If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as 'non-healthy', or of the healthy as 'non-pathological', can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the 'healthy'-'pathological' opposition, factual vs. rational, characterizes the ordinary usage of these concepts (...) and puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the 'healthy' and the 'pathological', it could explain some of the difficulties met in determining 'gold standards', in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as ‘non-healthy’, or of the healthy as ‘non-pathological’, can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the ‘healthy’–‘pathological’ opposition, factual vs. rational, characterizes the ordinary usage of these concepts (...) and puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the ‘healthy’ and the ‘pathological’, it could explain some of the difficulties met in determining ‘gold standards’, in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)

Readers expecting a history of nineteenth‐century pathology are in for a surprise. They will find instead a self‐conscious example of cultural studies, critical of some assumptions made in this field and of some feminist writing, but containing some alarming sentences like “My goal has been to give shape to the accidental palimpsests of an inveterately verbal, and increasingly visual, culture; to assemble a particular series of hermeneutic loose ends into a coherent account of how an extraordinarily bizarre system of signification (...) came into being” . With learned English like that, who needs Latin? But once we get into the main part of the book, things get much better. We are confronted with a study of the fringes of science, in popular writings, in literature, and in raree‐shows, one working from sources that the more austere scientifics of the Victorian period despised and that historians of science are prone to ignore. Metaphor and analogy are everywhere, and sensitive stomachs will be churned by vivid accounts of disease, deformity, and surgery.The first chapter is concerned with the cholera morbus, the plague of the nineteenth century, and with the way it could be perceived as an indicator of social ills. John Ruskin's word “illth” as an opposite of health is revived, and the terrible blackness of the shriveled and dehydrated victims of this disease imported from the East is linked with colonial and racist notions. The theme that a healthy body is like a well‐run state leads into the next chapter, on breast cancer. Surgery was not only agonizing but ineffective in the first half of the nineteenth century, but then the survival rate after three years rose gradually from 4.7 percent to 45 percent by 1900. O'Connor asks whether this saga, with cancer seen as cellular overproduction, reveals close connections with gender construction and the symbolic importance of breasts, concluding that it does not and that the language used really was neutral rather than sexual.She then looks at amputations and artificial limbs, seeing amputation as a threat to the whole masculine body that could be countered by prostheses almost undetectable to the observer. This allows reflection on illustration, where curiously disembodied hands are shown carrying out amputations; on dissembling and artificiality; on materialism; and on metaphors of wholeness and replacement and of extending senses and capacities. We see some extraordinary advertisements where men with artificial legs climb ladders and skate, perhaps on thin ice. The final chapter examines deformity, with monsters and freaks . P. T. Barnum is prominent here, but interesting links are also made to the Great Exhibition at the Crystal Palace and its successors and the numerous museums that were such a feature of the Victorian period. They are strikingly placed in a continuum, rather than opposed, in a discussion of chaos and order, capitalism and health, deformity and degeneration. Wonder is presented as the key to modern sensibility, and there is a nice quotation on page 152: “If Beauty and the Beast should be brought into competition in London at the present day, Beauty would stand no chance against the Beast in the race for popularity.” Readers will have been led into a fascinating world at the periphery of the respectable science that most of us study and will rejoice in the extraordinary sights they see. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female student population is (...) involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately... (shrink)

Riassunto: L’impianto cocleare è una neuroprotesi che consente un recupero parziale dell’udito nella persona sorda. Nonostante la sua generale efficacia nel contrastare alcuni dei problemi legati alla sordità, il suo utilizzo è stato fortemente osteggiato da quella parte della comunità sorda che vede nella sordità una forma di identità culturale e non una patologia. Questo articolo inquadra in una prospettiva neuroetica le preoccupazioni della comunità sorda – difficilmente comprensibili agli udenti – esaminando le analogie fra il rifiuto dell’IC e il (...) disagio che si osserva nella popolazione generale relativamente al Potenziamento Cognitivo. Nel PCog, individui sani insoddisfatti delle proprie prestazioni, o comunque desiderosi di migliorarle, ricorrono ad interventi artificiali per potenziare le proprie funzioni cognitive. L’analisi evidenzia come, nel rifiutare l’IC, la comunità sorda possa voler tutelare un insieme di valori non così diverso da quello che la comunità generale richiama spesso nelle sue preoccupazioni rispetto alla diffusione dei PCog. Parole chiave : Impianto cocleare; Potenziamento cognitivo; Sordità; Cultura sorda The cochlear implant as cognitive enhancement? A neuroethical perspective on some issues raised by the deaf community: The cochlear implant is a neuroprosthesis that allows for partial recovery of auditory function in individuals who are deaf. Despite its general efficacy, its use has been strongly opposed by a part of the deaf community that perceives deafness as a form of cultural identity, rather than a pathology. This article considers the concerns of the deaf community – which are often difficult for hearing people to understand – from a neuroethics perspective, proposing that such opposition to CI is analogous to the general population’s unease with regard to Cognitive Enhancement. CE allows healthy individuals who are unsatisfied with – or would like to improve – their performance to use artificial interventions that enhance cognitive functions. The analysis reveals that, when opposing CIs, the deaf community may be protecting a set of values similar to those that the general community often evokes when voicing concerns about CE diffusion. Keywords: Cochlear Implant; Cognitive Enhancement; Deafness; Deaf Culture. (shrink)

