Dynamic systems theory (DS) provides tools for exploring how simpler elements can interact to produce complex psychological configurations. It may, as Lewis demonstrates, provide means for explicating relationships between two reductionist approaches to overlapping sets of phenomena. The result is a description of psychological phenomena at a level that begins to achieve the richness we would hope to achieve in examining psychological life as it is experienced and explored in psychoanalysis.

Repression has remained controversial for nearly a century on account of the lack of well-controlled evidence validating it. Here we argue that the conceptual and methodological tools now exist for a rigorous scientific examination of repression, and that a nascent cognitive neuroscience of repression is emerging. We review progress in this area and highlight important questions for this field to address.

Populations in many Midwest cities are declining. To maintain infrastructure with a shrinking tax base, city planners have sometimes proposed to right size such cities, sometimes shutting down or removing infrastructure. Such proposals have been met with fierce resistance among many residents, especially in communities with a history of top-down, racialized city planning. This raises the question: if population loss is a near certainty, is it possible to shrink justly? Much work on environmental injustice focuses on removing bad things from (...) an environment, but in shrinking cities, there is a high likelihood that good things will be removed. Is it at all possible to do this in a manner that promotes justice? In our view, the answer is perhaps. Academics and professional city planners ought not determine the fate of cities, but can develop detailed conceptions of a city’s future for residents to consider. To this end, we build on a theoretical framework—the notion of a “just city”– to sketch a few ideas about what a just shrinking city might look like, identifying both a wider array of hazards, and possible benefits, to reducing city services than is often noticed. (shrink)

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

Populations in many Midwest cities are declining. To maintain infrastructure with a shrinking tax base, city planners have sometimes proposed to right size such cities, sometimes shutting down or removing infrastructure. Such proposals have been met with fierce resistance among many residents, especially in communities with a history of top-down, racialized city planning. This raises the question: if population loss is a near certainty, is it possible to shrink justly? Much work on environmental injustice focuses on removing bad things from (...) an environment, but in shrinking cities, there is a high likelihood that good things will be removed. Is it at all possible to do this in a manner that promotes justice? In our view, the answer is perhaps. Academics and professional city planners ought not determine the fate of cities, but can develop detailed conceptions of a city’s future for residents to consider. To this end, we build on a theoretical framework—the notion of a “just city”– to sketch a few ideas about what a just shrinking city might look like, identifying both a wider array of hazards, and possible benefits, to reducing city services than is often noticed. (shrink)

A father brings his six-year-old daughter and her older sister to their pediatrician to be evaluated for a history of cough, runny nose, and low-grade fever. In addition to signs of a cold, the girl's nasal bridge is quite swollen and bruised. When asked how her nose was injured, she shrugs, and her father's only conjecture is that she sleepwalks and might have bumped into something. The father sits impatiently and as questioning progresses becomes increasingly defensive, at one point angrily (...) declaring, “We don't beat our kids, if that's what you’re asking.” Further complicating the situation is information from nurses that this family is “on the brink” socially and financially, and that additional stress is likely “to blow this family apart.” A careful physical exam identifies no other injuries, and a thorough review reveals no evidence of prior suspicious injuries, frequent visits to the emergency room, or bleeding abnormalities. The evidence does not point to abuse as the most likely explanation for the injury, but it clearly is not ruled out. Should one report this family for suspected abuse? Is one required to report? (shrink)

Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they harbor suspicion. In this paper we outline the context of (...) the problem, discuss the nature and scope of its conceptual underpinnings, and offer recommendations for moving towards a concrete, practical solution. (shrink)

Within the field of medical ethics there is a startling amount of diversity regarding which issues and relationships are deemed relevant for ethical inquiry and analysis, what strategies are appropriate for examining and resolving ethical conflict, what should be the goals for medical ethics, even who should participate in that project. What I will try to make clear in this paper is that how we go about this process of doing medical ethics, of examining, reflecting, decisionmaking, and behaving, makes a (...) practical difference, and not just a philosophical one, in terms of the understandings we will reach about ethical matters. Without attempting to resolve any of the conflicts within or between different conceptions of doing ethics, I will try to articulate the differences in orientation, and particularly the tone and educational emphasis, that attend four major contemporary approaches to ethical inquiry and analysis: deductivism, principlism, modern casuistry, and feminist/relationist ethics. Keywords: casuistry, deductivism, ethics, feminism, principlism, relationism CiteULike Connotea Del.icio.us What's this? (shrink)

PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review (...) the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

In patients with schizophrenia, consent postmortem for organ donation for transplantation and research is usually obtained from relatives. By means of a questionnaire, the authors investigate whether patients with schizophrenia would agree to family members making such decisions for them as well as compare decisions regarding postmortem organ transplantation and brain donation between patients and significant family members. Study results indicate while most patients would not agree to transplantation or brain donation for research, a proportion would agree. Among patients who (...) declined organ donation for transplantation or brain research, almost half of family members would have agreed to brain donation for research and over 40% to organ transplantation. Male relatives are more likely to agree to organ donation from their deceased relatives for both transplantation and research. The authors argue that it is important to respect autonomy and interests of research subjects even if mentally ill and even if no longer living. Consent may be assisted by appropriate educational interventions prior to patient death. (shrink)

a short text on the concept of justice by Walter Benjamin. The text was preserved by Gershom Scholem on 8 October 1916, the same method by which most of Benjamin's early writings have reached us. However, this piece somehow remained undetected by the editors of the Gesammelte Schriften. It first appeared in German and English in Metaphysics of the Profane, New York: Columbia University Press, 2003, pp. 166-169, with permission of the German publishers Suhrkamp Verlag. It is presented (...) here with a typographical error corrected. (shrink)

The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The (...) purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees. (shrink)

Exploring the Illusion of Free Will and Moral Responsibility is an edited collection of new essays by an internationally recognized line-up of contributors. It is aimed at readers who wish to explore the philosophical and scientific arguments for free will skepticism and their implications.

an anarchist critique of Bolshevism, drawing on Walter Benjamin. The translation and commentary published as "Theories of Justice, Profane and Prophetic: Gershom Scholem on the Bolshevik Revolution" in Gershom Scholem: In memoriam, Vol. 2, Jerusalem Studies in Jewish Thought, 21, 2007.

Abstract : Libet’s famous experiments, showing that apparently we become aware of our intention to act only after we have unconsciously formed it, have widely been taken to show that there is no such thing as free will. If we are not conscious of the formation of our intentions, many people think, we do not exercise the right kind of control over them. I argue that the claim this view presupposes, that only consciously initiated actions could be free, places a (...) condition upon freedom of action which it is in principle impossible to fulfil, for reasons that are conceptual and not merely contingent. Exercising this kind of control would require that we control our control system, which would simply cause the same problem to arise at a higher-level or initiate an infinite regress of controllings. If the unconscious initiation of actions, as well as the takings of decisions, is incompatible with control over them, then free will is impossible on conceptual grounds. Thus, Libet’s experiments do not constitute a separate, empirical, challenge to our freedom. (shrink)

The thesis that republicanism was only suited for small states was given its decisive eighteenth-century formulation by Montesquieu, who emphasized not only republics' need for homogeneity and virtue but also the difficulty of constraining military and executive power in large republics. Hume and Publius famously replaced small republics' virtue and homogeneity with large republics' plurality of contending factions. Even those who shared this turn to modern liberty, commerce and the accompanying heterogeneity of interests, however, did not all agree with or (...) know about Publius' institutional responses to the problems of executive and military power. Throughout the late eighteenth and early nineteenth centuries, and on both sides of the Atlantic, it remained a live question whether large states could be stable moderate republics, with responses ranging from embraces of Montesquieuian limited monarchy, to denials that there was any real large-republic problem at all, with a variety of institutional solutions in between for those who thought there was a real but soluble large-republic problem. (shrink)

How can cross-disciplinary speculative narratives give us insights and open new paths of research? Borrowing from a number of disciplines, from Anthropology to Psychology or Art history, I will draw a hypothetical blueprint of processes that possibly led to the creation of the Ainu people’s patterns, an indigenous tribe from north Japan. From some particular key points I will narrate a speculative tale giving us possible insights about those specific patterns, as well as about the questions encapsulated in the split (...) representation in the art of Asia and America, questions that were raised by various anthropologists, from Franz Boas to Claude Levi-Strauss. I will demonstrate that those pattern-making habits were inherent to human being as a species until very recently. What kind of unconscious purpose or meaning they could have had and what it could mean in terms of the evolution of consciousness. (shrink)

