Dreaming is a communicative activity between the most sensitive archive of the enregistered experience of life on the earth, the brain, and the most plastic medium for the discovery and practice of meaning, the mind or culture. Both love and war have been made on the basis of dreams, not to mention scientific discoveries. In ancient Greece dreams were medicinal parts of curative sleeping or "incubation" rites in the temple of Aesculapius, and many psychoanalytic physicians today still consider dreams as (...) possessing therapeutic potential. The ethnographic literature gives ample testimony to the great significance accorded to dreams by all of the world cultures. Dreams form a rich store of ethnographic evidence, and their indigenous interpretations can often illuminate the central issues and conflicts of a people otherwise hidden from obvious view. Given these facts, plus the physiological facts that the dream process itself involves deeply-rooted material brain functions, and that rapid eye movement, or REM, sleep, which is the key indicator of human dreaming, is shared by all mammals, it remains strange how little attention is given to dreaming as a formative aspect of human evolution and culture. -/- This essay addresses dreaming as a formative aspect of human evolution and culture by viewing dreaming as a borderland between biology and culture, a thoroughly social, yet private experience. Dreaming not only highlights the "cultic" roots of culture—the spontaneous impulse to meaning—but also illustrates one of the ways in which the technics of the biosocial human body itself form the primary source of culture. I show why dreaming, although private, is a thoroughly cultural, biological, communicative activity. -/- Culture and biology are often treated by social scientists as though they were oil and water, not to be mixed. I should inform the culture theorist at the start that I am fully aware of the assumed nature-culture dichotomy, and that I reject it. I do so not because I am a sociobiologist, quite the contrary, rather because I am a semiotician, and my studies of signs have led me toward a critical reconstruction of the concepts of nature and culture. In what follows I beg the reader's patience, since I will draw from diverse materials and project some speculative hypotheses in places in order to make my argument. -/- . (shrink)

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by (...) reviewing the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common? (shrink)

One of the primordial functions of the brain is the acquisition of knowledge. The apparatus that it has evolved to do so is flexible enough to allow it to acquire knowledge about unambiguous conditions on the one hand, and about situations that are capable of two or more interpretations, each one of which has equal validity with the others. However, in the latter instance, we can only be conscious of one interpretation at any given moment. The study of ambiguity thus (...) gives us some insights into how activity at different stations of the brain can result in a micro-consciousness for an attribute, and also tell us something about interactions between different cerebral areas that result in several potential micro-conscious correlates, though only one predominates at any given time. Finally, the study of ambiguity also gives us insights into the neurological machinery that artists have tapped to create the ambiguity that is commonly a hallmark of great works of art. (shrink)

We are developing the Neurological Disease Ontology (ND) to provide a framework to enable representation of aspects of neurological diseases that are relevant to their treatment and study. ND is a representational tool that addresses the need for unambiguous annotation, storage, and retrieval of data associated with the treatment and study of neurological diseases. ND is being developed in compliance with the Open Biomedical Ontology Foundry principles and builds upon the paradigm established by the Ontology for General Medical Science (OGMS) (...) for the representation of entities in the domain of disease and medical practice. Initial applications of ND will include the annotation and analysis of large data sets and patient records for Alzheimer’s disease, multiple sclerosis, and stroke. (shrink)

The Brain and the Meaning of Life Paul Thagard Princeton: Princeton University Press, 2010 274 pages, ISBN: 9780691142722 (hbk): $29.95 This paper criticizes central arguments in Paul Thagard's The Brain and the Meaning of Life, concluding, contrary to Thagard, that there is very little that we can learn from brain research about the meaning of life. The paper offers a critical review of Thagard's argument against nihilism and his argument that it is love, work, and play, rather than other activities, (...) that make life meaningful. Moreover, the paper argues that the rich neurological information Thagard presents throughout the book does not contribute at all to his arguments and, more generally, that neurological research is irrelevant also to almost all other aspects of meaning of life research. (shrink)