BackgroundDespite severe cognitive dysfunction in Alzheimer's disease, aesthetic preferences in AD patients seem to retain some stability over time, similarly to healthy controls. However, the underlying mechanisms of aesthetic preference stability in AD remain unclear. We therefore aimed to study the role of emotional valence of stimuli for stability of aesthetic preferences in patients with AD compared to cognitively unimpaired elderly adults.MethodsFifteen AD patients score 12–26) without visual impairment and/or psychiatric disorder, as well as 15 healthy controls without cognitive impairment (...) matched in age, sex, art interest and highest level of education were included in this study. All participants were asked to rank-order eight artworks per stimulus category according to their preference twice with a 2-week span in-between. Based on these two rankings a preference change score was calculated. In order to assess explicit recognition memory of the artworks in the second testing session, four artworks of each stimulus category used in the preference ranking task were presented together with a content-matched distractor artwork painted by the same artist. Participants had to indicate which of the stimuli they had seen 2 weeks previously.ResultsAD patients [MMSE = 18.9 ± 3.6; Age = 85.4 ± 6.9; 33.3% male] had no explicit recognition memory of the artworks, whereas healthy controls [MMSE = 27.7 ± 1.4; Age = 84.3 ± 6.7; 33.3% male] correctly recognized 85% of stimuli after 2 weeks. AD patients had equally stable preferences compared to the control group for negative artworks, but less stable preferences for positive and neutral images.ConclusionEven in cognitively impaired AD patients, aesthetic preference for negatively-valenced artworks remains relatively stable. Our study provides novel evidence that AD patients may have a somewhat preserved implicit valence system for negative compared to neutral or positive visual information, especially in the domain of aesthetics. However, more studies need to further uncover the details of the underlying neurocognitive mechanisms of preference stability in pathological aging. (shrink)

The demonstration that hypnotic suggestion can inhibit word/colour Stroop highlights one of the benefits of using hypnosis to explore cognitive psychology and in particular attentional processes. The compelling results using a rigorous design have particular relevance for the presumed automaticity of some forms of information processing. Moreover the results support the potential that hypnotic suggestion offers for creating clinically informed analogues of relevant psychological and neuropsychological conditions. As with all novel research, the results of Raz and Campbell raise further operational (...) and theoretical questions, relating in this case to the use of hypnotic, post-hypnotic and non-hypnotic suggestion and the utility of existing measures of hypnotizability. (shrink)

Technophilia has been routinely pathologized in the science and technology studies literature. It is variously framed as a type of dangerous psychological deviance, a form of spiritual deficit, and a source of social destruction. This essay seeks to reframe technophilia as a way of life no more pathological than homosexuality, atheism, or other traditionally disparaged identities, and to note how its oppositional forms—much like gay activism or atheist humanism—can be as politically helpful and ethically grounded as any other progressive social (...) movement. (shrink)

This essay responds to four critical essays by Rosemary Kellison, Ebrahim Moosa, Joseph Winters, and Martin Kavka on the author’s recent book, Healthy Conflict in Contemporary American Society: From Enemy to Adversary (Cambridge, 2018). Parts I and II work in tandem to further develop my accounts of strategic empathy and agonistic political friendship. I defend against criticisms that my argument for moral imagination obligates oppressed people to empathize with their oppressors. I argue, further, that healthy conflict can be motivated by (...) a kind of “secular” love. This enables my position to immanently criticize and mediate the claims that one must either love (agapically) one’s opponent in order to engage them in “healthy conflict,” on one hand, or that one must vanquish, exclude, or “cancel” one’s opponent, on the other. In Part III, I demonstrate how my account mediates the challenge of an alleged standing opposition between moral imagination and socio-theoretical critique. I defend a methodologically pragmatist account of immanent prophetic criticism, resistance, and conflict transformation. Finally, I respond to one critic’s vindication of a strong enemy/adversary opposition that takes up the case of white supremacist violence in the U.S. I argue that the time horizon for healthy conflict must be simultaneously immediate and also long-term, provided that such engagements remain socio-critically self-reflexive and seek to cultivate transformational responses. (shrink)

In contrast to the “normativist” view, “naturalist” theorists claim that the concept of health refers to natural or normal states and propose different characterizations of healthy and diseased conditions that are meant to be objectivist and biologically grounded. In this article, we examine the core concept of these naturalist accounts of disease, i.e., the concept of biological malfunction, and develop a new formulation of the notion of malfunction following the recent organizational approach to functions in the philosophy of biology. We (...) focus on the notions of adaptive regulation and functional presupposition to develop a new conceptual framework that justifies the ascription of malfunctional behaviors to biological systems according to the embodied normativity of biological organizations. (shrink)