Dans ce long inédit, Benjamin Fondane révèle les implications philosophiques révolutionnaires qui découlent des travaux de Lévy-Bruhl (1857-1939) sur la mentalité primitive. En mettant à jour les mécanismes d'une logique différente, Lévy-Bruhl fait voler en éclat l'universalité de la logique d'Aristote sur laquelle repose notre pensée occidentale. Dès lors cette logique n'est rien d'autre qu'une arme politique qui fonde l'hégémonie de la rationalité.0La démonstration de Fondane est implacable et bouleverse notre conception de la philosophie. Il nous incite à reconsidérer (...) nos manières de penser et de vivre sous la contrainte de la raison, faisant écho à une tradition non aristotélicienne qu'incarnent des penseurs comme Michelstaedter, Lukasiewicz ou Alfred Korzybski. (shrink)

ERIC JACOBSON, Theories of Justice, Profane and Prophetic: Scholem on the Bolshevik Revolution. with commentary drawn from Walter Benjamin's Critique of Violence) in: Gershom Scholem. In Memoriam, Vol. II. Jerusalem Studies in Jewish Thought, No. 21, ed. Joseph Dan, Jerusalem: The Hebrew University of Jerusalem, 2007, 59-75.

Gershom Scholem's commentary on Walter Benjamin's "Notes to a Study on the Category of Justice", first published in German and English in Metaphysics of the Profane, New York: Columbia University Press, 2003, pp. 174-180, with permission of Suhrkamp Verlag.

Memory, mother of the Muses by Zeus, has nurtured culture for nearly three millennia while her nemesis, forgetfulness, has been demonized as an agent of destruction. In the modern age, however, memory has grown increasingly burdensome, opening the way for a more positive assessment of forgetfulness. Nietzsche praises animals for an inability to remember that preserves their innocence and happiness, and Freud documents the discontents of a civilization that cannot forget. ;In tracing the recent development of these issues, the dissertation (...) focuses primarily on Walter Benjamin, Hans Blumenberg, and Thomas Pynchon. Benjamin and his anguished "angel of history" show the destructive psychological effects of trying to use human memory as a secular form of redemption. Blumenberg's philosophy of history makes it possible to trace memory's responsibility for redemption to the modern age's inflated notion of the subject. Blumenberg's work also emphasizes the importance of metaphor and narrative in mediating and creating historical understanding, and this aesthetic distance weakens memory's redemptive relation to the past. Pynchon's protagonists, too, find that their desire to make historical meaning fully present is overshadowed by their fear of such presence. By reconciling themselves to a profane aesthetic distance from the past, Blumenberg and Pynchon redeem themselves from the melancholy engendered by an overly ambitious memory. ;Thus the dissertation attempts to recover a more modest and less oppressive memory by understanding it as a way to distance rather than redeem past injustices. This reconception of the function of memory helps establish an equilibrium between the pensive memory of Benjamin's "angel of history" and the innocent oblivion of Nietzsche's animals. ;In addition to the three major figures named in the title, the dissertation devotes sections and excursuses to Friedrich Nietzsche, Sigmund Freud, Ernst Cassirer, Martin Heidegger, Virginia Woolf, Ernst Robert Curtius, Elie Wiesel, Primo Levi, Michel Foucault, and Thomas Kuhn. Translations of two essays by Blumenberg, "Pensiveness" and "Being--A MacGuffin," and a comprehensive Blumenberg bibliography are included as appendices. (shrink)

