiguities dissipate when positioning is approached from a personal-constructs perspective , which draws attention to personal construction of selves, as distinct from social construction, and describes the dynamics of individual continuity, though understating the concrete contextuality (...) of personal becoming. The present essay considers the compatibility of the personal constructs approach with Harré’s positioning theory. (shrink)

School Counselling in a Chinese Context discusses research in school counselling in the Chinese context of Hong Kong schools and various educational settings, and provides a contextualized understanding of counselling issues. This book highlights key contextual conditions for counselling in Hong Kong a Chinese society. The sub themes addressed in the book include school practices and teacher perspectives on guidance, counselling, behaviour support and school discipline; whole-school guidance program for identity construction; school counselling for ethnic minority students; contextual influence of (...) the use of play therapy; school counselling for students with minority sexual orientation; Chinese cultural influence on counselling, etc. The book also develops new theoretical orientations to understanding various issues of counselling as arisen in the Chinese society of Hong Kong and helps school practitioners to develop culturally responsive approaches to school counselling for personal growth, spiritual and emotional education. The themes addressed in the book include: School practices and teacher perspectives on guidance, counselling, behavior support and school discipline School counselling for ethnic minority students Contextual and cultural influence of the use of play therapy School counselling for students with minority sexual orientation Chinese culture influence on parental participation in counselling School Counselling in a Chinese Context will be of interest to postgraduates and researchers in the field of Counselling, school psychology, child development and Chinese studies. ". (shrink)

Kelly suggested that it was useful to consider anyone as functioning as a scientist, in the business of applying theories, making hypotheses and predictions and testing them out in the practice of everyday life. One of Charles Peirce’s major contributions was to develop the disciplines of logic and the philosophy of science. We can deepen and enrich our understanding of Kelly’s vision by looking at what Peirce has to say about the process of science. For Peirce, the essence of science (...) was the application of the laws of inference. He developed a much broader concept of logic, elaborating the processes of deduction and induction and adding to these the logic of hypothetical inference, or ‘abduction’, even as Kelly broadened it further in his “departure from classical logic”. Examining the implications of these three forms of inference allows us to elaborate the dynamics involved in the process of construing, ordinacy and the cycles of experience, creativity and decision making. This is the second of a three part series examining the relationship between the work of Peirce and Kelly. The third will include a look at phenomenology, bipolarity, the self, dialogical process and sociological considerations. (shrink)

People construe reality by using words as basic units of meaningful categorization. The present theory-driven study applied the method of a free association task to explore how people express the concepts of the world and the self in words. The respondents were asked to recall any five words relating with the word world. Afterwards they were asked to recall any five words relating with the word self. The method of free association provided the respondents with absolute freedom to choose any (...) words they wanted. Such free recall task is suggested as being a relatively direct approach to the respondents’ self- and world-related conceptual categories, without enormous rational processing. The results provide us, first, with associative ranges for constructs of the world and the self, where some associative dimensions are defined by semantic polarities in the meanings of peripheral categories (e.g., Nature vs. Culture). Second, our analysis showed that some groups of verbal categories that were associated with the words world and self are central, while others are peripheral with respect to the central position. Third, the analysis of category networks revealed that some categories play the role of a transmitter, mediating the pathway between other categories in the network. (shrink)