For denoting ill, abnormal, generally undesirable social phenomena the term social pathology is most often accepted. It embodies also the sanctioned forms of deviant behaviour and the study of the causal relations of their origin and existence. The difficulty with delimitating precisely what is pathological stems from the fact that we are not able to give a satisfactory definition of the normal. The normal cannot be identified with the mediocrity. The paper supports the view that the normality is opposite to (...) anomy. The analogy to pathologization is "medicinalization" stemming out from the principle that while a deviant person, e.g. an offender of a crime, is as a rule responsible for his deed, in other kinds of offences the offender is usually referred to as "ill" and while an ill person cannot be expected to be responsible for his/her deeds, he/she must be "cured" . In this way the person is not only disburdened of his/her deed, but also of his/her responsibility. A negative phenomenon accompanying the pathologization and medicinalization is d e p r i v i n g sociology, social pedagogy and social work of their competencies in favour of medicine or pathopsychology. As a result the remedy is reduced to "therapy" and "custody" with consequent labelling of the persons concerned. The author sees social pathology as a branch of sociology investigating negative phenomena which result from social deviation and which are to a decisive degree the subject matter of social work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 313-316 [Access article in PDF] Normativity and Pathology Mike Gane Keywords: positivism, sociology, pathology, normativity. THE STRENGTH OF VICTORIA MARGREE'S contribution to the examination of the thematic of pathology and its Nietzschean/Canguilhemian variation is that it reveals the challenging complexity of this theme. My comments on this contribution are developed from an interest in the ways that the concern with pathology was part (...) of the initial program of the social sciences, particularly sociology, as it was inaugurated by Auguste Comte and Emile Durkheim in its formative period. Margree touches on the importance of social analysis at the end of her paper; my comments work to some extent in the opposite direction—from the social to the psychological. My concerns lead me to contest a number of her epistemological positions, particularly those concerning the notion of positivism and "objective" analysis.For the first positivist philosophers, positivism was primarily a method; in fact it embraced the set of methods developed by the sciences to obtain the highest degree of objectivity. It was explicitly opposed to methodological reductionism, arguing that each science had specific methods applicable to its own domain. Canguilhem was certainly against methodological reductionism (Renard 1996, 127), but Margree's conception of positivism in psychology as biological reductionism is quite a different and is a later-derived variation of positivism. As such perhaps it should not be conflated with early notions of pathology. Sociological positivism as developed in Durkheim's methodology, although different in many aspects from that of Comte, retained the idea that scientific objectivity was to be the result of epistemological procedures, not what might be called ontological reduction to a physical level of the object. Durkheim tries to clarify the rules governing the analysis of abnormal forms and to define social dysfunction and teratology. The general field of abnormal forms or pathology in the analysis of social life fell into decline after Durkheim and was abandoned in favor of the study of social deviance. The very idea of a study of social pathology itself was critiqued by Szasz and Foucault in particular as a new form of power, which came into existence at the end of the eighteenth century as an essential component of the disciplinary society. Foucault was himself clearly indebted to Canguilhem, and he made this evident on several occasions, such as his lectures at the Collège de France Les Anormaux given in 1974 and 1975 (Foucault 1999). Thus, although the field of pathology and abnormal forms continues in psychology it has been abandoned in sociology, leaving only traces (such as the concept of anomie) in the works of some thinkers such as Baudrillard, whose usage may be ironic more than an attempt to revive the terrain. Could it be that Canguilhem and Foucault [End Page 313] have then more or less swept the field clear of such scientism, even though the reconceptualization in terms of normativity suggested by Canguilhem has not been widely taken on? Indeed there may be important differences between the conceptualization of Canguilhem and Foucault (after all, as Margree points out, Canguilhem can be read as attempting to invert the relation between normativity and normative, not to withdraw from the terrain altogether). Foucault seems to approach a position elaborated in sociology earlier by Max Weber in his rejection of the attempt to use the field of pathology as a way of evading moral choices. Canguilhem discusses responsibility in "Thérapeutique, expérimentation, responsibilité" (1983, 391), noting the importance of professionalization and legal controls on professional practice.The fundamental issues posed by the project of social science continue to be haunted by the same set of problems as established in analysis of pathological phenomena, whether it be conceived in terms of order and disorder (chaos), social breakdown, radical evil, "failed states," even deviation or noncompliance with "correct" forms of language or behavior (harassment, racism, child abuse) and so on, or pathology (perversion, dysfunction, disease, illness, abnormalities). The question in part is: is there anything lost by replacing pathology with more political, religious, moral, and legal terminologies? From Foucault's point... (shrink)

Canguilhem criticized the concept of “public health”: health and disease are concepts that only apply to individuals, taken as organic totalities. Their extension to a different level of organization is purely metaphorical. The importance assumed by epidemiology in the construction of our knowledge of the normal and the pathological does, however, call for reflection on the role and the status of the population level of organization in our approach to health phenomena. The entanglement of the biological and the social in (...) human life and in contemporary societies justifies this level of analysis for better understanding the complexity and the interaction of health determinants both at the level of individuals and their interactions and at that of the population. But is this population level just a useful level of analysis that makes it possible to bring to light the social determinants of health at the individual level, or does it rest instead on characteristics of the population that are irreducible to individual characteristics, but which are nevertheless important for understanding and taking action with respect to both population and individual health? Defending this second alternative, I show how the epidemiological point of view, and in particular that of social epidemiology, leads us to rethink the possibility of a concept of “population health” that is not reducible to the sum of individual instances of health. (shrink)

As the multiple issues of the digital public sphere threaten our democracies and the cohesion of our societies, most attempts for a betterment of the digital networks and platforms revolve around a risk-response approach. This paper takes the opposite approach and develops a positive definition of the ideal ethical public sphere, combining normative features with original taxonomies. In view of defining common standards for a healthy digital public sphere, this paper offers an interdisciplinary literature review, and original recommendations, before discussing (...) potential leverages for implementing these changes. The suggested ethical normative features derive from a positive approach to the digital public sphere, as ideal common standards. Sustained by the underlying assumption that the composite landscape of the media ecosystem and its different layers (networks, platforms, users) cannot be steered by government regulations alone, the normative (deontological) approach serves to understand and justify the need for a normative approach, to help envision new pathways for an ethical transformation. (shrink)