Table of contents : 1. The beginnings of phenomenology: Husserl and his predecessors Richard Cobb-Stevens, Boston College 2. Philosophy of existence 1: Heidegger Jacques Taminiaux, University of Louvain, Belgium 3. Philosophy of existence 2: Sartre Thomas Flynn, Emory University 4. Philosophy of existence 3: Merleau-Ponty Bernard Cullen, Queen's University, Belfast 5. Philosophies of religion: Jaspers, Marcel, Levinas William Desmond, Loyola College 6. Philosophies of science: Mach, Duhem, Bachelard Babette Babich, Fordham University 7. Philosophies of Marxism: Gramsci, Lukacs, Benjamin, Althusser (...) Michael Kelly, University of Southampton 8. Critical theory: from Adorno to Habermas David Rasmussen, Boston College 9. Hermeneutics: Gadamer, Ricoeur Gary Madison, McMaster University 10. Italian idealism and after: Croce, Gentile, Vattimo Giacomo Rinaldi, University of Urbino, Italy 11. French structuralism and after: Barthes, Lacan, Lévi-Strauss, Foucault Hugh Silverman, State University of New York at Stony Brook 12. French feminism and after: de Beauvoir, Kristeva, Irigaray, Cixious Alison Ainley, Oxford Brookes University 13. Deconstruction Simon Critchley, Essex University 14. Derrida Timothy Mooney, Essex University 15. Postmodernist theory: Lyotard, Baudrillard Thomas Docherty, Trinity College, Dublin. (shrink)

One purpose for the field of consciousness studies may be to increase general understanding about consciousness and its place in human life, thereby possibly aiding us in living in better harmony within our societies and with our fellow humans. Neil Levy’s new work is a candidate for this latter purpose for the field. Consciousness studies may help us better understand how we function as conscious agents—or what role consciousness plays in our agency—and aid in our more just construction of (...) laws, especially those dealing with culpability. (shrink)

Combining the philosophy and musicology of T.W. Adorno, Walter Benjamin, and Gilles Deleuze, Joseph Weiss makes an original contribution to the field of aesthetics and critical theory. Highlighting previously hidden connections between these philosophers' work brings into focus a new perspective on the dynamic relationship between music, nature, history, and technology. Musical expression in this study is presented as one of the core ways in which human beings are able to escape their more base natures and instincts. The complex (...) ways in which song is taken up across time and place is viewed through the prism of different technologies and histories. This historical process, which Weiss refers to as the 'instrumentalization of the voice', following Deleuze, is illuminated though a wide-ranging analysis encompassing lullaby, jazz, classical music, and the electroacoustic avant-garde. Deepening the aesthetic analysis of music in relation to the conceptual problems of continental philosophy, Weiss reveals enlightening theoretical consequences. By engaging with an eclectic range of 20th century theorists, including Primo Levi, James Baldwin, Édouard Glissant, Fred Moten, and Angela Davis, Weiss makes the argument that advanced music remains a refuge for political hopes that are as yet blocked from realization. Speaking to contemporary debates on post-humanism, memory, and the threat of neo-fascist social relations, the author outlines a bold new aesthetics of music. (shrink)

Volume 20 of _The Annual of Psychoanalysis_ ably traverses the analytic canvas with sections on "Theoretical Studies," "Clinical Studies," "Applied Psychoanalysis," and "Psychoanalysis and Philosophy." The first section begins with Arnold Modell's probing consideration of the paradoxical nature of the self, provocatively discussed with John Gedo. Modell focuses on the fact that the self is simultaneously public and private, dependent and autonomous. Alice Rosen Soref next explores innate motivation and self-protective regulatory processes from the standpoint of recent infancy research; her (...) notion of a lifelong two-track model of self and relatedness helps establish a normative baseline that can anchor psychoanalytic theory. George Mahl makes an interesting contribution to Freud studies in the form of a new chronology of Freud's works and the number of pages they contain in the _Standard Edition_. The section ends with Robert Galatzer-Levy and Mayer Gruber's "quasi-experiment about disgust." They test and disconfirm the hypothesis that disgust is an affective response to an abstract sense of disorder rather than a transformation of a concrete, bodily experience by systematically exploring references to concepts of disgust in the Old Testament. Section II, on "Clinical Studies," opens with Henry Smith's fascinating elaboration of Freud's notion of "screen memories" into a theory of screening that denotes the general process by which mental content is organized. He illustrates his thesis by invoking the "screen language" employed by a patient throughout her analysis. Ernest Wolf next explores the tension between being a "scientist" and a "healer" in Freud and his followers to illuminate struggles within the psychoanalytic movement and to help account for current attitudes toward abstinence, neutrality, and gratification. Kenneth Newman focuses on this same triptych of technical precepts. He argues, in the spirit of Winnicott and Kohut, that analysts can only alter the hostile internal environments of their patients by becoming "usable" objects and cultivating an optimally responsive analytic environment. A particularly rich collection of applied analytic studies forms Section III of the volume. Individual chapters focus on the childhood of Vincent van Gogh ; the psychological healing process depicted in George Eliot's _Silas Marner_ ; the self-psychological meaning of "blood brotherhood" in D. H. Lawrence's _Women in Love_ ; ecstatic mysticism in the 19th-century Indian saint Sri Ramakrishna ; the disintegration of the Tyrone family in Eugene O'Neill's _Long Day's Journey into Night_ ; and the nature and analytic significance of Freud's aesthetic response to Michelangelo's _Moses_. Finally, in Section IV, George Brook examines the commonsense psychological knowledge of everyday life, that is, the nonpsychoanalytic knowledge on which much of clinical psychoanalysis ultimately depends. Taken together, the four sections of Volume 20 of _The Annual_ offer an exciting overview of contemporary psychoanalysis. Section I highlights recent trends in psychoanalytic theorizing and the testing of psychoanalytic propositions; Section II explores the relevance of new theoretical perspectives to clinical work; Section III demonstrates the applicability of these new perspectives to psychobiographical and literary analysis; and Section IV provocatively explores the points of connection between everyday ideas and attitudes and the tenets of psychoanalytic practice. (shrink)