The Sense of I: Conceptualizing Subjectivity: In Indian Philosophy (Sāṃkhya-Yoga) This book discusses the sense of I as it is captured in the Sāṃkhya-Yoga tradition – one of the oldest currents of Indian philosophy, dating back to as early as the 7th c. BCE. The author offers her reinterpretation of the Yogasūtra and Sāṃkhyakārikā complemented with several commentaries, including the writings of Hariharānanda Ᾱraṇya – a charismatic scholar-monk believed to have re-established the Sāṃkhya-Yoga lineage in the early 20th century. The (...) textual analysis of the classical Sanskrit sources and their constructive interpretation is enhanced by some crucial questions and points of dispute commonly picked up in the contemporary philosophy of mind, such as the challenge of ontological and categorical reductionism, the criteria of personal identity, the limits of agency and free will, the ineluctability of self-deception, etc. However, defining the sense of ego (ahaṃkāra) and ‘I-am-ness’ (asmitā) is the main focus of this research. Four chapters composing the study are subsequently devoted to: (1) the methodological assumptions of the present author and the basic historical distinctions relevant to the subject matter, (2) linguistic preconditioning of I-consciousness as well as metaphysical coherency and ambiguity of the concept of subjectivity presented by Sāṃkhya-Yoga philosophers, (3) cognitive and ontological issues concerning the embodied ego being opposed to inactive and contentless consciousness, or the pure self (puruṣa), (4) axiological evaluation of self-discipline and significance of liberation from ego. 1. The method, scope, and problem. In the first chapter, the method of comparative philosophy adopted in this book is introduced by a phenomenological analysis of ‘otherness’ and ‘alienness’ inspired by the considerations of Bernhard Waldenfels and his understanding of xenology. This section is followed by a critical reflection on the incommensurability of the alternative conceptual frameworks, supported by some arguments provided by Ludwik Fleck and Richard E. Nisbett. When explaining the term ‘comparative philosophy’, the author pays special attention to those proponents of the aforementioned current who contributed to the rapprochement of Western and Indian philosophical traditions by tracing both their similarities and divergences. The author makes references to numerous prominent researchers, such as Paul Masson-Oursel, Paul Deussen, Stanisław Schayer, Sarvepalli Radhakrishnan, Bimal K. Matilal, Raimundo Panikkar, Daya Krishna, Wilhelm Halbfass, and many others representing a younger generation. The historical introduction presents a concise survey of the evolution of the Sāṃkhya-Yoga textual tradition, and distinguishes five phases of its development: proto-Sāṃkhya (7th c. BCA – 1st c. CE), pre-classical phase (1st – 5th c. CE), classical Sāṃkhya (3rd – 9th c. CE), post-classical phase (till 14th c.), and neo-classical phase (since 1927). Here, the author also evaluates the primary sources, including Sanskrit commentaries, and the secondary sources in the light of their relevance and usefulness to the constructive interpretation of Yogasūtra and Sāṃkhyakārikā. Then, she makes some methodological remarks concerning the specificity of their reading. This section is concluded with highlighting three main strategies usually applied when interpreting Patañjali’s sūtras: (1) anti-philosophical approach – treating the text as a merely mystical report or the yogic vademecum, (2) anti-mystical perspective – which reads the text as a highly speculative divagation of no much use to a practitioner, (3) mystic-and- philosophical approach – emphasizing the fact that the theory of consciousness presented in Yogasūtra is both philosophically coherent and empirically (or mystically) verified. The author argues for the third, heuristic, perspective mentioned above. The last section of the first chapter aims to problematize the I-concept (aham) and the paradoxical situation of the ego searching for self-knowledge. This part starts with the acknowledgement of the deliberation on non-self (anātman) by Śāntideva, a Buddhist philosopher claiming that one’s own ego ought to be identified with the ego of any other. Then, the author unfolds the fundamental assumptions and scope of the constructive interpretation she wants to develop following K.C. Bhattacharyya’s clues. When explaining her reasons, she stresses both the need to reveal the philosophical meaning of the source materials and, at the same time, the need to make them meaningful on the ground of our contemporary philosophical enquiry. Thus, among the main purposes there is a reliable, scrupulous and careful reconstruction of the historical conception of the self as elaborated on in the classical period of Sāṃkhya-Yoga tradition, as well as reinterpretation of the sense of I as it was grasped by the Sāṃkhya-Yoga thinkers in terms of modern comparative and ‘polylogical’ discourse. 2. Naming I. In the second chapter, a variety of linguistic categories capturing different aspects of subjectivity is discussed in detail. A textual examination is preceded by clarification of the semantic distinctions made by Patañjali, such as a verbal convention (saṃketa) which stands for uniting or overlapping a word (śabda), its meaning (artha) and a mental state of comprehension (pratyaya) that ascribes the word to a particular object. Among the key concepts there is also explained a spontaneous mental activity referring to pseudo-objects posited only by words (vikalpa), which is unwittingly involved in every process of conceptualizing, designating, and naming objects. Such mental states can neither be ‘valid’ nor ‘invalid’, and are believed to unavoidably accompany one’s use of language. These presuppositions testify to Patañjali’s severe criticism towards all verbal conventions that not only affect the way we formulate and construct our views, but also determine the very process of perception. A major section of the chapter contains the analysis of the ambiguous sense of subjectivity and its basic aspects distinguished by the author in the result of a contextual and comparative study of the Sanskrit terms used in Yogasūtra and Sāṃkhyakārikā for naming I-consciousness. The six basic aspects of the self comprise: essentializing oneself, perceiving (something), getting conscious (of something), mastering or owning (something), and being capable of self-identifying as well as disidentifying oneself. A majority of the enumerated predicates ascribed to the self refer to different functions and activities of the empirical ego and the embodied mind. Yet, apart from this intentional, active, reactive, sensing, and objectifiable self Sāṃkhya-Yoga philosophers distinguish a sense of subjectivity going beyond all these psycho-physical characteristics: the self that remains unmanifest, non-active, free from experiencing any joy or pain, said to be the principle of consciousness. The plausibility of its existence as the final cause of the world is to be determined by the embodied ego by virtue of abductive reasoning based on the analysis of all material and psycho-physical phenomena preconditioned by three guṇas that compose the domain of nature (prakṛti). In the subsequent section, three Sanskrit notions – ahaṃkāra, asmitā, and puruṣa, most significant for the Sāṃkhya and Yoga understanding of subjectivity, are discussed closely one after another to expose their semantic, epistemic and metaphysical connotations. The chapter is completed by some pivotal remarks bringing out the problem of discrepancy between the metaphysical position implied by Patañjali and Īśvarakṛṣṇa, and the grammatical instruments applied by them to express it. 3. Cognizing I. The third chapter addresses two important issues in the phenomenology of self-perception, namely the question of psycho-physical dualism explained on the grounds of the considered darśanas, and the spiritual quest for the ideal embodiment of consciousness. While emphasizing the unity of human psycho-physical nature the author refers to several contemporary Western thinkers, such as Maurice Merleau-Ponty, Thomas Nagel, John R. Searle, David Chalmers and others, by making some comparative remarks on the idea of the embodied mind. Furthermore, three arguments for the plurality of selves (puruṣa-bahutva) are reconstructed and critically considered. The arguments given by Īśvarakṛṣṇa (SK 18) include the diversity of ways in which one experiences one’s life and death, the spatio-temporal distinctness of particular embodied egos, and the variations of features manifested by individual selves. The second section of this chapter presents a thorough inquiry into a non-theistic devotion and spiritual pragmatism defended by the adherents of Sāṃkhya- Yoga. God (īśvara) is defined here primarily as an object of meditative practice and a special tool convenient for yogic pedagogy. In the concluding part of this section four functions of devotional practice (īśvara-pranidhāna) are recognized and explained; they embrace: (1) prevention from mental scattering and dispersion, (2) therapy allowing to form some positive perceptual habits and the right cognitive approach, (3) enhancement of morally and spiritually required qualities, and (4) reinforcement of the sense of subjective identity being a complementary method of self-development. 4. Liberating oneself from I. The final chapter consists of three sections. The first one introduces the concept of liberation through action (pravṛtti-dharma), commonly opposed in Indian tradition to the path of renunciation (nivṛtti- dharma). According to Hariharānanda Ᾱraṇya’s interpretation, both Sāṃkhya- Yoga and Buddhism follow the latter one, which in terms of spiritual practice dynamics makes them much closer to each other than it is usually believed. In the subsequent section the idea of liberating oneself from one’s attachment to ego is explained in detail, along with the significance of gradual self-negation. Then the author raises the interpretation of the Sāṃkhya-Yoga perspective on liberation as self-distinction-through-renunciation. The main focus in this section is placed on the sense of agency (kartṛ), the problem of free will, and the criteria of moral and soteriological evaluation of one’s deeds. Some crucial questions on karmic conditioning of self-knowledge in the form of kleśas are also the subject of careful analysis. The next section undertakes the issue of ownership (mamakāra) of one’s activity and self-esteem (abhimāna) involved in spiritual growth. Again, some comparative remarks are made by referring to the Buddhist philosophers’ positions, such as Nāgārjuna, Āryadeva and Candrakīrti. Among others, the Buddhist refutation of the Sāṃkhya-Yoga concept of eternal, inactive, indifferent, irresponsible, and exclusively conscious self (puruṣa) is quoted and partly rejected in favour of the classical Hindu darśanas. In summary, the author emphasized the significance-generating or sense-creating function of I, its engagement in the search for its own raison d’être, its role in self-identification as well as subverting it, and the expediency of liberation from ego. The philosophers of classical Sāṃkhya and Yoga indicate a twofold sense of the self; on the one hand, the only appropriate designation: ‘I’ is true self (puruṣa), a passive and unknowable principle of consciousness whose existence makes the empirical phenomena meaningful. On the other hand, the ‘I’ clearly designates the current sense of the self, expressed as “I think”, “I doubt”, “I suffer”, etc. This second meaning of ‘I’, the specific sense of ‘mineness’, is recognized as a secondary and relative one – thus illusive and troublesome. However, its delusiveness does not mean that the empirical ego is an unreal or non-existent entity. What it implies is that the empirical self-identity is fundamentally inadequate and – according to the Indian thinkers – ought to be unveiled and, ultimately, given up. (shrink)