I much appreciate the honour of being invited to deliver the first Manson lecture, which, its founder has laid down, is to be devoted to the consideration of some subject of common interest to philosophy and medicine. I cannot think of anything which better fulfils that condition than the neurological approach to the problem of perception. The neurologist holds the bridge between body and mind. Every day he meets with examples of disordered perception and he learns from observing the effects (...) of lesions produced by disease, or by the physiologist's experiments, something of how the neural basis of perception is organized. It is possible to study perception as though this was largely irrelevant. How far that view is right will be for you to judge when I have finished. (shrink)

Lehar argues that a simple Neuron Doctrine cannot explain perceptual phenomena such as size constancy but he fails to discuss existing, more complex neurological models. Size models that rely purely on scaling for distance are sparse, but several models are also concerned with other aspects of size perception such as geometrical illusions, relative size, adaptation, perceptual learning, and size discrimination.

This paper examines neuroethics as a discipline in which ongoing formation and development in both ethics and medicine are shedding new light on the care of patients diagnosed as being in a vegetative state. From the perspective of the Catholic moral tradition, the author proposes that ethics and recent developments in functional neuroimaging form a complementary relationship that gives rise to an ethical imperative: because we can care for patients in a vegetative state, we should do so. This imperative for (...) care finds a particular expression in the ethical debate in light of the 2004 statement of Pope John Paul II that assisted nutrition and hydration for patients in a vegetative state should be considered, in principle, ordinary care. What do neurology and developments in scientific research teach us about patients in a vegetative state? Neuroethics is providing a unique opportunity for both medicine and ethics to discover more completely not only who we are as human beings but also how we should act. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 477–488. (shrink)

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

A new view of the functional role of the left anterior cortex in language use is proposed. The experimental record indicates that most human linguistic abilities are not localized in this region. In particular, most of syntax (long thought to be there) is not located in Broca's area and its vicinity (operculum, insula, and subjacent white matter). This cerebral region, implicated in Broca's aphasia, does have a role in syntactic processing, but a highly specific one: It is the neural home (...) to receptive mechanisms involved in the computation of the relation between transformationally moved phrasal constituents and their extraction sites (in line with the Trace-Deletion Hypothesis). It is also involved in the construction of higher parts of the syntactic tree in speech production. By contrast, basic combinatorial capacities necessary for language processing – for example, structure-building operations, lexical insertion – are not supported by the neural tissue of this cerebral region, nor is lexical or combinatorial semantics. The dense body of empirical evidence supporting this restrictive view comes mainly from several angles on lesion studies of syntax in agrammatic Broca's aphasia. Five empirical arguments are presented: experiments in sentence comprehension, cross-linguistic considerations (where aphasia findings from several language types are pooled and scrutinized comparatively), grammaticality and plausibility judgments, real-time processing of complex sentences, and rehabilitation. Also discussed are recent results from functional neuroimaging and from structured observations on speech production of Broca's aphasics. Syntactic abilities are nonetheless distinct from other cognitive skills and are represented entirely and exclusively in the left cerebral hemisphere. Although more widespread in the left hemisphere than previously thought, they are clearly distinct from other human combinatorial and intellectual abilities. The neurological record (based on functional imaging, split-brain and right-hemisphere-damaged patients, as well as patients suffering from a breakdown of mathematical skills) indicates that language is a distinct, modularly organized neurological entity. Combinatorial aspects of the language faculty reside in the human left cerebral hemisphere, but only the transformational component (or algorithms that implement it in use) is located in and around Broca's area. Key Words: agrammatism; aphasia; Broca's area; cerebral localization; dyscalculia; functional neuroanatomy; grammatical transformation; modularity; neuroimaging; syntax; trace deletion. (shrink)

The nature of reality has exercised philosophers and mystics, theologians and shamans. Yet what we perceive as reality is bounded, if not defined, by the apparatus with which we perceive: our brains. Neurology has to know the capacity normal and disordered of the tool with which we see the world; neurologists use evidence of disordered perception to recognize and classify illness in the brain.