Volume 25 of _The Annual_ is dedicated to the memory of Michael Franz Basch, who achieved distinction as both a psychoanalytic theorist of the first rank and an authority on the nature and conduct of dynamic psychotherapy. A wide range of original contributions bear witness to his theoretical, clinical, and educational interests. A number of papers remind us of Basch's prominence as a self-psychological theorist: Elson's self-psychological reappraisal of self-pity, dependence, and manipulation as self-states; Ornstein's developmental perspective on power, self-esteem, (...) and destructive aggression; Tolpin's review of sexuality from the standpoint of normal self development; and Wolf's discussion of self psychology and the "aging self." Basch's life-long educational concerns gain expression in Goldberg's discussion of clinical teaching, particularly the challenge of leading of case conferences; and Ornstein's and Kay's thoughtful consideration of "enduring difficulties" in American medical education. Additional highlights of the volume include: Fawcett's consideration of the role of pharmacotherapy in psychodynamic treatment; Jaffe's consideration of the applicability of hierarchical models to assessment and intervention in brief psychotherapy; Galatzer-Levy's review of the "witch" metapsychology; Gedo's analysis of mythic themes in the operas _Don Giovanni_ and _Der Rosenkavalier_; Modell's reflections on metaphor and affects; and Kernberg's discussion of a "new psychoanalytic mainstream," which he compares and contrasts with a parallel convergence of Kohutian and interpersonal analytic approaches. Many of these contributions incorporate reflections on Basch as a teacher and colleague, and the entire volume is framed by Goldberg's moving tribute. Analysts and psychotherapists sharing Basch's commitment to academic and clinical excellence and his keen awareness of the pragmatic requirements of doing effective therapy will find in Volume 25 a cornucopia of riches. (shrink)

Conceptions of evil have changed dramatically over time, and though humans continue to commit acts of cruelty against one another, today we possess a clearer, more moral way of analyzing them. In _Narrating Evil_, María Pía Lara explores what has changed in our understanding of evil, why the transformation matters, and how we can learn from this specific historical development. Drawing on Immanuel Kant's and Hannah Arendt's ideas about reflective judgment, Lara argues that narrative plays a key role in helping (...) societies acknowledge their pasts. Particular stories haunt our consciousness and lead to a kind of examination and dialogue that shape notions of morality. A powerful description of a crime can act as a filter, helping us to draw conclusions about what constitutes a moral wrong, and public debates over these narratives allow us to construct a more accurate picture of historical truth, leading to a better understanding of why such actions are possible. In building her argument, Lara considers Greek tragedies, Shakespeare's depictions of evil, Joseph Conrad's literary metaphors, and movies that portray human cruelty. Turning to such philosophers and writers as Jürgen Habermas, Walter Benjamin, Primo Levi, Giorgio Agamben, and Ariel Dorfman, Lara defines a reflexive relationship between an event, the narrative of the event, and the public reception of the narrative, and she proves that the stories of perpetrators and sufferers are always intertwined. The process of disclosure, debate, and the public fashioning of collective judgment are vital methods through which we make sense not only of new forms of cruelty but of past crimes as well. _Narrating Evil_ describes the steps of this process and why they are a crucial part of our attempt to build a different, more just world. (shrink)