Niccolò Machiavelli is credited with inspiring the MACH IV personality assessment instrument, which has been adopted widely in management, both public and private. The personality this instrument maps is manipulative, deceitful, immoral, and self-centred. The instrument emerged in 1970 and created a minor industry. There are at least eighty empirical studies in management that involved more than 14,000 subjects. Richard Christie, who created the scale, has said that it is derived from the works of Machiavelli. In a standard debriefing after (...) completing this scale, respondents would be told it concerns the Machiavellian personality. We argue that the Machiavellian personality in MACH IV has little, if anything, to do with Machiavelli, either the man or his works. If Machiavelli is alleged to be relevant to management, we argue that this personality assessment instrument does not demonstrate such relevance. To advance this case we first describe the development of the instrument, identifying some of the assumptions upon which it rests; then we assess each of its twenty items against Machiavelli’s texts. Wefind fewer than half of the items have even a tenuous connection with Machiavelli’s works, yet the instrument bears his name. Against this spurious Machiavelli we juxtapose another twenty passages from The Prince, showing a much more complex and subtle thinker than the one-dimensional cipher in the MACH IV scale. Machiavelli studies have done much to dispel the cloud of mythology around the man and his reputation, and we hope to do the same to MACHIV. In the name of intellectual honesty and sound scholarship, we urge management scholars to take note of this distortion of Machiavelli, and where possible address it, and that users of the MACH IV scale distinguish the man, Machiavelli, and his works from this instrument. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Defending a Phenomenological–Behavioral Perspective: Culture, Behavior, and ExperienceMarino Pérez-Álvarez (bio), José M. García-Montes (bio), Adolfo J. Cangas (bio), and Louis A. Sass (bio)KeywordsBehavior, contextual phenomenology, culture, experienceWe should like to express our sincere thanks to all the authors for their commentaries on our articles. Given the restrictions of space (a limitation they too had to contend with), we can only respond to a few aspects of their interesting remarks. (...) We shall reply of course on the basis of our own approach—an approach that sets out to integrate culture, behavior, and experience, and that might be termed contextual phenomenology, phenomenological behaviorism, or perhaps most accurately (albeit more awkwardly), the phenomenological–behavioral perspective.In her commentary, Ibáñez-Guerra (2008), referring to the target articles “Phenomenology and behaviorism” (Pérez-Álvarez, Sass, and Cangas 2008) and “The role of superstition in psychopathology” (García-Montes et al. 2008), wonders whether our maintaining of the spirit of Skinner, as well as our recourse to phenomenology, might not themselves represent forms of superstitious behavior. She points out that it is not always a good idea to put new wine in old barrels. For her, the new wine and new barrels would be represented by social constructivism, of which she is reminded by some aspects of our work. But in making her own case, Ibáñez-Guerra (2008) reveals certain common prejudices concerning behaviorism, prejudices that have apparently persisted even after reading our article. Thus, for example, she does not see operant behavior as incorporating intentionality (what, in the target article, is presented in terms of final causality), because she assumes that intentionality would necessarily imply a mentalist and dualist notion involving a supposed internal mental entity that causes behavior. Skinner (1974) himself noted and rejected this very assumption in a passage that clearly distinguishes his own approach from what he calls a “stimulus-response formula”: “Possibly no charge,” he wrote,is more often leveled against behaviorism or a science of behavior than that it cannot deal with purpose or intention. A stimulus-response formula has no answer, but operant behavior is the very field of purpose and [End Page 281] intention. By its nature it is directed toward the future: a person acts in order that something will happen, and the order is temporal.(pp. 55–6)The place Skinner gives to intentionality and purpose is elaborated in our target article.Furthermore, Ibáñez-Guerra (2008) assumes that, on methodological grounds, Skinner rejects all that is not observable, or at least that cannot be operationalized. This, however, is simply incorrect, at least as regards Skinner’s radical behaviorism. As the reader may recall, radical (as opposed to methodological) behaviorism is neither operationalist nor does it reject private or subjective events because of their unobservability. Indeed, Skinner specifically acknowledges that such events are in fact observable—at least for one person: the subject him- or herself. The question for Skinner is to understand how the part of the world that is only observable and experiential for oneself is constructed or formed. In the end, it turns out that radical behaviorism is more radical, in the Aristotelian ontological sense (see Pérez-Alvarez, Sass, and García-Montes 2008), than post-modern constructionism. Indeed, as we remarked, radical behaviorism can still surprise us today. Similarly, phenomenology is starting to be missed in the clinical context (Andreasen 2007). We believe that radical behaviorism and phenomenology, mutually readjusted, are in fact excellent wines for the times we live in—if only we knew how to appreciate them.In their commentary on “Phenomenology and behaviorism: A mutual readjustment,” Fletcher and Hayes (2008) argue that the philosophy and theory of Acceptance and Commitment Therapy (ACT)/Relational Frame Theory (RFT) already contain the salutary aspects of phenomenology that we highlight in our target article. Their insistence on reducing the affinities we find between phenomenology and behaviorism to ACT/RFT consists, in our view, in a scientific–technical argument that is more scientistic than strictly philosophical in nature. Their insistence on the scientific–technical argument itself implies an unclarified philosophical assumption. On what grounds do experimental data constitute the last word? Has... (shrink)

