We aim, in this paper, to discuss how far the ethical framework for assessing medical research, generalized into other institutional settings, is also appropriate for social science research, particularly qualitative research. Recently, researchers have raised concerns about ‘ethics creep’, incompatibility with participatory methodologies and the exclusion of service users. Researchers are increasingly raising questions as to whether the processes of governance and the paradigmatic assumptions pervading research ethics committees are fit for purpose when they deliberate on non-clinical research that uses (...) social science methods. We review whether ethical scrutiny by research ethics committees is asking the wrong questions and holding research to the wrong standards. (shrink)

Le care : le mot et la chose. Si la chose a toujours existé – le fait de prendre en charge et de soigner les enfants, les malades, les blessés, les vieilles personnes, entre autres – ce terme a connu une modification et revêtu une importance dans les pays anglophones qu’il n’avait pas il y a une trentaine d’années. En France, l’adoption – sans le traduire – du mot anglais dans ce sens moderne serait encore plus récente, datant des années (...) 2000. Que ce soit aux États-Unis, au Royaume-Uni ou en... (shrink)

EBONY PATTERSON, RUBEN MARTINEZ, LAURENT CRENSHAW, KARLA R. WILLIAMS, LARRY BROWN, TIFFANY HALL, KRISTEN M.J. HARRIS, MICHAEL SMITH, KHYLA CRAINE, NYAH CARMICHAEL, SHANNA DUBOSE, EBONY DAVIS, NICOLE BREWER, KARLA HARLIN, BRIAN HARRIS, KATRINA GIPSON, CANDICE B.N. REYNOLDS.

This study contributes to understanding stakeholder engagement strategies by examining competitive responses alongside sociopolitical implications after a major exogenous shock—the 1998 Master Settlement Agreement (MSA) between the “Big Four” U.S. tobacco firms and 46 state attorneys general. We compare the different stakeholder engagement strategies of the two remaining U.S. tobacco manufacturers, Philip Morris (PM) and R. J. Reynolds (RJR), between 1998 and 2017. Implications for stakeholder theory from a relatively rare natural experiment highlight the importance of simultaneously managing multiple (...) stakeholders, inclusive of domestic and international sociopolitical and value chain stakeholders over time, for sustained value creation. Although PM and RJR initially pursued heterogeneous strategies by re-configuring relationships with relevant stakeholders, each firm’s growth prospects for the first decade post-MSA were exacerbated by various stakeholders through withholding and selective engagement strategies. Implications for how multiple, simultaneous stakeholder relationships can serve as important resources for achieving or limiting sustained growth are discussed. (shrink)

Any theory of how language is internally organized and how it interacts with other mental capacities must address the fundamental question of how syntactic and lexico-semantic information interact at one central linguistic compositional level, the sentence level. With this general objective in mind, we examine ““lightverbs””, so called because the main thrust of the semantic relations of the predicate that they denote is found not in the predicate itself, but in the argument structure of the syntactic object that such a (...) predicate licenses. For instance, in the sentence.. (shrink)

One of the most important aspects of Grice’s theory of conversation is the drawing of a borderline between what is said and what is implic- ated. Grice’s views concerning this borderline have been strongly and influentially criticised by relevance theorists. In particular, it has become increasingly widely accepted that Grice’s notion of what is said is too lim- ited, and that pragmatics has a far larger role to play in determining what is said than Grice would have allowed. (See for (...) example Bezuidenhuit 1996; Blakemore 1987; Carston 1991; Recanati 1991, 1993, 2001; Sperber and Wilson 1986; Wilson and Sperber 1981.) In this paper, I argue that the rejection of Grice has moved too swiftly, as a key line of objection which has led to this rejection is flawed. The flaw, we will see, is that relevance theorists rely on a misunderstanding of Grice’s project in his theory of conversation. I am not arguing that Grice’s versions of saying and implicating are right in all details, but simply that certain widespread reasons for rejecting his theory are based on misconceptions. (shrink)