Failings of a categorical systemFor decades, standardized classification systems have attempted to define psychiatric disorders in our mental health care system, with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association (APA), 2013) and International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10; World Health Organization, 2010) being internationally best-known. One of the major advantages of the DSM must be that it has seriously diminished the international linguistic confusion regarding psychiatric disorders. Since (...) its introduction, it contributed extensively towards one common international language for defining and conceptualizing psychiatric disorders. Strikingly, within the field of psychological testing a similar step forward seems to have not yet been taken. At present, there exists no international standard for the use of psychological tests that takes the definition of a specific symptom as listed in DSM-5 as its starting point, and reliably and validly measures this symptom. Rather, the majority of tests are measuring constructs consisting of a multitude of symptoms. For example, the Beck’s Depression Inventory (Beck et al., 1996) measures core symptoms of depression summing up to a depression score. Accordingly, we believe it is time for a change. The diagnostics of psychiatric disorders, where disorders are defined as nosological units with a single cause, a single organic substrate, and a single time course, has been problematic for centuries. The field of psychiatry has always been ambivalent about its desire to follow a medical model (Blaney, 2015), but afflicted due to its definitions of pathology. The definition of a psychiatric disorder in DSM-5 offers little room for a clear cut pathogenesis and harsh demarcation of syndromes. This is reflected in the DSM-5, where it states: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p.20). An unfortunate and recognized consequence of this definition within the current system is that many symptoms overlap within categories of psychiatric disorders and patients end up diagnosed with many co-morbid disorders.Two fundamental problemsRegardless of new attempts to improve the diagnostics of psychiatric disorders, the DSM-5 represents the status quo. Consequently, the distinction between diagnosis and classification remains substantial and more than a discussion on semantics. We identify two fundamental problems within the current framework. Generally, a psychiatric diagnosis is considered to be descriptive (Hengeveld and Schudel, 2003). The clinician will describe a syndrome (its nature, timespan, and severity) within the framework of a disorder, and often include a differential diagnosis, predisposing protective or vulnerability factors, and provoking or maintaining factors. Within the DSM-5 framework, a similar ‘approach to clinical case formulation’ is taken (APA, 2013, p. 19). Evidently, a descriptive diagnosis has a hypothetical character. It consists of the clinician’s hypothesis and is based on his or hers professional considerations according to the abovementioned factors. Once the clinician has formulated a descriptive diagnosis, it is then complementary ‘translated’ into a DSM-5 classification. Herein lies the problem. For the layman, the existence of this distinction between diagnosis and classification is usually unknown. Preceding treatment, the clinician will give the client a classification of the existing psychiatric problems and the client may attribute more meaning to it than appropriate, thereby fostering the risk of reification. Second, the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units – ‘you either have it, or you don’t’. DSM-5 states about this: “(…) scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors (…)”. And “(…) we have come to recognize that the boundaries between disorders are more porous than originally perceived.” (APA, 2013, p. 6). This leads to a fundamental problem. Because the overwhelming majority of psychiatric disorders examined thus far using taxometric methods appear to be dimensional in nature (Haslam, 2003; Widiger and Samuel, 2005), consequently all of their categorizations become artificial and debatable. Even though DSM-5 took a modest step towards a more dimensional approach, its core remains categorical. To illustrate, consider the Borderline Personality Disorder (BPD). This classification consists of nine diagnostic criteria of which a minimum of five need to be present for the diagnosis of BPD. A simple numerical combination algorithm leads to a staggering number of 256 distinct presentations of BPD (Albion et al., 2013). Due to this chameleon-like nature, the disorder’s diagnostic validity becomes questionable. Strikingly, this number is relatively small when compared to other conditions, e.g., there are 636,120 ways to have posttraumatic stress disorder (Galatzer-Levy and Bryant, 2013).DSM-5 does propose an alternative model for personality disorders based on personality functioning and traits (APA, 2013, p. 761), as a possible answer to the problem that most patients fit with multiple co-morbid personality disorders or to the category of personality disorder not otherwise specified. In November 2012, the chair committee of APA decided to move this alternative model to section III of DSM-5 and to sustain the categorical system in section II. A potential solutionDSM-5 and its predecessors have brought about an invaluable improvement regarding the formulation of a common international language for psychiatric disorders. However, the individual disorders fit poorly with its starting point of discrete units and strict boundaries. Van Os (2014) has argued for a better balance between the categorical and personalized aspects of psychiatric disorders. We argue for a two-step approach.Particularly due to the ‘weak boundaries’ between disorders, it might be beneficial to limit ourselves by merely categorizing clients into the main categories of the DSM-5 according to their most prominent symptoms (Van Os, 2014), i.e. their main complaint. In other words, clinicians could first ask themselves whether the symptomatology is concerning a neurodevelopmental disorder, or a bipolar and related disorder, or a depressive disorder, and so on. It will drastically reduce the over 400 classifications in DSM-5 down to 20 categories. Van Os (2014) even argues to combine some of the main categories, reducing this number even further to 15 categories. The advantages of reducing the over 400 classifications are fivefold: 1) a syndrome, being an aggregation of symptoms, creates a false relation between symptoms that are that are already heterogeneous themselves; 2) 15 broad categories are functional: it results into a very heterogeneous group of clients within a category and thus prevents stereotypes and invites further personalizing of complaints; and 3) a dimensional measure of a symptom rather than a syndrome will correspond better with the client regardless of it not providing the complete picture. Focusing on the main complaint will indicate where there is an immediate need for care (Van Os, 2014); 4) it will allow clinicians to recognise subthreshold conditions more easily (Magruder and Calderone, 2000); and 5) it might facilitate the development of clear demarcations between normal and abnormal functioning (Kessler, 2002; Widiger and Samuel, 2005). Please, see also Table 1.This also fits well within scientific advances, as thus far strongest evidence has been found for a distinction between internalizing and externalizing disorders, even superseding these 15 main categories (DSM-5; APA, 2013, p.13, but see Weiss et al., 1998). The second step would concern the personalized aspect, which we argue to define on a level of core symptoms of the specific main category, to be agreed upon later. To assess these core symptoms, the field of psychological testing could develop an internationally applicable instrument to reliably and validly measure each (core) symptom on a dimensional scale. Many of these instruments are readily available and have proven its psychometric properties within scientific research. Elements from these instruments could be easily transformed to work within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. Importantly, current psychological testing mainly implies the use of self-report measures. This leads to an abundance of auto-amnestic information. To increase the reliability and validity of psychological tests to assess DSM-5 symptoms, it may be important to add two additional information resources. This would entail psychological tests where a next of kin answers questions about the symptom of the client, and psychological tests that include the clinicians’ judgment, such as structured clinician-based interviews. Conversely, we also need to acknowledge the well-known limitations of clinical judgment (e.g., Faust, 1986; Garb, 1998). Advantages of a new frameworkThe changes we suggest have big implications and are not easily implemented in the current framework. Clients may prefer the comfort of a single clear label, similar to what they are used to in other areas of medicine. Health insurance providers and policy makers may argue for single labels as well. Therefore, it would require a lot of explanation from our clinicians to promote a change. Our suggestions for broader categories may not disambiguate the current situation better than the existing approach, but it will promote personalisation of health care. Difficulties in diagnostic reliability will remain in disorders that fall on the boundaries of the taxons, e.g., schizoaffective disorder versus bipolar disorder with psychotic characteristics, which may benefit from further study. There are also some politically tinged questions to keep in mind: How will we finance our health care, and how will we ensure a gradual transition from the current financing system, including clients who already have their labels? What about visitations from insurers and health inspection? How can they control for a good standard of quality in health care when considering the increasing heterogeneity? Nevertheless, we argue that the benefits outweigh the disadvantages. We will see a shift from a categorical to a personalized approach, which will lead to less (self) stigmatizing, less estrangement, and it will challenge reification thinking. DSM-V states that “a reformulation of research goals should also keep DSM-5 central to the development of dimensional approaches to diagnosis that will likely supplement or supersede current categorical approaches to diagnosis in coming years” (APA, 2013, p. 13). Our proposition for psychological testing on symptom level could contribute to this development. Furthermore, this new approach will do more justice to the heterogeneity of symptoms within and outside of classification categories, see also Table 1. Moreover, in this new approach we join forces of expert knowledge from the fields of psychiatry and psychological science. Finally, it offers new and potentially better opportunities to map health care needs. This in turn will lead to a better interface for allocation of appropriate treatment. It will present a clearer picture of when preventative care is preferred over treatment and vice versa. Importantly, health care needs will be more closely attuned to the ‘own story’ of the client.We argue for the national and international psychological associations in Europe and the United States of America to support the idea of a collective approach to develop an internationally standardized psychological testing battery to reliably assess all the core symptoms of the main categories in DSM-5. (shrink)