ABSTRACT In this paper I examine some of the issues surrounding the moral status of the therapy known as ‘deprogramming’. I argue against the extreme view that all deprogrammings are morally impermissible. In certain instances deprogramming is morally justified because it is quite capable of restoring the conditions needed for the exercise of autonomy. The view of autonomy I am following is that constructed by Gerald Dworkin, wherein two conditions must be met in describing a person as autonomous—authenticity and (...) procedural independence. Autonomy of another type, described by Dworkin as authenticity plus substantive independence, may be lost by persons involved in cults but in those instances deprogramming as reconstructed in this paper is not a morally justified measure. (shrink)

This book uses insights from disability studies to understand in a deeper way the ethical implications that genetic technologies pose for Christian thought. Theologians have been debating genetic engineering for decades, but what has been missing from many theological debates is a deep concern for persons with genetic disabilities. In this ambitious and stimulating book, Devan Stahl argues that engagement with metaphysics and a theology of nature is crucial for Christians to evaluate both genetic science and the moral use of (...) genetic technologies, such as human genetic engineering, gene therapy, genetic screenings, preimplantation genetic diagnosis, and gene editing. Using theological notions of creation ex nihilo and natural law alongside insights from disability studies, the book seeks to recast the debate concerning genetic well-being. Following the work of Stanley Hauerwas, Stahl proposes the church as the locus for reimagining disability in a way that will significantly influence the debates concerning genetic therapies. Stahl's project in "genethics" proceeds with an acute awareness of her own liberal Protestant tradition's early embrace of the eugenics movement in the name of scientific and medical advancement, and it constructively engages the Catholic tradition's metaphysical approach to questions in bioethics to surpass limitations to Protestant thinking on natural law. Christianity has all too frequently been complicit in excluding, degrading, and marginalizing people with disabilities, but the new Christian metaphysics developed here by way of disability perspectives provides normative, theological guidance on the use of genetic technologies today. As Stahl shows in her study, only by heeding the voices of people with disabilities can Christians remain faithful to the call to find Christ in "the least of these" and from there draw close to God. This book will be of interest to scholars in Christian ethics, bioethics, moral theology, and practical theology. (shrink)