Around the world, many schools were closed as one of the measures to contain the spread of the COVID-19 pandemic. School closure brought about important challenges to the students' learning process. This context requires strong self-regulatory competences and agency for autonomous learning. Moreover, online remote learning was the main alternative response to classroom learning, which increased the inequalities between students with and without access to technological resources or for those with low digital literacy. All considered, to level the playing field (...) for students without digital resources, there is an urgent need to promote self-regulatory competences through offline intervention solutions. The current paper describes a project with this purpose, using radio broadcasting and letters to reach elementary students without digital resources. Moreover, potential reach and participants' perspectives of the project implementation are presented and discussed. The project draws on a prior evidence-based story-tool intervention grounded on a self-regulated learning framework. The original intervention was set previous to the COVID-19 pandemic and was implemented in the classroom context (N= 1,103 students). Once the schools had been closed down, the mode of intervention was adapted with the collaboration of the community. Alternative solutions were developed as follows: (i) story chapters were read on the radio and students received to their homes a printed script, prompting reflection, and suggesting related activities; (ii) students were provided with the story-tool to read autonomously and received letters from the main characters of the story which included, for example, suggestions for activities and reflection. These two alternative modes of intervention delivery potentially reached 394 elementary students, including students with digital resources. Interviews conducted with a group of students were provided information about the positive aspects of these two modes of intervention delivery, perceived learning (e.g., planning), constraints, and suggestions to improve the project. The current work is likely to merit attention from researchers and educational practitioners, given the need to use offline alternatives to provide support for students without digital resources to engage in autonomous learning during the pandemic period. This project may also be used as an alternative or a complementary solution to online modality. (shrink)

Beginning from a basis in the theoretical analysis of comparative religious ethics provided by David Little and Sumner Twiss, this essay extends that analysis by sketching certain "benchmark" theoretical options in comparative religious ethics and by identifying certain fundamental questions which ethicists ought to address to the data supplied by descriptive studies of comparative religions. To illustrate the application of the theoretical model thus defined, the essay concludes with an analysis of selected themes in the essays by Campany, Guberman, and (...) Read in this Focus. (shrink)

Metanormativists hold that moral uncertainty can affect how we ought, in some morally authoritative sense, to act. Many metanormativists aim to generalize expected utility theory for normative uncertainty. Such accounts face the “easy problem of intertheoretic comparisons”: the worry that distinct theories’ assessments of choiceworthiness are incomparable. The easy problem may well be resolvable, but another problem looms: while some moral theories assign cardinal degrees of choiceworthiness, other theories’ choiceworthiness assignments are merely ordinal. Expected choiceworthiness over such theories is undefined. (...) Call this the “hard problem of intertheoretic comparisons.” This paper argues that to solve the hard problem, we should model moral theories with imprecise choiceworthiness. Imprecise choiceworthiness assignments can model incomplete cardinal information about choiceworthiness, with precise cardinal choiceworthiness and merely ordinal choiceworthiness as limiting cases. Generalizing familiar decision theories for imprecise choiceworthiness to the case of moral uncertainty generates puzzles, however: natural generalizations seem to require reifying parts of the model that don’t correspond to anything in normative reality. I discuss three ways of addressing this problem: by demystifying the reified elements by using them as promiscuously as possible; by constructing alternative decision theories that don’t require the troublesome elements; and by employing an alternative model of metanormative decision problems, and of moral uncertainty generally. (shrink)

Emoji faces, which are ubiquitous in our everyday communication, are thought to resemble human faces and aid emotional communication. Yet, few studies examine whether emojis are perceived as a particular emotion and whether that perception changes based on rendering differences across electronic platforms. The current paper draws upon emotion theory to evaluate whether emoji faces depict anatomical differences that are proposed to differentiate human depictions of emotion. We modified the existing Facial Action Coding System to apply to emoji faces. An (...) equivalent “emoji FACS” rubric allowed us to evaluate two important questions: First, Anatomically, does the same emoji face “look” the same across platforms and versions? Second, Do emoji faces perceived as a particular emotion category resemble the proposed human facial expression for that emotion? To answer these questions, we compared the anatomically based codes for 31 emoji faces across three platforms and two version updates. We then compared those codes to the proposed human facial expression prototype for the emotion perceived within the emoji face. Overall, emoji faces across platforms and versions were not anatomically equivalent. Moreover, the majority of emoji faces did not conform to human facial expressions for an emotion, although the basic anatomical codes were shared among human and emoji faces. Some emotion categories were better predicted by the assortment of anatomical codes than others, with some individual differences among platforms. We discuss theories of emotion that help explain how emoji faces are perceived as an emotion, even when anatomical differences are not always consistent or specific to an emotion. (shrink)