We currently exist in a post-biological age. Mixed-realities shape the way in which we live modern life; half in physical form, half in a hyper-mediated virtual environment of network protocols. This article discusses network-based impacts on neurological navigation and the ways in which the human auditory cortex is developing through conjuncture with post-biological combinations of sound. In doing so, it examines the capacity of the human brain in decoding and understanding the abundance of sound in confluent, variegated realms of existence (...) and how such increased perceptions expand consciousness and, in turn, affect sonic creativity as a somewhat mimicry or response to our immediate auditory environments. Conclusively, it will be argued that the exploration of sound-based creativity can be reinterpreted for post-biological spaces, taking particular aim at the reflective approaches of musique concrète and how such technologically infused ideas can be transformed and recontextualized to match the power and capacity of today’s hybrid environments of occupancy. (shrink)

The neurological criteria for the determination of death remain controversial within secular and Catholic circles, even though they are widely accepted within the medical community. In Determining Death by Neurological Criteria, Matthew Hanley offers both a practical and a philosophical defense. Hanley shows that the criteria are often misapplied in clinical settings, leading to cases where persons declared dead apparently spontaneously revive. These instances are often connected to a rushed decision to retrieve donated organs, thus undermining the trust of the (...) public in organ donation. Hanley calls on health care institutions to take seriously their obligation to establish strict protocols for the determination of death, including who may conduct the examinations. From a broader perspective, Hanley considers how the criteria rely on a philosophical conception of the person as a living organism whose unity disintegrates at death. This view, he notes, corresponds to the Catholic conviction that the soul is the life-principle of the body, which departs at death, bringing about the destruction of the body-soul composite. The Vatican, recognizing that death is a medical judgment, has generally given its approval to the criteria. Hanley also reviews the many and various objections offered by detractors, including against the use of the apnea test, which is faulted as a practice that sometimes hastens death. The problem of the continued presence of certain vital functions within the deceased body of the brain dead is explored in detail, with reference to particular cases and to solutions proposed by leading physicians and bioethicists. Hanley likewise addresses the dilemma of having two separate standards for death, one neurological and the other cardiopulmonary. Given the possibility of resuscitation following loss of the cardio-circulatory system, he concludes that the neurological criteria must be the true standard. Stoppage of the heart leads swiftly to the final necrosis of the brain. -- Provided by publisher. (shrink)

This chapter provides a brief overview of the history of behavioral neurology, dividing it roughly into six eras. In the ancient and classical eras, emphasis is placed on two transitions: firstly, from descriptions of head trauma and attempted neurosurgical treatments to the exploratory dissections during the Hellenistic period and the replacement of cardiocentrism; and secondly, to the more systematic investigations of Galenus and the rise of pneumatic ventricular theory. In the medieval through post-Renaissance eras, the scholastic consolidation of knowledge (...) and the role of compendia are emphasized, along with the use of new methods from within a mechanistic framework. With the discovery of electrical conductance and the rise of experimentalism, we frame the modern era as period of intense debate over localization, decomposition, and other mechanistic principles, and marked by rapid discovery about the brain. The chapter ends with a discussion of the contemporary era, focusing on the establishment of behavioral neurology research on aphasia, apraxia, and neuropsychiatric conditions. (shrink)

This article examines the imagination by way of various studies in cognitive science. It opens by examining the neural correlates of bodily metaphors. It assumes a basic knowledge of metaphor studies, or the primary finding that has emerged from this field: that large swathes of human conceptualization are structured by bodily relations. I examine the neural correlates of metaphor, concentrating on the relation between the sensory motor cortices and linguistic conceptualization. This discussion, however, leaves many questions unanswered. If it is (...) the case that the sensory motor cortices are appropriated in language acquisition, how does this process occur at the neural level? What neural preconditions exist such that this appropriation is possible? It is with these questions in mind that I will turn my attention to studies of neural plasticity, degeneracy and the mirror neuron activation. Whereas some scholarship in philosophy and cognitive neuroscience has aimed to identify the neurological correlates of consciousness, examining plasticity, degeneracy and activation shifts the discussion away from a study of correlates toward an exploration of the neurological dynamics of thought. This shift seems appropriate if we are to examine the processes of the “imagination.”. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address (...) variation in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