The recent publication of The New Wittgenstein signals the arrival of a distinctive "therapeutic" reading of Ludwig Wittgenstein"s philosophical enterprise. As announced in its Preface, this collection presents the "nonsense" of philosophy as the subject of Wittgenstein"s therapeutic work. The simple, plain nonsense of many philosophical remarks is revealed under the scrutiny of Wittgenstein"s investigations, according to this interpretation, leading us to see that such remarks "fail to make any claim at all" (Crary 6). This view of Wittgenstein"s use of (...) "nonsense" as a term of criticism begins with the work of Stanley Cavell, on this account, and has extended more recently to work on a wide area of Wittgenstein"s concerns, elevating "nonsense" to a central position in his philosophy. This paper argues that, in at least one case of Wittgenstein"s talk of nonsense, this "therapeutic reading" (Crary 7) oversimplifies the subtlety of Wittgenstein"s writing. Indeed, one of the most prominent cases of "nonsense" in the later Wittgenstein concerns the remark "I know I am in pain". Though Wittgenstein repeatedly treats this remark as nonsense, this treatment is not final in his philosophy of psychology. Rather, though his rich discussion in the later manuscripts of the indeterminacy of psychological judgments, the relation of these judgments to knowledge, and the role of first-person psychological descriptions, Wittgenstein is able to find what sense a remark such as "I know I am in pain" might perhaps have. "I know I am in pain" may be called nonsense, but this is not the last word on the matter in Wittgenstein"s text: as Cavell says, ""it makes no sense to say these things" (in the way we think it does)" (Cavell 70). Wittgenstein is able to find what sense our remarks of first person psychological knowledge might have, contrary to what the therapeutic reading in The New Wittgenstein would have us suppose. Therefore, at least in one case, the therapeutic reading of Wittgenstein goes wrong. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinicians’ “Folk” Taxonomies and the DSM: Pick Your PoisonG. Scott Waterman (bio)Keywordsnosology, classification, diagnosis, psychopathologyWith attention turning to the process of formulating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; e.g., Kendler et al. 2008), the study by Flanagan and Blashfield (2007) of the similarities and differences between clinicians’ “folk” taxonomies and psychiatry’s official one is timely, and its lessons are in need of (...) analysis. In this commentary I first address questions raised by the existence of multiple de facto taxonomies, and by the characteristics of those taxonomies themselves, before focusing attention on the DSM diagnostic system and its attributes that make acceptance by its constituencies far less than complete. Although the aim of Flanagan’s and Blashfield’s study is explicitly descriptive rather than normative, it provides an important opportunity to examine the extent to which our taxonomies serve the purposes for which they were constructed—whether by experts or by clinicians.There are certainly reasons to expect significant deviations between clinicians’ everyday taxonomies and the official one. Perhaps the most glaring reason is the fact that—even if it were desirable—no one can be familiar with the enormous number of categories codified by the DSM. On the other hand, the remarkable hegemony of the DSM—in the education and training of physicians and clinical psychologists, in clinical communication, and in the ubiquitous administrative functions of billing and coding—makes such deviations at least somewhat surprising and in need of scrutiny and explanation. The first question, however, is whether one should be concerned by the existence (surprising or otherwise) of multiple taxonomies. Flanagan and Blashfield make the compelling case that, given the high rate at which Americans seek clinical attention for psychiatric problems, the stakes are commensurately high for our efforts at categorizing those problems in valid and useful ways. And the extent to which a gulf exists between the way psychiatry and clinical psychology are written about and taught on the one hand, and conceptualized and practiced by clinicians on the other, invites a multitude of problems—among which cynicism about our disciplines may be one of the most pernicious.At least as important as their finding of only moderate correlations between clinicians’ taxonomies [End Page 271] and that of the DSM are the characteristics of clinicians’ diagnostic systems themselves. One potentially major artifact of their methodology, however, must be borne in mind: the instruction to the clinicians in their study to “[p]ut together the diagnoses that have similar treatments…” (emphasis mine). Although they cite previous work (Flanagan and Blashfield 2006) in defense of the proposition that such instruction did not unduly influence their findings, it was certainly an avoidable potential problem, which itself likely reflects the history of our clinical disciplines in which the treatment cart frequently pulled the diagnosis horse. It is, therefore, not unlikely that clinicians’ taxonomies might emphasize treatment considerations even if they had not been directed to do so. The fallacious reasoning behind such intuitively appealing practice, however, must be exposed. The implicit assumption that treatment response is a proxy for other important characteristics of illnesses is predicated on the false proposition that our treatments exert their effects via similar mechanisms across the various indications for their uses, thus allowing us to infer from such responses that what was awry in the first place among the conditions for which a given treatment is effective must be closely related. Categorizing mania and trigeminal neuralgia together by virtue of their shared responses to anticonvulsant therapy, or considering autoimmune platelet deficiencies to be closely related to abdominal trauma due to the fact that each sometimes requires splenectomy, are examples of the potential results of acting on that false premise.Another parameter on which the clinicians in the current study based their nosologies—most explicitly by the “dimensional experts”—is the “environmental” versus “biological” one. Given that a coherent dichotomy would either distinguish environmental from genetic etiological factors, or would contrast psychological (i.e., subjective or first-person) from biological (i.e., objective or third-person) manifestations of illness, a taxonomy one of whose axes purports to represent an environmental/biological continuum cannot... (shrink)