Political corporate social responsibility (PCSR) calls for firms to implement and engage in deliberative democracy processes and structures, addressing governance gaps where governments are unwilling or unable to do so. However, an underlying assumption that the implementation of PCSR will enrich democratic processes in society has been exposed and challenged. In this conceptual article, we explore this challenge by developing a framework to reveal the dynamics of firms’ deliberative democratic processes and structures (meso level), and those at nation state (macro (...) level). Using existing cases as illustrative examples, we demonstrate that despite the public good premise of PCSR theory toward thickening the overall democracy in a society, corporate democratization at meso level can have the opposite effect and may actually erode macro-level democratic control of society and the economy. These findings imply a need for multilevel analysis in PCSR research and greater consideration of state-level public institutions and the responsibilities of business firms toward those institutions. Furthermore, we contribute to the PCSR literature by identifying the disruptive mechanisms associated with these dynamics and outline two alternative perspectives to allow firms to continue to take on political responsibilities. (shrink)

Neoliberal cultural frames of individual choice inform mothers’ accounts of why they refuse state-mandated vaccines for their children. Using interviews with 25 mothers who reject recommended vaccines, this article examines the gendered discourse of vaccine refusal. First, I show how mothers, seeing themselves as experts on their children, weigh perceived risks of infection against those of vaccines and dismiss claims that vaccines are necessary. Second, I explicate how mothers see their own intensive mothering practices—particularly around feeding, nutrition, and natural living—as (...) an alternate and superior means of supporting their children’s immunity. Third, I show how they attempt to control risk through management of social exposure, as they envision disease risk to lie in “foreign” bodies outside their networks, and, therefore, individually manageable. Finally, I examine how these mothers focus solely on their own children by evaluating—and often rejecting—assertions that their choices undermine community health, while ignoring how their children benefit from the immunity of others. By analyzing the gendered discourse of vaccines, this article identifies how women’s insistence on individual maternal choice as evidence of commitment to their children draws on and replicates structural inequality in ways that remain invisible, but affect others. (shrink)

The relationship between construal and redundancy has not been previously explored empirically. Russian aspect allows speakers to construe situations as either Perfective or Imperfective, but it is not clear to what extent aspect is determined by context and therefore redundant. We investigate the relationship between redundancy and open construal by surveying 501 native Russian speakers who rated the acceptability of both Perfective and Imperfective verb forms in complete extensive authentic contexts. We find that aspect is largely redundant in 81% of (...) uses, and in 17% of contexts aspect is relatively open to construal. We contend that anchoring in redundant contexts likely facilitates the independence of construal in contexts with less redundancy. However further research is needed to discover what makes contexts redundant since known cues for aspect are absent in the majority of such contexts. Native speakers are fairly consistent in giving the original aspect high ratings, but less consistent in rating the non-original aspect, indicating potential problems in testing the reactions of speakers to non-authentic data. (shrink)

Camisha Russell has written a beautiful essay articulating why race and racism should be centered within bioethics. I agree with her assertion that Black Lives Matter (and the subsequent backlash t...

Despite rarely explicitly thematizing the problem of dirty hands, this essay argues that Merleau-Ponty’s political work can nonetheless make some important contributions to the issue, both descriptively and normatively. Although his political writings have been neglected in recent times, his interpretations of Marxism and Machiavelli enabled him to develop an account of political phronesis and virtù that sought to retain the strengths of their respective positions without succumbing to their problems. In the process, he provides grounds for generalizing the problem (...) of “dirty hands” beyond Michael Walzer’s influential understanding that pertains primarily to “emergencies” and singular time-slice actions, and addresses concerns about the coherence of the very idea that there is justified action that one ought to do which remains wrong. Merleau-Ponty does this by emphasizing the diachronic relationship between theoretical principles and concrete political action over a period of time, thus imbuing the problem of dirty hands with a historicity that is not sufficiently recognized in the more static and action-focused discussions. (shrink)

