Book reviewed in this article: No Longer Patient: Feminist Ethics & Health Care. By Susan Sherwin Feminist Perspectives in Medical Ethics. Edited by Helen Bequaert Holmes and Laura M. Purdy.

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, (...) and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are (...) fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. (shrink)

Braitenberg et al.'s target article presents the best current integration of anatomical and physiological data, and provides a qualitative description of cerebellar function in terms of the dynamics of processes based on the geometry of the cerebellar cortex. We compare the proposed model to our own quantitative model based on the concept of Purkinjeunit.

A deep investigation of proprioceptive processes is necessary to understand the relationship between sensory afferent inputs and motor outcomes. In this work, we investigate whether and how perception of wrist position is influenced by the direction along which the movement occurs. Most previous studies have tested Joint Position Sense through 1 degree of freedom wrist movements, such as flexion/extension or radial/ulnar deviation. However, the wrist joint has 3-DoF and many activities of daily living produce combined movements, requiring at least 2-DoF (...) wrist coordination. For this reason, in this study, target positions involved movement directions that combined wrist flexion or extension with radial or ulnar deviation. The chosen task was a robot-aided Joint Position Matching, in which blindfolded participants actively reproduced a previously passively assumed target joint configuration. The JPM performance of 20 healthy participants was quantified through measures of accuracy and precision, in terms of both perceived target direction and distance along each direction of movement. Twelve different directions of movement were selected and both hands tested. The left and right hand led to comparable results, both target extents and directions were differently perceived according to the target direction on the FE/RUD space. Moreover, during 2-DoF combined movements, subjects’ perception of directions was impaired when compared to 1-DoF target movements. In summary, our results showed that human perception of wrist position on the FE/RUD space is symmetric between hands but not isotropic among movement directions. (shrink)

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts – including health care systems and research institutions – perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two‐spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter‐spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us (...) the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter‐spaces, thereby instigating counter‐institutional practices, for those who experience otherness. (shrink)

The 1991 film The Silence of the Lambs tracks the fictional pursuit of an American serial killer by a Federal Bureau of Investigation trainee, via the assistance of another incarcerated serial killer. It features psychologically disturbing themes, such as corpses, the mutilation of skin and monstrous persons. Incidentally, these are all themes regularly encountered by nurses in their day‐to‐day practices, including forensic mental health nurses. Despite regular encounters with these themes and phenomena, nurses continue to find them disturbing and troubling, (...) but, at the same time, clinically fascinating. This paper will mobilize Kristeva's poststructuralist, psychoanalytic concept of abjection to relate the encounters in The Silence of the Lambs to those of nurses, to reconceptualize feelings of both disgust and fascination and to consider how vulnerability may benefit nursing practice. Of particular relevance are the breakdown of skin encountered in nursing practice, encounters with corpses and work with forensic patients considered monstrous. The film provides opportunity for nurses to conceptualize abjection in their own practice and to consider how a reconceptualization of boundaries and vulnerability may prove productive. (shrink)

Three experiments investigated response times for remember and know responses in recognition memory. RTs to remember responses were faster than RTs to know responses, regardless of whether the remember–know decision was preceded by an old/new decision or was made without a preceding old/new decision . The finding of faster RTs for R responses was also found when remember–know decisions were made retrospectively. These findings are inconsistent with dual-process models of recognition memory, which predict that recollection is slower and more effortful (...) than familiarity. Word frequency did not influence RTs, but remember responses were faster for words than for nonwords. We argue that the difference in RTs to remember and know responses reflects the time taken to make old/new decisions on the basis of the type of information activated at test. (shrink)

Book reviewed in this article: No Longer Patient: Feminist Ethics & Health Care. By Susan Sherwin Feminist Perspectives in Medical Ethics. Edited by Helen Bequaert Holmes and Laura M. Purdy.

A long-awaited translation on the philosophical relation between technology, the individual, and milieu of the living.

Hegel argues in the Lectures on the Philosophy of Religion that the notion that “God is love” (1 John 4:8) well expresses the self-developing infinitude of being. As such, love expresses the unity of difference and is, therefore, the “representation” (Vorstellung) of reason (Vernunft). This requires, however, transcending the abstract notion of the perfect God that stands over and above finite reality. At the same time love has a subjective dimension, embodied not only in mutual recognition but in the experience (...) of the highest forms of unity with otherness. This ultimately requires of the individual that he or she embrace the nothingness of his or her being and yet also engage responsibly in ethical life (Sittlichkeit). (shrink)