BackgroundGait Analysis of healthy people, imitating pathological conditions while walking, has increased our understanding of biomechanical factors. The influence of the pelvis as a biomechanical constraint during gait is not specifically studied. How could mimicking a pelvic attitude influence the dynamic mechanical interaction of the body segments? We proposed an investigation of the pelvic attitude role on the gait pattern of typically developed people when they mimicked pelvic anteversion and posteroversion.Materials and methodsSeventeen healthy volunteers were enrolled in this study. They (...) simulated a pelvic anteversion and posteroversion during walking, exaggerating these postures as much as possible. 3D gait analysis was conducted using an optoelectronic system with eight cameras and two force plates. The kinematic, kinetic, and spatio-temporal parameters were compared between the three walking conditions.ResultsIn Pelvic Anteversion gait we found: increased hip flexion, increased knee flexion during stance, and reduction of ankle flexion-extension Range of Motion compared with Pelvic Normal gait. In Pelvic Posteroversion gait compared with PN, we found: decreased hip flexion-extension RoM with a tendency to hip extension, decreased knee maximum extension in stance, and increased ankle maximum dorsiflexion in stance.ConclusionThe configuration of PA contains gait similarities and differences when compared with pathologic gait where there is an anteversion as seen in children with Cerebral Palsy or Duchenne Muscular Dystrophy. Similarly, attitudes of PP have been described in patients with Charcot-Marie-Tooth Syndrome or patients who have undergone Pelvic Osteotomy. Understanding the dynamic biomechanical constraints is essential to the assessment of pathological behavior. The central nervous system adapts motor behavior in interaction with body constraints and available resources. (shrink)

: In direct opposition to the dominant nativist perspective tracing back to Descartes, William James suggested that the sense of self is constructed through a never-ending process of reflexivity. In more recent years, empirical data from various psychological domains have further strengthened this constructivist perspective. Notably, Gergely and Watson’s social biofeedback model has been proposed as a central mechanism in the development of emotional introspection, which itself constitutes a crucial step in the process leading to a mature sense of (...) self. In accordance with the social biofeedback model, it has been suggested that reiterated failures in biofeedback mechanisms predispose an individual to mental suffering. While borderline personality disorder and antisocial behavior have received the most attention, here I make a preliminary attempt to examine the impact of dysfunctional biofeedback on the pathogenesis of narcissism, suggesting that some central features of pathological narcissism may result from serious and reiterated disruptions in social biofeedback. This preliminary exploration aims to deepen our understanding of the origins of psychological suffering. In this sense, my effort could contribute to the construction of a causal model going beyond the purely categorical, atheoretical analysis of mental diseases typical of the diagnostic and statistical manuals. Keywords: Self; Self-ing Process; Social Biofeedback Model; Narcissism Il farsi e il disfarsi del sé. Biofeedback sociale, meccanismi causali e narcisismo patologico Riassunto: La prospettiva costruttivista sullo sviluppo del sé, efficacemente difesa da William James in opposizione all’innatismo di stampo cartesiano, è oggi ulteriormente avvalorata da numerosi dati empirici provenienti da diversi ambiti della psicologia. Il modello del biofeedback sociale di Gergely e Watson è stato proposto quale meccanismo centrale nello sviluppo dell’introspezione emotiva. In accordo a tale modello, ripetuti gravi fallimenti del biofeedback predispongono al disturbo mentale, segnatamente al disturbo borderline di personalità e al comportamento antisociale. In questo saggio mi occuperò di disturbo narcisistico di personalità, suggerendo che anche alcuni dei sintomi principali di questa patologia potrebbero derivare da disfunzioni gravi e reiterate del biofeedback. Nonostante la sua natura preliminare, la mia indagine si inscrive nell’alveo di quelle ricerche che mirano costruzione di un modello causale che vada oltre l’analisi puramente categoriale e ateoretica tipica dei manuali statistico-diagnostici. Parole chiave: Self; Identità personale; Social Biofeedback Model; Disturbo narcisistico di personalità. (shrink)

The article is the text of a lecture given at the Faculty of the Humanities, March 2001. It argues that one implication of recent advances in the sciences of life may be that the binary opposition of the normal and the pathological is put into question. Canguilheim’s distinction between vital and social norms is challenged and superseded by a Foucauldian genealogical approach to programs for the government of individuals, and the norms of life that emerged in the nineteenth and (...) twentieth centuries are argued to be fundamentally social. Viewing genetics, biopsychiatry, and the commercialisation of drug development and biomedicine, the author argues that the logic of normalisation is loosing its hold, and being replaced by strategies for the continuous molecular management of variation, the modulation of susceptibilities, and the capitalisation of life itself. (shrink)

The paper discusses the conceptualisation of mental disorder as a representation, rather than an illness, and relates this perspective to the modern understanding of mental health as a healthy »narrative« or life story. The author proceeds to briefly consider the evolution of concepts of illness in psychiatry and a gradual reappearance of Lacanian psychoanalysis and psychiatry. The key concepts of Lacanian psychotherapy pave the way to a growing together of standard psychotherapy and modern philosophical practice within the novel concept of (...) integrative psychotherapy. (shrink)