En este libro, la autora desarrolla su concepción del juicio reflexionante inspirada en Emmanuel Kant y en Hannah Arendt para concentrarse en cómo cierto tipo de narraciones modelan nuestras nociones de lo que consideramos moral. Lara nos ofrece distintas concepciones sobre el mal en su formulación histórica mediante los ejemplos de las tragedias griegas, las diferentes concepciones sobre el mal en la obra de Shakespeare, el uso literario de la metáfora en la obra de Joseph Conrad y en narraciones fílmicas (...) que describen la crueldad humana. Lara sugiere que el aprendizaje moral es un proceso en el que intervienen las instituciones sociales, la voluntad de los individuos y de las sociedades para comprometerse a un debate abierto y con ello modelar los juicios colectivos sobre el pasado. Lara enfatiza que el juicio reflexionante se da entre un evento, una narración de dicho evento y la recepción pública de dicha narrativa. En este libro se aportan importantes métodos para la comprensión del fenómeno moral del mal, porque introducen nuevas verdades desvelatorias acerca de eventos particulares que no pueden ser simplemente captados por medio de categorías conceptuales. Lara utiliza como fuentes a Jürgen Habermas, Walter Benjamin, Primo Levi, Giorgio Agamben y Ariel Dorfman para probar la conclusión de este tipo de narraciones: la acción (de crueldad) ata de manera definitiva al perpetrador con su víctima. (shrink)