Genomic screening at population scale generates many ethical considerations. One is the normative role that people’s preferences should play in determining access to genomic information in screening contexts, particularly information that falls beyond the scope of screening. We expect both that people will express a preference to receive such results and that there will be interest from the professional community in providing them. In this paper, we consider this issue in relation to the just and equitable design of population screening (...) programs like reproductive genetic carrier screening (RGCS). Drawing on a pluralistic public health ethics perspective, we claim that generating and reporting information about genetic variants beyond the scope of the screening program usually lacks clinical, and perhaps personal, utility. There are both pragmatic and ethical reasons to restrict information provision to that which fits the stated purpose of the program. (shrink)

ABSTRACT:Based on theoretical insights of discourse ethics as developed by Jürgen Habermas, we delineate a proposal to further develop the institutionalization of social accounting in multinational corporations (MNCs) by means of “Social Accountability 8000” (SA 8000). First, we discuss the cornerstones of Habermas's discourse ethics and elucidate how and why this concept can provide a theoretical justification of the moral point of view in MNCs. Second, the basic conception, main purpose, and implementation procedure of SA 8000 are presented. Third, we (...) critically examine SA 8000 from a Habermasian perspective, and discuss advantages and drawbacks of the initiative. Fourth, to address the drawbacks, we introduce a “discourse-ethically” extended version of SA 8000. We show that this approach is theoretically well-founded and able to overcome some of the current deficits of the certification initiative. We demonstrate that the extended version of SA 8000 can be successfully applied on a cross-cultural basis, and that our findings have significant implications for other international ethics initiatives. (shrink)

The image of the hospital is presented to the public as a place of healing. Though the oft‐criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing practices (...) may disrupt the agency of both patients and nurses alike. (shrink)

This article outlines a semantic approach to the logics of unknown truths, and the logic of false beliefs, using neighborhood structures, giving results on soundness, completeness, and expressivity. Relational semantics for the logics of unknown truths are also addressed, specically the conditions under which sound axiomatizations of these logics might be obtained from their normal counterparts, and the relationship between refexive insensitive logics and logics containing the provability operator as the primary modal operator.

This paper argues for a methodological point that bears on a relatively long-standing debate concerning collective beliefs in the sense elaborated by Margaret Gilbert: are they cases of belief or rather of acceptance? It is argued that epistemological accounts and distinctions developed in individual epistemology on the basis of considering the individual case are not necessarily applicable to the collective case or, more generally, uncritically to be adopted in collective epistemology.

Many men who have sex with men (MSM) express feeling marginalized by discourses within public health and sexual health nursing that determine bareback sex is deviant and unsafe. Their resistance to risk‐based discourses can be seen within radical sex practices such as deliberately becoming‐infected with HIV (bug‐chasing) and breeding‐infection (gift‐giving). The metaphors of bug‐chasing and gift‐giving, particularly those spread across global online spaces, can influence the sexual experiences and practices of MSM. A metaphor analysis was conducted of Internet forums discussing (...) HIV chasing and gifting metaphors, and showed a variety of discursive meanings, tactics and effects to the radical sex practice. A radical research approach was used to explore the processes of becoming‐infected and breeding‐infection as determinant steps in the symbolic resistance of risk‐based discourses, as well as the creation of new forms of life and community among MSM. Our analyses demonstrate how the gifting/chasing metaphors express MSM's marginalization as well as their lines of flight from having their practices captured within public health discourses. We hope to offer alternative nursing approaches for thinking through and engaging with transgressive and queer sexual practices. (shrink)

Alice has insomnia. She has trouble falling asleep and part of the problem is that she worries about it and realizes that her worrying about it tends to keep from falling asleep. It occurs to her that thinking that she will not be able to fall asleep may be a kind of self-fulfilling prophecy. Perhaps she even has a thought that might be expressed like this: I am not going to fall asleep because of my having this very thought. This (...) thought attributes to itself the property of keeping her awake. (shrink)

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that (...) new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of ‘assemblage’. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs. (shrink)

The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding (...) patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? (shrink)

How to embed reflexivity in public participation in techno-science and to open it up to the agency of publics are key concerns in current debates. There is a risk that engagements become limited to “laboratory experiments,” highly controlled and foreclosed by participation experts, particularly in upstream techno-sciences. In this paper, we propose a way to open up the “participation laboratory” by engaging localized, self-assembling publics in ways that respect and mobilize their ecologies of participation. Our innovative reflexive methodology introduced participatory (...) methods to public engagement with upstream techno-science, with the public contributing to both the content and format of the project. Reflecting on the project, we draw attention to the largely overlooked issue of temporalities of participation, and the co-production of futures and publics in participation methodologies. We argue that many public participation methodologies are underpinned by the open futures model, which imagines the future as a space of unrestrained creativity. We contrast that model with the lived futures model typical of localized publics, which respects latency of materials and processes but imposes limits on creativity. We argue that to continue being societally relevant and scientifically important, public participation methods should reconcile the open future of research with the lived futures of localized publics. (shrink)