In this paper I will develop an investigation of mental illness in relation to errors of judgment. Even based on the rational/irrational opposition, during the 18 th century reason is seen appropriating madness, and not only whenever it classifies mental illnesses and develops special scientific knowledge about them. More importantly, madness lurks in the very workings of modern reason. And of course, it sneaks into the error of judgment, making all border between the two very thin. A case can (...) then be made for the complementarity between reason and madness. In this sense, madness finds a place in Kant's project, from its very foundations. Recognizing the finiteness of the human intellect and stating accordingly the need for an exact survey of its limits means at the same time recognizing the possibility of error in judgment and the danger that knowledge may turn into madness. Provided one is to accept the methodological assumption that there is a continuity between the _Transcendental Dialectic_ and the section of the _Anthropology_ on judgment and mental illness, a constellation of essential Kantian notions comes to the fore as underpinning the overall transcendental project. A picture unfolds based on which error can affect, at the very least, perception, imagination and judgment. Errors of judgment, illusions, and madness are thus never far apart in Kant's accounts on human faculties, their dialectical drifts, and the possibility of psychopathy. (shrink)

Two experiments examined the typicality structure of contrasting political categories. In Experiment 1, two separate groups of participants rated the typicality of 15 individuals, including political figures and media personalities, with respect to the categories Democrat or Republican. The relation between the two sets of ratings was negative, linear, and extremely strong, r = −.9957. Essentially, one category was treated as a mirror image of the other. Experiment 2 replicated this result, showing some boundary conditions, and extending the result to (...) liberal and conservative categories. The same method was applied to two other pairs of contrasting categories, healthy and junk foods, and male and female jobs. For those categories, the relation between contrasting pairs was weaker and there was less of a direct trade-off between typicality in one category versus typicality in its opposite. The results are discussed in terms of implications for political decision making and reasoning, and conceptual representation. (shrink)

In their interesting and informative paper ‘From Szasz to Foucault: On the Role of Critical Psychiatry,’ Pat Bracken and Phil Thomas contrast, in a clear and helpful way, some central themes in the works of Thomas Szasz and Michel Foucault. They go on to endorse a form of critical psychiatry inspired by the latter. Szasz’s critique of psychiatry, they explain, is premised on binary oppositions, principally that between ‘mental’ and ‘bodily.’ Szasz begins by assuming the legitimacy of the distinction and (...) proceeds to argue that the term ‘illness’ can only be legitimately applied to what is ‘bodily.’ According to Szasz, there are medical pathologies, which are to be understood in naturalistic, biological terms, and .. (shrink)

Genetic and environmental factors leading to Alzheimer's disease (AD) converge in a pathogenic pathway that leads to the accumulation of mis‐folded amyloid peptide (Aβ) in the brain. Removal of Aβ from the brain has thus been the focus of academic and industrial research in the last decade. The concept of immunization therapy could be proven in animal models mimicking amyloid pathology but a multicenter clinical trial in which AD patients were vaccinated with aggregated Aβ has resulted in somewhat unanticipated and (...) partially conflicting results. The occurrence of meningoencephalitis in 6% of vaccinated individuals forced the discontinuation of the clinical study, preventing the generation of sufficient data for an unequivocal statement about the effectiveness of such a therapy approach. This study, however, clearly showed that vaccination induced the production of antibodies against Aβ in some immunized patients. Moreover, circulating anti‐Aβ antibodies are found in healthy humans suggesting a protective role of such physiological antibodies. Nonetheless, the physiological role of the immune system in preventing AD is not fully understood. This article summarizes crucial animal and clinical data underscoring the potential of the immune system for AD treatment. BioEssays 29:927–932, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

In this article, I explore how methods of investigation can allow us either to appreciate the intact cognitive and social abilities of people with Alzheimer’s disease or unwittingly obscure those same abilities. Specifically, I shall assert that (1) the biomedical- quantitative approach, while being generally appropriate for drug efficacy studies, does not allow us to appreciate the many significant strengths possessed by people diagnosed with dementia, (2) qualitative/narrative approaches do so admirably, and (3) understanding the cognitive and social strengths of (...) people diagnosed is of paramount importance for developing optimal care giving approaches and reveals strikingly the shared humanity of those diagnosed with dementia and those deemed healthy. (shrink)

Sensorimotor synchronization, the coordination of physical actions in time with a rhythmic sequence, is a skill that is necessary not only for keeping the beat when making music, but in a wide variety of interpersonal contexts. Being able to attend to temporal regularities in the environment is a prerequisite for event prediction, which lies at the heart of many cognitive and social operations. It is therefore of value to assess and potentially stimulate SMS abilities, particularly in aging and neurocognitive disorders, (...) to understand intra-individual communication in the later stages of life, and to devise effective music-based interventions. While a bulk of research exists about SMS and movement-based interventions in Parkinson’s disease, a lot less is known about other types of neurodegenerative disorders, such as Alzheimer’s disease, vascular dementia, or frontotemporal dementia. In this review, we outline the brain and cognitive mechanisms involved in SMS with auditory stimuli, and how they might be subject to change in healthy and pathological aging. Globally, SMS with isochronous sounds is a relatively well-preserved skill in old adulthood and in patients with NCDs. At the same time, natural tapping speed decreases with age. Furthermore, especially when synchronizing to sequences at slow tempi, regularity and precision might be lower in older adults, and even more so in people with NCDs, presumably due to the fact that this process relies on attention and working memory resources that depend on the prefrontal cortex and parietal areas. Finally, we point out that the effect of the severity and etiology of NCDs on sensorimotor abilities is still unclear: More research is needed with moderate and severe NCD, comparing different etiologies, and using complex auditory signals, such as music. (shrink)