Contemporary philosophical debates about the competing merits of neurological and phenomenological approaches to understanding both psychiatric illness and religious experience—and, indeed, the relationship, if any, between psychiatric illness and religious experience. In this chapter, I propose that both psychiatric illness and religious experiences - at least in some of their diverse forms - are best understood phenomenologically in terms of radical changes in a person's 'existential feelings', in the sense articulated by Matthew Ratcliffe. If so, explanatory priority should be assigned (...) to phenomenology and not to neurology. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

Over 20 unstable microsatellite repeats have been identified as the cause of neurological disease in humans. The repeat nucleotide sequences, their location within the genes, the ranges of normal and disease‐causing repeat length and the clinical outcomes differ. Unstable repeats can be located in the coding or the non‐coding region of a gene. Different pathogenic mechanisms that are hypothesised to underlie the diseases are discussed. Evidence is given both from studies in simple model systems and from studies on human material (...) and in animal models. Since somatic instability might affect the clinical outcome, this is briefly touched on. Available data and theories on the timing and mechanisms of the repeat instability itself are discussed, along with factors that have been observed to affect instability. Finally, the question of why the often harmful unstable repeats have been maintained throughout evolution is addressed. (shrink)

The prelims comprise: Introduction A (re)Defmition of what Human Gene Therapy is About Neurological Gene Therapy Ethics and Gene Therapy Acknowledgments Notes.

Terminally ill patients in 10 states plus Washington, D.C. have the right to take prescribed medications to end their lives (medical aid in dying). But otherwise-eligible patients with neuromuscular disabilities (ALS and other illnesses) are excluded if they are physically unable to “self-administer” the medications without assistance. This exclusion is incompatible with disability rights laws that mandate assistance to provide equal access to health care. This contradiction between aid-in-dying laws and disability rights laws can force patients and clinicians into violating (...) one or the other, potentially creating an underclass of patients denied medical care that is available to those with other (less physically disabling) terminal illnesses. The immediacy of this issue is demonstrated by a lawsuit in Federal court filed in August 2021, requesting assistance in self-administration for terminally ill patients with neuromuscular diseases. This paper discusses the background of this conflict, the ethical issues at the heart of the dilemma, and recommends potential remedies. (shrink)

One of the traditional views of self-deception has been in terms of a dynamically-driven defense mechanism which is employed in order to enhance self-esteem by denying contradictory evidence. Denial is evident during stressful events in everyday life, as well as in cases of mental and somatic impairments. A detailed analysis of a specific neurological syndrome, prosopagnosia, where covert recognition of familiar faces may coexist with lack of overt recognition, demonstrates the inapplicability of the dynamic interpretation of self-deception in terms of (...) denial to some neurological syndromes, and the usefulness of a new conceptualization of this process in terms of dissociation between modular and central processes. It is proposed that self-deception be considered a complex process which may be conceived of as a defense mechanism in everyday life, and as a product of functional dissociation in neurological syndromes. (shrink)