Previous research has shown that drawing improves short-term mood in children when used to distract from rather than express negative thoughts and feelings. The current study sought to examine how drawing might elevate mood in children ages 6–12 by examining the role played by absorption, enjoyment, and perceived competence as well as entering an imaginary world; and whether children spontaneously use drawing to distract from a sad mood. Across three studies, children were asked to think of a disappointing event. After (...) a sad mood induction, they drew for 5 min. Mood was measured before and after the mood induction and after drawing. Three main findings emerged. First, drawing to distract led to greater absorption and enjoyment than did drawing to express. Second, children’s mood improved equally when drawing imaginary and real scenes showing that the key ingredient is that the content of the drawings be distracting in nature. Third, drawing improved mood even when children were given no instructions on the content of their drawings and children were more likely to use drawing as a way to distract themselves from a sad mood. These studies help to define the characteristics of drawing activities that foster mood improvement in children and highlight the important role of the arts in emotion regulation. (shrink)

As scholars integrate empirical approaches to ethical questions in healthcare, relational autonomy theory must inform research design and change practice. Qualitative approaches are well suited to issues where patient values play a central role, and they can be combined with relational autonomy theory to investigate the factors influencing autonomy-rich experiences. This paper draws upon my experience conducting bioethics research related to clinical trial decision-making to develop a systematic method for applying relational autonomy as a theoretical lens to qualitative health research. (...) The resultant practical guide utilizes Susan Sherwin’s theory of relational autonomy and presents an empirical method responsive to autonomy-relevant questions. (shrink)

In Promoting Justice Across Borders: The Ethics of Reform Intervention, Lucia Rafanelli offers a framework for normatively evaluating reform interventions. In this comment, I focus not on Rafanelli’s explicit argument, with which I largely agree, but rather on how this argument implicitly maps the terrain of justice, injustice, and justice-promotion. I suggest that Rafanelli overstates the importance and distinctiveness of reform intervention compared to other justice-promoting projects, and in so doing downplays forms of justice-promotion besides reform intervention, including powerful entities (...) reducing their own unjust practices and subaltern groups fighting for justice for themselves. However, if we view reform intervention as one type of justice-promoting project among others, then we can see that, while Rafanelli’s framework is in one sense less consequential than she suggests, it also potentially offers insight into a much wider range of contexts than she acknowledges. (shrink)

Despite the scientific consensus, climate change continues to be socially and politically controversial. Consequently, teachers may worry about accusations of political indoctrination if they teach climate change in their classrooms. Research shows that many teachers are using the ‘teaching the controversy’ approach to teach climate change, essentially allowing students to make up their own mind about climate change. Drawing on some philosophical literature about indoctrination and controversial issues, we argue that such an approach is inappropriate and, given the escalating crisis (...) that is climate change, potentially dangerous. Instead, we propose integrating three well-established educational practices, Philosophy for Children, place-responsive pedagogies, and Critical Indigenous Pedagogy, to help teachers and students critically examine climate change controversy while still meeting the key goals of climate change education. (shrink)

The science, technology, engineering, and mathematics (STEM) classroom is an ideal site for implementing community-based ethics resources. Doing so fulfills programmatic requirements in the social reality of science and demonstrates increased applicability of science concepts to issues of immediate community concern. This chapter elaborates on the Re-envisioning Ethics Access and Community Humanities (REACH) initiative at Salisbury University, its community research methodology, and the implementation of community-sourced ethics cases in the biology classroom. Preliminary student and instructor feedback is summarized. As opposed (...) to using more traditional ethics resources, such as cases sourced from the national media or case-based ethics readers, the use of community-based cases demonstrates promise in increasing student engagement in discussion, the applicability of course content, and a sense of the social importance of science in addressing contemporary ethics issues. We end with future implications of this pedagogical approach for revising ethics instruction in the STEM classroom. (shrink)