This essay discusses four key criticisms recently leveled against the main attempts to use conceptual analysis to understand health and disease. First, it examines the weaknesses of these attempts and suggests a better way to proceed. Next, it briefly discusses another disease debate concerning pathological mechanisms and suggests that this approach could be more fruitful than that of conceptual analysis. The final section demonstrates how Georges Canguilhem's biological philosophy of disease avoids some of the problems associated with conceptual analysis, and (...) how he can contribute to both debates. Canguilhem's appeal to biological normativity is understood as contributing to a theoretical explanation, and a possible naturalization, of what is specific to healthy and pathological phenomena. (shrink)

Given that visualisations via medical imaging have tremendously increased over the last decades, the overall presence of colour-coded brain slices generated on the basis of functional imaging, i.e. neuroimaging techniques, have led to the assumption of so-called kinds of brains or cognitive profiles that might be especially related to non-healthy humans affected by neurological, neuropsychological or psychiatric syndromes or disorders. In clinical contexts especially, one must consider that visualisations through medical imaging are suggestive in a twofold way. Imaging data not (...) only visually render pathological entities, but also tend to represent objective and concrete evidence for these psychophysical states in question. This article aims to identify key issues in visually rendering psychiatric disorders via functional approaches of imaging within the neurosciences from an epistemological point of view. (shrink)

Given the resurgence of scientific studies on the etiology of homosexuality in the wake of the AIDS epidemic, this article considers the effects these studies had on contemporaneous queer filmmakers. By using the subject of criminality as a way to talk about homosexual causality, queer films of the 1990s illustrate that contemporary scientific studies on homosexuality were historically and politically situated in relation to cultural anxieties about other forms of deviance. This article focuses on films that dissect the hetero-normative tendency (...) to amalgamate forms of deviance in order to distinguish between the diseased and the healthy. Such products of New Queer Cinema highlight this amalgamation of criminality and homosexuality in order to challenge demands by the LGBT community of the 1980s and 1990s for “more positive images” in film. This article argues that queer filmmakers have manipulated the image of the queer criminal to usurp the medical tendency to biologize and pathologize the notion of queer transgression. In such a way, queer films that enthusiastically dramatize the queer outlaw perpetuate myths about homosexuality in order to dissect and discredit them. (shrink)

Internationally, calls for feedback of findings to be made an ‘ethical imperative’ or mandatory have been met with both strong support and opposition. Challenges include differences in issues by type of study and context, disentangling between aggregate and individual study results, and inadequate empirical evidence on which to draw. In this paper we present data from observations and interviews with key stakeholders involved in feeding back aggregate study findings for two Phase II malaria vaccine trials among children under the (...) age of 5 years old on the Kenyan Coast. In our setting, feeding back of aggregate findings was an appreciated set of activities. The inclusion of individual results was important from the point of view of both participants and researchers, to reassure participants of trial safety, and to ensure that positive results were not over-interpreted and that individual level issues around blinding and control were clarified. Feedback sessions also offered an opportunity to re-evaluate and re-negotiate trial relationships and benefits, with potentially important implications for perceptions of and involvement in follow-up work for the trials and in future research. We found that feedback of findings is a complex but key step in a continuing set of social interactions between community members and research staff (particularly field staff who work at the interface with communities), and among community members themselves; a step which needs careful planning from the outset. We agree with others that individual and aggregate results need to be considered separately, and that for individual results, both the nature and value of the information, and the context, including social relationships, need to be taken into account. (shrink)

IntroductionSpatial navigation is a complex cognitive function that declines in older age. Finding one’s way around in familiar and new environments is crucial to live and function independently. However, the current literature illustrates the efficacy of spatial navigation interventions in rehabilitative contexts such as pathological aging and traumatic injury, but an overview of existing training studies for healthy older adults is missing. This scoping review aims to identify current evidence on existing spatial navigation interventions in healthy older adults and analyze (...) their efficacy.MethodsTo identify spatial navigation interventions and assessments and investigate their effectiveness, four electronic databases were searched. Two independent reviewers conducted a screening of title, abstract and full-texts and performed a quality assessment. Studies were eligible if published in English, the full text was accessible, at least one group of healthy older adults was included with mean age of 65 years or older, three or more spatial navigation-related training sessions were conducted and at least one spatial ability outcome was reported.ResultsTen studies were included, only healthy older adults were assessed further. Studies differed in sample size, type of training, total intervention duration, and intervention period.ConclusionThe spatial navigation abilities addressed and the measures applied to elicit intervention effects varied in quantity and methodology. Significant improvements were found for at least one spatial ability-related outcome in six of 10 interventions. Two interventions achieved a non-significant positive trend, another revealed no measurable post-training improvement, and one study did not report pre-post-differences. The results indicate that different types of spatial navigation interventions improve components of spatial abilities in healthy older adults. The existing body of research does not allow conclusions on transferability of the trained components on everyday life spatial navigation performance. Future research should focus on reproducing and extending the promising approaches of available evidence. From this, valuable insights on healthy aging could emerge.Trial RegistrationThis scoping review was preregistered at Open Science Framework. (shrink)

In her paper, ‘Sharing online clinical notes with patients: implications for nocebo effects and health equity’, Blease bridges findings from two research fields to describe possible unintended consequences of providing patients access to clinical notes. 1 She explains how nocebo effects, genuine psychological and physiological reactions following negative expectations, may arise after patients read such notes. Blease emphasises that the likelihood of nocebo may be greater for those patient groups who experience stigmatisation in healthcare. We argue that this is the (...) case for patients with so-called medically unexplained symptoms (MUSs) and that clinicians who work with them should consider nocebo but not for the reasons they may think. MUS is a term used to refer to persistent physical symptoms which cannot be fully or reliably attributed to a structural pathology. They include common symptoms such as chronic or recurrent pain in joints and muscles, fatigue, paresthesia or digestive... (shrink)