This paper presents a dialogue between a psychotherapist whom we will call Lilly, and Ross Channing Reed, Ph.D., a philosopher and philosophical counselor. Lilly begins by asking Ross a series of questions regarding philosophical counseling and his approach to working with her. Ross discusses his philosophy and approach to philosophical counseling, what it is like to provide counseling for a therapist, and the educational nature of philosophical counseling. Topics addressed include the nature of unarticulated trauma, the repetition compulsion, moral evil, (...) the narrative construction of a human life, the potentially debilitating effects of moralizing about feelings, the importance of humor, spirituality and philosophy, embodiment, the arts, and Alice Miller’s concept of the “Enlightened Witness.” Next, Ross asks Lilly a series of questions relating to her personal and professional journey prior to and during philosophical counseling. Lilly reveals that she spent significant time in therapy with a psychologist prior to philosophical counseling. She discusses why she sought counseling from a philosopher, how philosophical counseling has been beneficial in her personal and professional lives, and how philosophical counseling has been different from other forms of counseling. (shrink)

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer (...) at least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment Is RelevantRonald C. Petersen (bio)Keywordsaging, Alzheimer’s disease, dementia, mild cognitive impairment, pharmaceutical industryGraham and Ritchie (2006) have contributed a scholarly document that implores us to reexamine nosological categories and certain diagnostic outcomes. They have chosen mild cognitive impairment (MCI) as the target of their scrutiny and have raised several interesting issues. I would like to comment on their approach and suggest that MCI is a useful (...) clinical entity that does serve a practical function and hopefully will lead to a better quality of life for aging persons.There are several clarifications concerning the construct of MCI that need to be emphasized. Graham and Ritchie have asserted that all persons with MCI eventually evolve to Alzheimer's disease (AD) and have claimed that this is the inevitable outcome of the disorder. Although it is true that many of the early studies on MCI focused on the amnestic subtype as a precursor to AD (Bennett et al. 2002; Ganguli, Dodge, Shen, and DeKosky 2004; Lopez et al. 2003; Petersen et al. 1999), subsequent work has expanded the construct to include prodromal forms of other disorders (Petersen 2004; Winblad et al. 2004). As such, the construct of MCI has become flexible in recent years to account for alternative types of intermediate cognitive impairment.The authors state that MCI addresses those individuals speculated to have an inevitable dementia. Certainly, we do not presume that dementia is inevitable in the aging process; rather, we posit that if certain criteria are fulfilled in persons who are aging, the likelihood of a person progressing to a certain type of dementia is quite high. As such, this is an important precondition about which to learn, because interventional strategies may be available.Graham and Ritchie argue that some cognitive changes with aging are "normal" and trying to classify these individuals as "abnormal" is performing a disservice to much of the aging population. We draw an important distinction between the cognitive changes of normal aging, as they are recognized to exist, and what we feel constitutes the pathologic changes of MCI. We believe that the abnormal cognitive function found in MCI has a high probability of progressing to a greater degree of cognitive dysfunction in a relatively short period of time and these behavioral changes are accompanied by pathologic brain changes that are manifested on magnetic resonance imaging scans, positron emission tomography scans, cerebrospinal fluid biomarkers, and autopsy studies (Hampel et al. 2004; Jack et al. 1999; Markesbery et al. [End Page 45] 2006; Petersen et al. 2006). This type of progression is in contradistinction to other individuals who are experiencing cognitive changes of normal aging. These individuals do not progress rapidly to greater degrees of impairment and autopsy studies reveal that their brains do not harbor the pathologic changes found in the MCI population (Knopman et al. 2003).The cognitive and behavioral changes accompanying persons with MCI are devastating and cannot be ascribed to "senility" or "He is just getting old." It is a mistake to imply that by labeling people with a condition such as MCI we are doing them a disservice. Most of these individuals are seeking medical attention for their perceived difficulties. Consequently, addressing these concerns and educating the individuals on the implications of their symptoms are important services. Although we may not have adequate therapies at present, this does not imply that we should ignore the symptoms.We cannot treat many conditions at present, yet we do not avoid the opportunity to characterize the condition and make a diagnosis. Even if this were part of the aging process, this does not mean that we should ignore the disability and refuse to treat it. Most individuals develop an inflexibility of their optical lenses as they age, yet corrective lenses of one type or another are believed to be extremely beneficial at alleviating this disability associated with the aging phenomenon. No one would argue that it is inappropriate to treat this condition because it is "just a part of aging."It should be noted that I have stressed the situation in which individuals are seeking medical attention for their cognitive concerns. It is quite a different situation if an... (shrink)