Feelings associated with grief are regularly described as painful, but in what respect are they to be understood as pain? The acute pain of easily located tissue damage has long been the paradigm of pain in scientific and philosophical analysis, a dominance serving to obscure features the pain of grief might share not only with chronic pain but with some depressive suffering. Two examples of such commonalities are explored (ways pain feelings are experienced as in and of the body; and (...) are often recessed to the background of consciousness). These features are introduced to illustrate how a preliminary search for additional pain paradigms might proceed, and in so doing to offer some support for the proposal that pain endured as part of grieving may be real pain, not merely 'pain'. (shrink)

In his paper, in this journal, Sterelney claims that cases of extended mind are limiting cases of environmental scaffolding and that a niche construction model is a more helpful, general framework for understanding human action. He further claims that extended mind cases fit into a corner of a 3D space of environmental scaffolds of cognitive competence. He identifies three dimensions which determine where a resource fits into this space and suggests that extended mind models seem plausible when a resource is (...) highly reliable, individualised/entrenched and a single-user resource. Sterelney also claims that the most important cognition-enhancing resources are provided collectively by one generation to the next. In this paper, I argue that Sterelney is both right and wrong and this because he focuses primarily on external, physical resources and construes scaffolding as exclusively unidirectional and diachronic. Using examples of unfamiliar tool use, visual processing and human emotional ontogenesis, I argue, respectively, that extended mind cases include those which fail to meet Sterelney’s dimensional criteria; that the most important cognition—enhancing resources are those which actually build brains; that these are provided on a one-to-one basis in emotional ontogenesis; and, this depends on bidirectional and synchronic cognitive scaffolding. (shrink)

Dispositions and potentialities seem importantly similar. To talk about what something has the potential or disposition to do is to make a claim about a future possibilitythe "threats and promises" that fill the world (Goodman 1983, 41). In recent years, dispositions have been the subject of much conceptual analysis and metaphysical speculation. The inspiration for this essay is the hope that that work can shed some light on discussions of potentiality. I compare the concepts of disposition and potentiality, consider whether (...) accounts of these concepts are subject to similar difficulties, and whether having a disposition or a potentiality can depend on extrinsic factors. The concept of a disposition I am working with is drawn from the recent literature in metaphysics and philosophy of science that focuses on the analysis of dispositional concepts and their role in a broader ontology. The concept of a potentiality is drawn from the bioethics literature that focuses on the moral relevance of potentialities that subjects of medical decisions mayor may not possess. Some preliminary conclusions I draw are the following: I. Potentialities are dispositions; 2. Due to problematic cases, potentiality ascriptions, like disposition ascriptions, are not reducible to counterfactual statements; and 3. Like dispositions, some potentialities can be extrinsic. Here I do not aim to draw any conclusions about the moral relevance of potentialities but rather to outline conceptual and metaphysical options available to those who seek to employ this concept. However, to the extent that these options are relevant to answering moral questions, I am skeptical about the prospects of finding a value-neutral way to choose between them. I have tried to outline a number of options regarding the nature of potentialities for those who would like that notion to play some role in their theorizing in bioethics, or elsewhere. There still are a number of decisions to make about how to explicate the concept of potentiality that is most relevant for one's purposes. How should one flesh out the associated counterfactuals, regardless of whether they hope to reduce potentiality claims to counterfactual conditionals? How should one circumscribe the relevant possible circumstances of manifestation for a given potentiality? Are the circumstances necessary for the actualization of a given potentiality to be counted circumstances of possession or circumstances of manifestation? Is the kind of which something is potentially a member a natural kind or a class whose membership is determined by convention? My anticipation, and perhaps my worry, is that these questions do not have answers that can be determined independently from the conclusions about the moral relevance of potentiality that a given theorist aims to establish. (shrink)

My thanks to Professors Hawkins and Szmukler for their thoughtful commentaries; I am particularly glad to see these scholars' valuable expertise directed toward what raises pressing issues not only for psychiatry but for contemporary society.Prof. Hawkins reasons that the use of forced feeding with some anorexia is justified, while emphasizing that this will occur rarely. She and I are in agreement that a mere handful of cases may be affected by our debate, since anecdotal evidence from clinical settings as well (...) as the studies Hawkins cites suggest that forced feeding will often be contraindicated. Still, the matter can equally well be cast hypothetically, as I implied in my earlier discussion. If forced feeding... (shrink)

Ideas of racial genetic determinism, though unsupported by scientific evidence and atavistic, are common and readily apparent in American medical education. These theories of biologic essentialism have documented negative effects in learners, including increased measures of racial prejudice.