La philosophie autrichienne, depuis Bolzano jusqu’à Musil et Wittgenstein en passant par Mach et la tradition brentanienne, est marquée par une obsession singulière : la clarté et la précision. Quelques traits de cette obsession, en particulier la critique sévère des différentes formes de bavardage philosophique, sont décrits et situés par rapport à la culture autrichienne en général. Mais chaque vertu a son vice, et les vertus cognitives de la pensée autrichienne n’échappent pas à la règle. Quatre exemples de la pathologie (...) de la précision sont analysés : Freud, Ehrenfels, Weininger et le dernier Husserl .Austrian philosophy from Bolzano, Mach and the Brentanian tradition to Musil and Wittgenstein is characterised by an obsession : clarity and exactness. Some features of this obsession, in particular the harsh criticisms of different types of philosophical blethering, are described, as is their place within Austrian culture. Each virtue has its vice and the cognitive virtues of Austrian thought are no exception. Four examples of the pathology of exactness are analysed : Freud, Ehrenfels, Weininger and the later Husserl. (shrink)

This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

Morality and mental health are now inseparably linked in our view of character. Alcoholics are sick, yet they are punished for drunk driving. Drug addicts are criminals, but their punishment can be court ordered therapy. The line between character flaws and personality disorders has become fuzzy, with even the seven deadly sins seen as mental disorders. In addition to pathologizing wrong-doing, we also psychologize virtue; self-respect becomes self-esteem, integrity becomes psychological integration, and responsibility becomes maturity. Moral advice is now sought (...) primarily from psychologists and therapists rather than philosophers or theologians. This book asks: are we replacing morality with therapy, in potentially confused and dangerous ways, or are we creatively integrating morality and mental health? According to the book, it's a little bit of both. It surveys the ways in which morality and mental health are related, touching on practical concerns like love and work, self-respect and self-fulfillment, guilt and depression, crime and violence, and addictions. Terming this integrative development “the therapeutic trend in ethics,” the book uses examples from popular culture, various moral controversies, and draws on line of thought that includes Plato, the Stoics, Freud, Nietzsche, and contemporary psychotherapeutic theories. The book develops some interesting conclusions, among them that sound morality is indeed healthy, and that moral values are inevitably embedded in our conceptions of mental health. In the end, the book shows how both morality and mental health are inextricably intertwined in our pursuit of a meaningful life. (shrink)

Christopher Boorse’s biostatistical theory of medical disorder claims that biological part-dysfunction (i.e., failure of an internal mechanism to perform its biological function), a factual criterion, is both necessary and sufficient for disorder. Jerome Wakefield’s harmful dysfunction analysis of medical disorder agrees that part-dysfunction is necessary but rejects the sufficiency claim, maintaining that disorder also requires that the part-dysfunction causes harm to the individual, a value criterion. In this paper, I present two considerations against the sufficiency claim. First, I analyze Boorse’s (...) central argument for the sufficiency claim, the “pathologist argument,” which takes pathologists’ intuitions about pathology as determinative of medical disorder and conclude that it begs the question and fails to support the sufficiency claim. Second, I present four counterexamples from the medical literature in which salient part-dysfunctions are considered nondisorders, including healthy disease carriers, HIV-positive status, benign mutations, and situs inversus totalis, thus falsifying the sufficiency claim and supporting the harm criterion. (shrink)

Objective: Body checking (BC) and avoidance (BA) form the behavioral component of body image disturbance. High levels of BC/BA have often been documented to hold a positive and potentially reinforcing relationship with eating pathology. While some researchers hypothesize, that patients engage in BC/BA to prevent or reduce levels of anxiety, little is known about the mediating factors. Considering the great comorbidity between eating disorders and in particular social anxieties, the present study investigated whether socially relevant types of anxiety mediate the (...) relationship between eating pathology and BC/BA. Method: 83 participants reporting an eating disorder and 323 healthy participants (14-25 years) took part in an online survey. Eating pathology was measured with the Eating Disorder Examination Questionnaire and Body Checking and Avoidance Questionnaire. Trait and social anxiety were assessed by means of the State Trait Anxiety Inventory (STAI-T), the Fear of Negative Evaluation (FNE) and the Social Appearance and Anxiety Scale (SAAS). Separate mediation analyses were carried out with eating pathology as independent variable, BC/BA as dependent variable and STAI, FNE and SAAS as mediating variables. Results: Anxieties correlated highly positive with eating pathology in both groups. SAAS mediated the relationship between ED pathology and BC/BA in participants with ED and mediated the relationship between ED pathology and BA in healthy participants. FNE mediated the relationship between eating pathology and BA for participants with eating pathology. Discussion: SAAS mediated the relationship between eating pathology and BC/BA. Being afraid of bodily evaluations may represent a particular relevant fear that triggers safety behaviors. (shrink)

Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced by (...) an imposter or another patient with schizophrenia believes that “The Organization” painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield’s harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions according to teleosemantics, a popular naturalist account of mental content, but harmful false beliefs do not have to be pathological. I examine those objections in detail and show that they should be rejected after all. (shrink)

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. First, (...) we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making. (shrink)