Spanish culture has recently shown interest about Neuroethics, a new line of research and reflection. It can be said that two general, and somewhat opposing, perspectives are currently being developed in Spain about neuroethics-related topics. One originates from the neuroscientific field and the other from the philosophical field. We will see, throughout this article, that the Spanish authors, who I am going to select here, deal with very diverse neuroethical topics and that they analyse them from different intellectual assumptions. However, (...) I consider that there is one constant concern, which emerges extensively or briefly in each one of the books that I am going to present. I am referring to the problem of freedom. Spanish neuroscientists, in general, stress and accept the new determinism that emanates from recent research about the brain, whilst those who engage in the study of philosophy usually point in their texts to the limitations of empirical research that purport to "demonstrate" the new neurological determinism. I will dedicate the last section, which is more extensive in length, to the work that I consider the most valuable, at least until the present day, and whose title is Neuroética y Neuropolítica (Tecnos, Madrid, 2011). Professor Adela Cortina (chair of Moral Philosophy at Valencia University and member of the Spanish Royal Academy of Moral and Political Science) is its author. But, firstly, I am going to refer to the works written by neuroscientists, and then to those written by philosophers. This will enable us to obtain a global view of the neuroethics models that are being constructed in Spain. (shrink)

Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may (...) affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment. (shrink)

IntroductionCerebral visual impairment results from damage to cerebral visual processing structures. It is the most common cause of pediatric visual impairment in developed countries and rising in prevalence in developing nations. There is currently limited understanding on how neurologic, developmental, and ophthalmic factors predict outcome for pediatric CVI.MethodA retrospective manual chart review of pediatric CVI patients seen at the tertiary pediatric hospital neurology and neuro-ophthalmology service between 2010 and 2019 was conducted. Patients were stratified into severity groups, and followed (...) over time to identify outcome predictors. Collected baseline characteristics included perinatal, genetic, developmental, and neurologic history, along with neuroimaging and fundoscopic findings on examination. Longitudinal data collected included age, seizure control, and type of therapy received. Linear mixed-effect models were used for longitudinal CVI grade outcome analysis.ResultsA total of 249 individuals spanning 779 patient visits were identified. Mean age at diagnosis was 18.8 ± 16.8 months. About 64.3% were born at term age. Perinatal history revealed hypoxic ischemic encephalopathy in 16.5%, intraventricular hemorrhage in 11.6%, and seizures in 21.7%. At presentation, 60.3% had a diagnosis of cerebral palsy and 84.7% had developmental delay. Among all subjects, 78.6% had epilepsy; 33.8% had an epileptic encephalopathy, with spasms/hypsarrhythmia being most common. Abnormal neuroimaging was present in 93.8%. Genetic anomalies were present in 26.9%. Baseline visual examination revealed no blink-to-light in 24.5%; only BTL in 34.5%, fixation/tracking in 26.5%, and optokinetic drum follow in 14.4%. Longitudinal data analysis showed that perinatal history of HIE, a positive epilepsy history, using multiple epilepsy medications, cerebral palsy, and abnormal fundoscopic findings were all negatively associated with CVI grade change over time. After controlling for significant confounders, receiving any type of therapy [early childhood intervention, physical and occupational therapy, refractive error correction or glasses] was significantly associated with longitudinal improvement in CVI grade compared to patients who did not receive any therapy, with glasses yielding the largest benefit.ConclusionThis study offers extensive insights into neurologic, developmental and ophthalmologic features in patients with moderate to severe CVI. In concordance with previous findings, aspects of perinatal history and epilepsy/seizure control may help inform severity and prognosis in the general neurology or ophthalmology clinic. Conversely, these aspects, as well as genetic and specific epilepsy traits may alert vision health care providers in the clinic to pursue visual evaluation in at-risk individuals. Longitudinal follow-up of CVI patients showed that interventional therapies demonstrated vision function improvement greater than no therapy and maturational development. (shrink)

In an editorial to a recent issue of Neurology, Richard Dees expresses the same criticism in an even more rigorous epistemic tone: Veikko Launis, Ph.D., is Professor of Medical Ethics and Adjunct Professor of Ethics and Social Philosophy at the University of Turku, Finland.FootnotesThis article is part of the Neuroethics of Brainreading research project, directed by myself and funded by the Academy of Finland. I am grateful to Olli Koistinen, Pekka Louhiala, Helena Siipi, and an anonymous referee for helpful (...) comments, criticism, and suggestions. (shrink)

Glowacki explored the conditions required for peace and argued its preconditions arose only within the last 100,000 years. The present commentary addresses some major brain changes that occurred only in Homo sapiens within that period of time and the verbal and nonverbal cognitive sequelae of those neurological changes that may have aided the diplomatic negotiations required for peaceful solutions.