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) (...) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally. (shrink)

Power density spectra and phase synchrony measurements were taken from intracranial electrode grids implanted in epileptic subjects. Comparisons were made between data from the waking state and from the period of unconsciousness immediately following a generalised tonic–clonic seizure. Power spectra in the waking state resembled coloured noise. Power spectra in the unconscious state resembled coloured noise from 1 to about 5 Hz, but at higher frequencies changed in two out of three subjects to resemble white noise. This boosted unconscious gamma (...) power to a higher level than conscious gamma power. For both gamma and beta passbands, synchrony measurements showed more widespread phase synchrony in the unconscious than the conscious state. We conclude that neither gamma activity per se nor phase synchrony per se are neural correlates of consciousness. (shrink)

Originally published in 1990. This study argues that scepticism is an intelligible view and that the issue scepticism raises is whether or not certain sceptical hypotheses are as plausible as the ordinary views we accept. It discusses psychological concepts, definitions of knowledge, belief and hypothetic inference. Starting from ‘Is skepticism a problem for epistemology’, the book takes us through the argument for the possibility of scepticism, including looking at sense data and considering memory and perception.

This article explores a case study of a mindfulness teacher, Beth, and her experiences of teaching mindfulness to 11- to 16-year-olds in several English schools. It shows why Beth was drawn to teaching mindfulness, which was both to alleviate the stress amongst her pupils and improve her own mental health. It illustrates how and why she became a confident, successful mindfulness teacher: she learnt about mindfulness at various classes, retreats and teacher-education training sessions, spending thousands of pounds on her own (...) training. It argues that her positioning as a mindfulness teacher in an unmindful school system created an overwhelming demand for her services, but also huge stress upon her. It develops McCaw’s conceptions of ‘thin’ and ‘thick’ mindfulness (2020), arguing that while Beth began by practising ‘thin’ mindfulness – seeing it as a way of solving exam stress amongst her pupils – she became increasingly a ‘thick’ practitioner; her experiences of mindfulness led to profound personal change and, ultimately, to her becoming very disillusioned about teaching mindfulness in an unwelcoming educational, ‘unmindful’ environment. (shrink)

There has been much discussion of the phrase ‘perpetuum… carmen’ and of its relation to Callimachus' rejection of the . Much less has been written about deducite in line 4. However it is, I believe, equally important for the ‘programme’ of Ovid's poem. Deducere is a metaphor frequently applied to poetry in general with the sense of ‘to write, compose something.’ In certain contexts the reference is much more specific and indicates subtle and polished writing of the kind associated with (...) Callimachus. (shrink)

Collision sports pose a high risk of concussion. How to respond to this risk is more ethically complex when considering children and adolescents due to a) incomplete evidence regarding the impact of concussion on developing brains, b) physiological and social vulnerability, and c) the young person’s reliance on proxy decision-makers, usually parents. There is also a lack of clear definitions of (a) collision sport (vs. contact sport) and (b) what constitutes a child or adolescent. We consider whether parents should be (...) free to allow their children/adolescents to play contact or collision sport. The article analyses the harms and benefits of collision sport and methods of determining risk, before outlining our support for the precautionary principle. We then consider whether the ‘best interests’ or ‘right to an open future’ framework ought to be applied to the issue of childhood participation in collision sport. Rather than supporting a ban of child/adolescent participation in collision sport, we argue that permissibility should be decided on a sport-by-sport basis. Moreover, we apply the ‘Accountability of Reasonableness’ framework to ensure that sound ethical values guide and support protections for this vulnerable group in the absence of high-quality evidence. (shrink)

The common view is that no novel IS an argument, though it might be reconstructed as one. This is curious, for we almost always feel the need to reconstruct arguments even when they are uncontroversially given as arguments, as in a philosophical text. We make the points as explicit, orderly, and (often) brief as possible, which is what we do in reconstructing a novel’s argument. The reverse is also true. Given a text that is uncontroversially an explicit, orderly, and brief (...) argument, in order to enhance plausibility, our first instinct is to flesh it out with illustrations and relationships to everyday life. If this process is fictive (e.g., with “thought experiments”) and orderly, it is story-telling. This paper investigates whether there is a principled way of determining a novel’s argument, which should contribute as much to understanding arguments as to understanding novels. (shrink)