: Extreme pain and suffering are associated with depression as well as tissue damage. The impossibility of imagining any feelings of pain and suffering intersect with two matters: the kind of imagining involved, and the nature of delusions. These two correspond to the sequence of the following discussion, in which it is contended first that feelings of pain and suffering resist being imagined in a certain, key way, and second that, given a certain analysis of delusional thought, this precludes the (...) possibility of delusional affections while allowing delusions about affections. Keywords: Pain; Imagination; Delusion; Affection; Feelings Dolore immaginato e dolore illusorio Riassunto: Dolore estremo e sofferenza sono solitamente associati a depressione e danni tissutali. L’impossibilità di immaginare il provare dolore e sofferenza dipende da due fattori: il tipo di immaginazione coinvolta e la natura dell’illusione. Questi due fattori saranno trattati in parallelo nell’analisi che qui si propone, in cui si discuterà in primo luogo come il provare dolore e sofferenza oppongano resistenza all’essere immaginati in un certo modo e in secondo luogo come, secondo una certa analisi del pensiero illusorio, questo preclude la possibilità di affezioni illusorie mentre consente illusioni circa le affezioni. Parole chiave: Dolore; Immaginazione; Illusioni; Affezione; Sensazioni. (shrink)

Most of us experience the world through competing perspectives. A job or a religion seems important and fulfilling when looked at in one way; but from a different angle they seem tedious or ridiculous. A friend is obtuse from one point of view, wise from another. Continuing to hold both views at once can be unsettling, highlighting conflicts between our own judgments and values, and undermining our ability to live purposefully and effectively. Yet, as Jennifer Church argues in this (...) book, inner conflict can be a good thing, and not just as a temporary road bump on the road to resolution. This book describes several desirable types of "double consciousness"--or being of two minds--and explains why and how they should be maintained. Church looks critically at some common ideas about identity, including a popular belief about narratives that suggests our lives should "make sense" as a story. She also examines how empathy can helpfully cause us to be of two minds, and how various forms of irony and laughter enable us to benefit from holding onto opposing views. Finally, Church shows the merit of acknowledging reality while sometimes being guided by fantasy. Why It's OK to Be of Two Minds is for anyone who's held two opposing views simultaneously, which is to say it's for everyone. Key Features: Argues against a longstanding philosophical idea: that it is important to resolve inner conflicts that result from competing systems of beliefs Examines the role of empathy and friendship in maintaining a valuable form of double consciousness Considers how irony and laughter allow us to dedicate ourselves to our particular projects while acknowledging their ultimate insignificance Shows how fantasies that conflict with our beliefs can make a positive contribution to the way we live our lives. (shrink)

No matter how unintuitive it might seem that aesthetic pleasure should be the point where art and morality meet, this is a noteworthy possibility that has been overshadowed by aestheticians’ more visible concerns. Here I briefly survey relevant strands in the literature over the past century, before introducing themes covered in this inaugural issue of Australasian Philosophical Review.

John Cooper and Pierre Hadot suggest that contemporary philosophy can no longer be regarded as a way of life as it has become an academic discipline of study that is theoretical and abstract. According to them, for philosophy to be considered a way of life, it has to be able to shape one’s understanding of the world, guide how one should respond from moment to moment, and reach an existential level in defining one’s being. In this article, I discuss how (...) Jean-Paul Sartre’s existentialist philosophy is a way of life that has been overlooked by Cooper and Hadot. I show that Sartre’s existentialism presents an interconnected perspective of human existence and human development in history, is able to guide our philosophical reasoning about our everyday decisions, and offers a practical guide to living an authentic life through assuming responsibility for our life choices and engaging with our situations. (shrink)