This article describes how Pribram's holonomic brain theory fits into Neurological Positivism's overall perspective of the evolution of the algorithmic organization of space and time in the brain. It is proposed that the principles of holonomic theory themselves represent a dynamical "diagram of forces" that have resulted from evolutionary processes - thus the holonomic space and time in the brain. The maximum-power evolution guided self-organizing, exteriorizing derivation of mathematics from the algorithmic patterns of the preadapted human brain is described. It (...) is proposed further that the workability of mathematics in the "real world," far from being a mystery, is a necessary result of the origin of mathematics in neural circuitry patterns that are, in turn, encapsulations of real world dynamics. It is concluded that the organization of symbol systems is naturally approaching in power the algorithmic organization of the brain itself. (shrink)

Advances in cognitive neuroscience make cosmetic neurology in some form inevitable and will give rise to extremely difficult ethical issuesConsider the following hypothetical case study. A well heeled executive walks into my cognitive neurology clinic because he is concerned that he is becoming forgetful. It turns out that he is going through a difficult divorce and my clinical impression is that his memory problems stem from the stress he is experiencing. I place him on a selective seratonin reuptake (...) inhibitor, sertraline, and in a few weeks he feels better. Around this time his 13 year old daughter has difficulty at school and is diagnosed by the school psychologist as having attention deficit disorder. I place her on adderall, a stimulant combination drug, which seems to help with her behaviour in school. My patient then comes to me because he is experiencing the “tip of the tongue” phenomena more frequently. He is concerned that his word finding difficulty interferes with his ability to function in high level meetings. I suggest we try a cholinesterase inhibitor to see if this helps. I am careful to explain that the Food and Drug Administration does not approve such a use for this medication. He wants to try it and is pleased with the results.A few months later, this patient visits me with his 16 year old son, a talented middle distance runner. His father thinks if he were just a bit better, among the elite high school runners in the state, he would be far more competitive as an applicant for selective colleges. We discuss various options. Because of a recent report that sildenafil, which is used conventionally for male impotence, may improve oxygen carrying capacity, I prescribe this medication. The son does not object.Encouraged by these pharmacologic successes, my patient …. (shrink)