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as ‘restitution’ and narratives common within the context of drug services such as ‘recovery’ can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals (...) in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as ‘junkies’ and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate ‘companion’ stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately. (shrink)

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In (...) this paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

In response to the many changes currently going on in health care, this book offers the combined insight and wisdom of a stellar group of scholars and professionals with extensive experience in the health care field. The book opens with a look at people's actual experience of health care today, from four different perspectives. It then addresses foundational questions, including the nature of medicine, nursing, and justice. Surveyed next are the changing economics of health care as well as the impact (...) of these changes on such areas as mental health care, long-term care, health care for minorities, and legal malpractice. The closing section of the book assesses from a Christian perspective available constructive alternatives, including creative funding strategies with special attention to the needs of poor persons, physician unions, and the use of "alternative medicine" therapies. (shrink)

A theory can be an explanation of a piece of the world. A theory of law is intended to be an explanation of that phenomenon of social communication which we call Law. But, Raffaele De Giorgi, perhaps the person responsible for the introduction of luhmannian theory in Argentina, (jointly with Torres Nafarrate in Mexico in translating Luhmann’s work to Spanish), asked: What is a theory of society? What is the “Law of society”? And answered: Can we discuss this?, hands managed (...) by hands, nothing different from a prostheses. According to De Giorgi we are sure that the themes that we use as objects or objects that we use as themes, are our construction, we think that we turn around ourselves, while we continue rotating around the vacuum. It is a paradox, or another paradox: ¿Is it possible to get out or get rid of these paradoxes? Logic does not help us. Logic, according to Luhmann, can only see to the fact that some expressions, with unavailable truths, are in contradiction with other expressions, the problem cannot be resolved us- ing logical operations. With the help of Gegenparadoxierungen (against-par- adox), systemic therapy is the alternative where the problem can be toler- ated. And, according to Luhmann, the placement of the paradox should be conducted in a more or less skilled, successful, or useful way to break the logjam.A creative use of paradoxes, especially legal ones, allows us to observe how Luhmann’s theory has impacted existing theories in ArgentinaThemes such as the paradoxality of law, or its being without foundation (and without beginning, the vacuity of their principles and the opacity of its distinctions and operations), filtered theories (like Carlos Cárcova or Ernesto Grün) and jurisprudential practices have started shifting things to what Bielefeld Professor has called “old European”Resumen:Una teoría puede ser una explicación de un sector del mundo. Una teoría del derecho pretende ser una explicación de ese fenómeno de comunicación social que llamamos derecho. Pero, Raffaele De Giorgi, tal vez uno de los máximos responsables de la introducción de la teoría de la luhmanniana en la Argentina (junto a Javier Torres Nafarrate de México, a través de su traducción de las obras de Luhmann al español), pregunta:¿Qué es una teoría de la sociedad? ¿Qué es el “Derecho de la sociedad”? y responde: es que podemos discutir esto?, manos que son manejadas por manos, nada diferente de una prótesis. Y agrega: estamos seguros de que los temas que usamos como objetos o los objetos que utilizamos como temas, son nuestra construcción, pensamos que nos volvemos sobre nosotros mismos, mientras continuamos girando alrededor del vacío.Es una paradoja, u otra paradoja. ¿Es posible salir, deshacerse de estas paradojas? La lógica no nos ayuda. La lógica dice Luhmann, sólo puede ver el hecho de que algunas expresiones, cuya verdad no está disponible, entran en contradicción con otras expresiones, para las cuales vale decir la misma cosa. Usando operaciones lógicas, el problema no puede ser resuelto. Como terapia sistémica la única que podemos ver, con el auxilio de la Gegenparadoxierungen (“contra-paradoja”), es un lugar menos doloroso en el que puede tolerarse el problema. Y recordó que, en cierto sentido, la colocación de la paradoja se realizará con más o menos éxito, esto es: de manera útil para desbloquear la situación.Y es el uso creativo de paradojas, especialmente uno que se hizo por el Derecho, el que nos permite observar cómo su teoría (la de Luhmann) se ha comenzado a reciclar en las teorías existentes en Argentina. Temas como el problema de la paradojalidad del Derecho, de su ser sin fundamentos y sin comienzo, de la vacuidad de sus principios y la opacidad de sus operaciones y distinciones, se filtran teorías (como las de Carlos Cárcova o Ernesto Grün) y prácticas de la jurisprudencia y puede verse que ha comenzado a remover ese tipo de pensamiento que el profesor de Bielefeld había llamado “vétero europeo”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Which Kind Is It?Andy Hamilton (bio)Keywordshuman kinds, mild cognitive impairment, multiple personality disorder, practical kinds, social constructionThere is much stimulating material in the Graham and Ritchie's paper (2006), concerning not just disease-classification but also the ethics of diagnosis. My concern is with the way in which they adduce Ian Hacking's views in the philosophy of science in support of their own. The authors quote with approval his (...) "dynamic nominalism" and its influence on Zachar's concept of "practical kinds." Hacking's view, as the authors quote it, is that "People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised" (1995, 21). The act of classifying changes both the classifier and the subject of classification, resulting in facts and categories that are both socially created and real. Hacking calls this "the looping effect of human kinds," and comments that "Multiple personality [disorder] is an almost too perfect illustration of this feedback effect" (1995, 21). The authors comment that Zachar (2000) builds on Hacking's position, discarding essentialist notions of classification that are limited to inherent biological properties, and turning instead to "practical kinds—nonarbitrary cultural artifacts intended to meet pragmatic needs (e.g. therapeutic, predictive prognostic, labeling effects, and physiology)" (Graham and Ritchie 2006, 36). Practical kinds, they believe, offer a way out of the clinical approach focused on mild cognitive impairment (MCI) as a precursor to, or mild form of, Alzheimer's disease. The inclination of the authors, as I read them, is to treat MCI as a practical or human kind, and not, like Alzheimer's disease, as a natural kind.My concern is whether the "looping effect of human kinds" can be transferred to the case of MCI from Hacking's original case study in Rewriting the Soul, multiple personality disorder (MPD). Hacking wished there to undermine the traditional debate over whether MPD is a "social or psychiatric artifact." He claims, correctly I think, that the presupposition behind the question "Is MPD a real disorder as opposed to a product of social circumstances?" should be rejected. The fact that a disorder is a product of social circumstances does not make it less real (1995, 12). On the looping of human kinds, Hacking comments that "The concept of child abuse [implicated in MPD] may itself be so made and molded by attempts at knowledge and intervention, and social reaction to these studies, that there is no stable object, child abuse, to have knowledge about." This is a "no fact of the matter" response, and it [End Page 51] is based on the recognition of conceptual change. He later adds that child abuse "is a real evil, and it was so before the concept was constructed. It was nevertheless constructed. Neither reality nor construction should be in question" (1995, 61, 68). However, Hacking's conclusions about the reality of MPD express only a muted skepticism. Utilitarian skeptics approach this question by asking, "What is the most effective treatment?" Hacking writes that "in their hearts [such skeptics] suspect that the outcome of multiple therapy [therapy that condones or even encourages the development of multiples in the patient] is a type of false consciousness" (1995, 267). The skeptics about MPD are making a moral judgment, he believes; but on whether that moral judgment is correct, he is silent, although the suspicion must be that he agrees with it.How do these considerations apply to the case of MCI? Graham and Ritchie rightly note that classifying a subject as suffering from MCI, and informing them of the diagnosis, will affect them adversely—it will cause suffering not least because there is at present no cure. However, it must surely be conceded that any disease at all—physical or mental—is a social entity insofar as it involves behavioral ascriptions to the subject concerning their incapacity. The authors also note the vested interests—especially from the pharmaceutical industry—in developing a diagnostic category of MCI. These interests are present in the development of any significant diagnostic... (shrink)