This review article presents and summarises my doctoral dissertation ‘Reading Romans, Constructing Paul(s): A Conversation between Messianic Jews in Jerusalem and Paul within Judaism Scholars’, defended on 24 September 2021 at Lund University. It is a highly interdisciplinary study between New Testament studies and the anthropology of Christianity. It focuses on Paul and readings of Romans 11, where the Messianic Jewish readings originate from ethnographic fieldwork conducted in Jerusalem through so-called Bible-reading interviews. This article summarises each chapter, provides examples from (...) the empirical chapters ‘Identity and Torah’, ‘Relations and Yeshua’ and ‘Time and Land’, and finishes by pointing out three major conclusions followed by three additional key contributions that the study makes. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 57-62 [Access article in PDF] Listening to People Or Listening to Prozac?Another Consideration of Causal Classifications Jennifer Hansen Keywords causal classification, descriptivism, melancholia, neurasthenia, depression, cultural relativism. The shape and detail of depression have gone through a thousand cartwheels, and the treatment of depression has alternated between the ridiculous and the sublime, but the excessive sleeping, inadequate eating, suicidiality, withdrawal from social (...) interaction, and relentless despair are all as old as the hill tribes, if not as old as the hills. In the years since man achieved the capacity for self-reference, shame has come and gone; treatments for bodily complaints have alternated and crossed with treatments for spiritual ones; pleas to external gods have echoed pleas to internal demons. To understand the history of depression is to understand the invention of human being as we now know and are him. Our Prozac-popping, cognitively focused, semi-alienated postmodernity is only a stage in the ongoing understanding and control of mood and character. (Solomon 2001, 286) ALTHOUGH ANDREW SOLOMON clearly believes that "the shape and detail of depression have gone through a thousand cartwheels," Jennifer Radden gives us pause before assuming that depression is just another name for Dame Melancholy. Solomon's claim depends on a deeper metaphysical claim about the nature of depression and its causes. The current method of psychiatric nosology, descriptivism, does not necessarily support equating melancholia and depression. Furthermore, it appears that adopting descriptivism as the sole method of classifying mental disorders commits us to cultural relativist psychiatry. Below I reconsider whether we want to rule out causal classifications and suggest that embracing both descriptivism and causal classifications offer us greater possibilities in understanding human illness and culture.Although the occasion for Jennifer Radden's essay is to investigate whether or not melancholia and depression refer to the same thing, her essay detours into a consideration of extra-descriptivist models of psychiatric illness versus the descriptivism of current psychiatric nosology. This detour turns out to be warranted; her purely academic question yields to a timelier question concerning the proper methodology for classifying mental disorders. Whereas debates about psychiatric nosology are perennial, the recent success of the new generation of antidepressants [End Page 57] is reviving biological psychiatry and its search for the neurochemical origins of depression. Hence, embedded in Radden's question concerning whether or not melancholia is the same thing as clinical depression, is another important question concerning the causes of mental illness, particularly depression.Currently, with its descriptivist approach, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify mental illness, such as clinical depression, based on underlying causes. The cluster of symptoms and behavioral signs that lead a clinician to diagnose one as depressed that are contained in either the DSM or the International Classification of Diseases (ICD) may be too fuzzy or elusive to give any clear distinction between major depression, mild depression, and the blues. For example, one group of epidemiologists points out that [t]he DSM-III, DSM-III-R, and DSM-IV acknowledge that depression, like many mental disorders, has no currently obvious natural classes... If natural classes of depression exist, then their nosology awaits the discovery of distinct and reliable genetic, biological, clinical, or other predictors of risk, severity, or clinical course. Clinicians have a tradition of separating depressions into subtypes; however, this subtyping has not yet led to clear-cut delineations of syndromes in populations. (Kaelber 1995, 4) The evidence is still insufficient to establish the biological or psychological origins of depression. Although many theories exist that explain why people become depressed, scientifically we are not yet in a position to determine which is the right theory. From a pragmatic perspective, however, whether or not we know what causes depression, we can nonetheless attempt to alleviate suffering from depression. And it is with this goal in mind that the DSM-IV and ICD-10 classify mental disorders.Now, given that our current methodology for psychiatric nosology does not establish causes, it is also insufficient for determining what... (shrink)