In this paper Nietzsche's physiology of pain is critically related to recent theories of neurology of pain. Nietzsche offers no encompassing notion of a neurology of pain like the well-known theories of, for instance, Melzack and Wall do. But, as will be shown, Nietzsche's notion of physiology offers a productive connection with contemporary neurology, particularly with Wall's newest notion of the neurology of pain. Thus I shall not discuss Nietzsche's view on science in general, but the (...) possible application of his philosophy to a particular science. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Neurology of Culture, or How We Move From Rage to Ritual in the Process of HominizationGregory J. Lobo (bio)The most (or rather the only) effective form of reconciliation—that would stop this crisis, and save the community from total self-destruction—is the convergence of all collective anger and rage towards a random victim, a scapegoat, designated by mimetism itself, and unanimously adopted as such.—René Girard, Evolution and Conversion, 64.INTRODUCTIONHow (...) do we move from rage to ritual? How do we become human? The work of René Girard would seem to offer an answer to this question. In this brief essay I want to simply add some evolutionary and neuroscientific details to Girard's theory, which flesh out while also corroborating the basic components of it. [End Page 255]To do this I need to draw a distinction between religion and culture. I mention this from the outset because the main source upon which I draw to represent Girard's thinking is the book Evolution and Conversion. Dialogues on the Origins of Culture, with Pierpaolo Antonello and João Cezar de Castro Rocha, published in 2008. I use this particular source because, as Girard's interlocutors say in their foreword to it, this book "is intended as a reassessment of Things Hidden since the Foundation of the World, 30 years on,"1 and it evidences the "ways in which, over 30 years, mimetic theory has matured, and its fruitfulness become more apparent, even since the initial excitement of Girard's groundbreaking works in the 1970s."2 I highlight my need to distinguish between culture and religion due to the fact that in Evolution and Conversion Antonello and Castro Rocha state forthrightly that for Girard (and, one might presume, for Girardians), culture and religion "amount to the same thing."3 But it is not totally clear that this holds. For as Girard, in the same book, says, "religion, as an institution, comes into being through the scapegoat mechanism."4 Thus, the question arises as to what it is that allows humans to have institutions in the first place. Surely the answer is the capacity for culture as such, understood as the very capacity for symbolic thought, for the manipulation of mental images and their combination into new ones. Hopefully, in the discussion that follows, my insistence on the need to analytically distinguish between culture and religion will be born out. For now, I simply ask the reader to play along. If the reader is game, I can restate my purpose: What is the neurology of culture, such that we can become human, or move from blind rage to deliberate ritual?THE MIMETIC MECHANISMGirard, we should recall, insists that we start "from a purely naturalistic standpoint."5 With this injunction in mind, I will give an account of the "mimetic mechanism," an expression that "describes the whole process, beginning with mimetic desire, which then becomes mimetic rivalry, eventually escalating to the stage of a mimetic crisis and finally ending with the scapegoat resolution"6 that strives for naturalistic representation. Therefore, I will avoid terms like "community" or even "group," which already suggest the existence of something like cultural realities. A naturalistic standpoint, which I take to be a scientific standpoint, must strive to circumvent begging the question by using terms like these, for they refer exactly to the phenomena we are trying to explain: a self-conscious sense of belonging and community. [End Page 256]For those familiar enough with its presuppositions about the human nature that underlies, or is the foundation of, human culture, the mimetic mechanism can be presented in a somewhat straightforward fashion. This presentation relies on Chapter 2 of Evolution and Conversion.The desire of Homo sapiens is in essence mimetic. That is, an individual member of the species desires what its proximal conspecifics—its models—desire. That two conspecifics should desire the same thing leads, inevitably, to two intermediate outcomes. First, the desire for what the other desires intensifies, due to the effects of mimesis; second, this drives the two now mutual models almost inevitably into conflict, as they become doubles. This is conflictual mimesis. The conflict can turn violent and... (shrink)

This paper explores the impacts of neurological intervention on selfhood with reference to recipients’ claims about changes to their self-understanding following Deep Brain Stimulation for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken and (...) occludes what is ethically salient in changes from DBS. Rather, by adopting a relational narrative approach to identity and autonomy, I show that the ethically salient issue from DBS is impacts on autonomous agency—whether one’s actions and beliefs are one’s own, and how DBS may hinder, or foster, embodied, relational autonomy competences. This approach recognizes that if sufficiently significant, impacts on autonomy competences may pose a threat to one’s ability to contribute to the process of authoring one’s own life and so pose a threat to identity formation. I argue this approach resolves the confusion in the literature about whether and how DBS threatens identity and provides a complex picture of how DBS may affect selfhood by disrupting narrative identity formation and revision, distorting agency and/or undermining autonomy. (shrink)

Some employ neurological theories of empathy to train medical students and to explain why care work is emotionally exhausting. I argue, however, that these theories develop conceptual and methodological confusion that creates a reductive and misdirected focus in patient-centered care. Neurological theories on empathy do not help us understand patient-centered care, nor do they help us understand why care work can be exhausting. By discussing examples of care work, I argue that empathic attentiveness to patients is a dialogical ethical response (...) to the whole person and takes place in daily care settings of working, helping, and responding to each other. (shrink)