In this paper we attempt to understand the intellectual origins of Albert Ellis' Rational Psychotherapy (now known as Rational Emotive Behavior Therapy). In his therapeutic practice Ellis used a 'lumper' argument to replace the focus of change in psychoanalysis: not the lengthy uncovering and reworking of the individual's personal history, but the demands in self-talk through which the client is currently dis turbed. In constructing around this the persuasive (rhetorical) package that became his therapy, Ellis drew on (...) a number of popular intellectual movements, operationalism, General Semantics, the holistic theory of emotion, cognitive psychology, and psychoanalysis itself. (shrink)

One of the leading causes for failing at expatriate assignments is the accompanying expatriate partners’ unhappiness with life abroad or inability to adjust to the challenges of the host country. Strength-based therapeutic interventions have the potential to increase individuals’ mental health and well-being. The current study formed part of a multimethod study consisting of three related but independent sub-studies. The first sub-study identified the strengths of Gratitude, Curiosity and Hope to be positively associated with AEPs’ resilience and well-being. These results (...) were used to construct a quantitative model that illustrates the interplay between these constructs. In the second sub-study, the proposed model was qualitatively reviewed by a smaller group of AEPs to inform and enrich our understanding of AEPs’ personal experiences of these constructs. In the current study, a panel of practicing psychologists who provide counselling services for South African expatriates and AEPs were asked to qualitatively review a proposed quantitative model. A cross-sectional, interpretive descriptive research design, applying purposive sampling was used to identify and recruit participants. The objective for the current study was firstly to ascertain why participants thought strengths of Gratitude, Curiosity and Hope featured so prominently in the model. Secondly, the study aimed to determine how these participants would, from their experience in working with AEPs, enhance these strengths and AEPs’ resilience in therapy, and ultimately facilitate greater well-being and successful adjustment abroad. Participants completed an online questionnaire consisting of two semi-structured, open-ended questions. The data were analyzed using primary and secondary cycle coding to ultimately develop themes. Results indicated that strengths of Curiosity, Gratitude and Hope featured prominently because these strengths include elements that form part of the process of expatriation. Participants were able to suggest practical strength-based therapeutic techniques which would assist in enhancement of strengths, resilience and ultimately well-being. It is proposed that the therapeutic techniques and approaches suggested in this study could contribute to the success rate of expatriate assignments. (shrink)