In opposition to traditional forms of dualism and monism, the author holds that our bodily self includes certain aspects of otherness. This is shown concerning the phenomenological issues of intentionality, of self-awareness and of intersubjectivity, by emphasizing the dimension of pathos. We are affected by what happens to us before being able to respond to it by acts or actions. Every sense, myself and others are born out of pathos. The original alienness of our own body, including neurological processes, (...) creates shifting degrees of nearness and remoteness, and allows for pathological deviations such as depersonalisation, paranoia or trauma. Such a phenomenology of body crosses the borderlines of different disciplines. (shrink)

Prior research has unveiled a pathologization effect where individuals perceived as having bad moral character are more likely to have their conditions labeled as diseases and are less often considered healthy compared to those viewed as having a good moral character. Moreover, these individuals are perceived as less unlucky in their affliction and more deserving of it. This study explores the broader impacts of moral character on such judgments, hypothesizing that these effects reach deeper and extend to both negative and (...) positive moral evaluations. The pathologization effect also raises concerns about potential discrimination and the overmedicalization of normal health variations, so we also examine whether providing more detailed descriptions of conditions mitigates the influence of judgments of moral character. The methodology and broader implications of our findings are discussed, emphasizing the need for a deeper understanding of how moral judgments might influence patient care. (shrink)

Causation is important when considering how an organism maintains health, why disease arises in a healthy person, and how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

This essay develops an account of health, the functional efficiency theory, which derives from Christopher Boorse's biostatistical theory. Like the BST, the functional efficiency theory is a nonevaluative view of health, but unlike the BST, it argues that the fundamental theoretical task is to distinguish levels of efficiency with which the parts and processes within organisms and within systems within organisms function. Which of these to label as healthy or pathological is of secondary importance. Because the statistical distributions that Boorse's (...) account relies on are distributions of functional efficiency, the functional efficiency theory arguably complements rather than challenges the BST. (shrink)

Comparing the phenomenology, neurochemical pathology, and psychopharmacology of hallucinations and dreaming is limited by the available data. Evidence to date reveals no simple correspondence between the two states. Differences in the phenomenology of visual hallucinations and the visual component of dreams may reflect variations in visual context acting on the same underlying mechanism – the minimal visual input during dreaming contrasts with the more substantial perceived context in hallucinations. Variations in cholinergic, dopaminergic and serotonergic neurotransmitter function during sleep and during (...) hallucinations in Lewy body dementias, together with relevant drug effects suggest that, on the whole, different, potentially opposite, changes characterise the two states. A similar analysis of other psychotic features in Lewy body dementia and other disorders suggests that, in contrast to hallucinations, there may be more convincing parallels between dreaming and delusional states. (shrink)

Jennifer Radden argues that delusions play an important role in modernist epistemology, which is preoccupied with the justification and evaluation of beliefs. Another theme running through the book is the importance of culture for attribution of delusion. Beliefs that look delusional will not be treated as pathological if they are expressions of religious views or other culturally acceptable forms of life. It is hard to see why cultural acceptability should play a role in the modernist project of justification. I suggest (...) that we think less about a philosophical project of justification and turn our attention instead to commonsense judgements of the circumstances in which we see a belief as evidence of underlying pathology. I discuss cases in which unjustified beliefs are nonetheless treated as phenomena that are consistent with our views of how healthy human beings act, and suggest that alongside folk psychology we should acknowledge a folk epistemology that embraces such instances. I suggest that delusions are beliefs that folk epistemology treats as inexplicable, and that this approach solves some of the puzzles that Radden identifies as growing out of the modernist epistemic project. (shrink)

An argument in the cognitive enhancement literature is that using stimulants in populations of healthy but socially disadvantaged individuals mistakenly attributes pathology to nonpathological individuals who experience social inequalities. As the argument goes, using stimulants as cognitive-enhancing drugs to solve the social problem of poorly educated students in inadequate schools misattributes the problem as an individual medical problem, when it is really a collective sociopolitical problem. I challenge this argument on the grounds that not all types of enhancement have to (...) be explained in medical terms, but rather at least one conception of enhancement can be explained in social terms—opportunity maintenance. Therefore, I propose that as a moral requirement we ought to explore whether stimulants could be a means of remedying underprivileged children's experiences of social inequalities that are borne from inadequate schools for the sake of increasing their chances for opportunities and well-being. (shrink)

This essay argues that what is central to Christopher Boorse’s biostatistical theory of disease as statistically subnormal part function (BST) are comparisons of the “functional efficiency” of parts and processes and that statistical considerations serve only to pick out a healthy level of functional efficiency. On this interpretation, the distinction between health and pathology is less important than comparisons of functional efficiency, which are entirely independent of statistical considerations. The clarifications or revisions of the BST that this essay offers are (...) friendly amendments that render moot some of the most prominent criticisms of Boorse’s account. (shrink)

Jason Springs’s Healthy Conflict in Contemporary American Society is a masterful attempt to practice productive conflict and democratic dialogue in the face of static antagonisms and deep‐seated divisions. In my response, I underscore Springs’s insistence on mediating between the moral imagination of Richard Rorty and the prophetic critique of Cornel West. For the author of Healthy Conflict, any hope in the survival of democracy relies on balancing critique of domination with constructive proposals for a more just and equitable world. On (...) the one hand, Springs rejects any strong distinction between moral imagination and socio‐political critique; in fact, he argues for their intertwinement, especially in the work of West. At the same time, there are moments when he suggests an opposition between expanding the moral imagination and engaging in the critical enterprise, especially as he identifies the limits in Foucault regarding normativity and democratic struggle. I respond to this slippage by arguing that Foucault, and critical theory more broadly, open up possibilities for rethinking ethics, politics, and our relationship to the violence that sustains the order of things. (shrink)