This book challenges the view that bad beliefs - beliefs that blatantly conflict with easily available evidence - can largely be explained by widespread irrationality, instead arguing that ordinary people are rational agents whose beliefs are the result of their rational response to the evidence they're presented with.

The paper aims to defend the standard view of what it dubs ‘Self-understanding’ — i.e. (very roughly) our knowledge of why we behave as we do — from the threat posed to it by Neo-Ryleanism. While the standard, entrenched view regards self-understanding as special in kind and status, the Neo-Rylean agrees with Gilbert Ryle that our method of understanding ourselves is much the same as our method of understanding others, involving self-interpretation on the basis of the available evidence. Neo-Ryleanism has (...) been gaining ground in recent decades, fuelled by a wide range of empirical results which allegedly demonstrate that subjects confabulate items of self-understanding. The paper rejects this attack on the received view. After critically examining one extant response to the Neo-Rylean, which gratuitously accuses her of equivocation, the paper proceeds to offer its own response, casting doubt over the suggestion that the experimental results actually demonstrate widespread confabulation. (shrink)

In the past two decades, epistemologists have significantly expanded the focus of their field. To the traditional question that has dominated the debate — under what conditions does belief amount to knowledge? — they have added questions about testimony, epistemic virtues and vices, epistemic trust, and more. This broadening of the range of epistemic concern has coincided with an expansion in conceptions of epistemic agency beyond the individualism characteristic of most earlier epistemology. We believe that these developments have not gone (...) far enough. While the weak anti-individualism we see in contemporary epistemology may be adequate for the kinds of cases it tends to focus on, a great deal of human knowledge production and transmission does not conform to these models. Furthermore, the dispositions and norms that are knowledge-conducive in the familiar cases may not be knowledge-conducive generally. In fact, dispositions that, at an individual level, count as epistemic vices may be epistemic virtues in common social contexts. We argue that this overlooked feature of human social life means that epistemology must become more deeply and pervasively social. (shrink)