Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, (...) exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables. (shrink)

Offering both a discussion of feminism in its postmodern context and a critique of contemporary theory, the author here challenges feminists to move away from a theory-based approach, which focuses on securing or contesting "women" as an ...

This original analysis examines the three leading traditional solutions to the dilemma of divine foreknowledge and human free will--those arising from Boethius, from Ockham, and from Molina. Though all three solutions are rejected in their best-known forms, three new solutions are proposed, and Zagzebski concludes that divine foreknowledge is compatible with human freedom. The discussion includes the relation between the foreknowledge dilemma and problems about the nature of time and the causal relation; the logic of counterfactual conditionals; and the differences (...) between divine and human knowing states. An appendix introduces a new foreknowledge dilemma that purports to show that omniscient foreknowledge conflicts with deep intuitions about temporal asymmetry, quite apart from considerations of free will. Zagzebski shows that only a narrow range of solutions can handle this new dilemma. A compelling contribution to the field, The Dilemma of Freedom and Foreknowledge will appeal to students and scholars of theistic philosophy and the philosophy of religion. (shrink)

In this book, Linda Wetzel examines the distinction between types and tokens and argues that types exist (as abstract objects, since they lack a unique ...

An ethic for wrongdoers -- Repaying moral debts : self-punishment and restitution -- Changing one's heart, changing the past : repentance and moral transformation -- Reforming relationships : the reconciliation theory of atonement -- Forgiveness, self-forgiveness, and redemption -- Making amends for crime : an evaluation of restorative justice -- Collective atonement : making amends to the Magdalen penitents.

Widely regarded as one of the foremost figures in contemporary philosophy of religion, this book by Linda Zagzebski is a major contribution to ethical theory and theological ethics. At the core of the book lies a form of virtue theory based on the emotions. Quite distinct from deontological, consequentialist and teleological virtue theories, this one has a particular theological, indeed Christian, foundation. The theory helps to resolve philosophical problems and puzzles of various kinds: the dispute between cognitivism and non-cognitivism (...) in moral psychology, the claims and counterclaims of realism and anti-realism in the metaphysics of value, and paradoxes of perfect goodness in natural theology, including the problem of evil. As with Zagzebski's previous Cambridge book Virtues of the Mind, this book will be sought out eagerly by a broad swathe of professionals and graduate students in philosophy and religious studies. (shrink)

CHAPTER ONE Political Theory as a Signifying Practice Political theory has been a heroic business, snatching us from the abyss a vocation worthy of giants. ...

An accessible and engaging introduction to the philosophy of religion. Written with verve and clarity by a leading philosopher and contributor to the field Places key issues and debates in the philosophy of religion in their historical contexts, highlighting the conditions that led to the development of the field Addresses the core topics, among them the the existence of God, the problem of evil, death and the afterlife, and the problem of religious diversity Rich with argument, yet never obtrusive Forms (...) part of the _Fundamentals of Philosophy_ series, in which renowned scholars explore the fundamental issues and core problems in the major sub-disciplines of philosophy. (shrink)

A picture held us captive. And we could not get outside it, for it lay in our language and language seemed to repeat it to us inexorably. Wittgenstein.

The statistical interpretation introduced by Born in mid-1926 is not the interpretation now associated with his name. Born's own understanding of that interpretation is revealed by looking at some of its roots in Born's earlier work with Franck on collisions, his collaboration with Jordan on that topic, his contributions to matrix mechanics, his attempt in collaboration with Wiener at an operator formulation of quantum mechanics, and at the exposition of the interpretation in Born's first papers on a wave mechanical treatment (...) of collisions. (shrink)

Culture is surely important in human learning. But the relation between culture and psychological mechanism needs clarification in three areas: (1) All learning takes place in real time and through real-time mechanisms; (2) Social correlations are just a kind of learnable correlations; and (3) The proper frame of reference for cognitive theories is the perspective of the learner.

If one is a woman, one is often surprised by a sudden splitting of consciousness, say in walking down Whitehall, when from being the natural inheritor of that civilization, she becomes, on the contrary, outside of it, alien and critical. Virginia Woolf.

This article considers why truth-telling is so difficult in institutions, and deceit and paltering are so common. Drawing on recent examples of churches and charities exposed for covering up the truth about abuse, the article explores the institutional barriers to truthfulness and considers how they might be removed.

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires as a condition of accreditation that every health care institution -- hospital, nursing home, or home care agency -- have a standing mechanism to address ethical issues. Most organizations have chosen to fulfill this requirement with an interdisciplinary ethics committee. The best of these committees are knowledgeable, creative, and effective resources in their institutions. Many are wellmeaning but lack the information, experience, and skills to negotiate adequately the complex ethical (...) issues that arise in clinical and organizational settings. Handbook for Health Care Ethics Committees is the first resource designed to address the range of work performed by ethics committees as part of their multiple responsibilities, including education, case consultation, and policy development. It features an eight-chapter curriculum reviewing the content of contemporary health care bioethics and discussing the ethical foundations of clinical practice, with each subsequent section focusing on a set of ethical issues that commonly arise in the clinical setting. Through case studies, the authors explore issues such as informed consent and refusal, decision making and decisional capacity, truth telling, decision-making concerns of minors, end-of-life issues, palliation, justice in and access to health care services, and organizational ethics. They offer sample policies and procedures, draft guidelines and protocols, and key legal cases. Providing both a strong theoretical foundation and practical applications, this handbook will be essential reading for every member of a health care ethics committee. (shrink)

That contempt and dishonor are closely related has been shown not only in recent discussions of the subject, but also in Aristotle's investigation of emotions in the judiciary. In this paper, I will discuss the ways in which the ancient Greeks—and, in particular, the polis of Athens—institutionalized what Bell calls “apt contempt” (i.e., contempt as a response to actual and serious faults of character which stems from the contemnor's concern for the values at stake) through the legal penalty of atimia (...) (“dishonor”). Not only does Athenian evidence prove Bell's point that contempt can be “apt”—it also represents an early case study of a community that formalized such “apt” contempt in law and in the formal enactment of collectively approved social norms. And yet, the Greeks were also aware of the potential ambivalence of notions such as “contempt” and “dishonor.” This ambivalence is likely to have been one of the factors that catalyzed a differentiation, within the semantic field of atimia, between “dishonoring” ( atiman/ atimoun) and “disrespecting” ( atimazein)—between “apt” and “inapt” contempt. (shrink)

According to standard philosophical analyses, only victims can forgive. There are good reasons to reject this view. After all, people who are neither direct nor indirect victims of a wrong frequently feel moral anger over injustice. The choice to foreswear or overcome such moral anger is subject to most of the same sorts of considerations as victims’ choices to forgive. Furthermore, bystanders’ reactions to their experiences of moral anger often reflect either virtues or vices that are of a piece with (...) what we normally describe as a forgiving or unforgiving disposition. In this paper, I reject the view that only victims can forgive by comparing the experience and regulation of moral anger by victims and bystanders. The virtues of victims and bystanders with regard to moral anger are so similar that there is no good reason to apply different labels. However, the recognition of forgiveness in bystanders offers us more than simple consistency. It also leads us to think about the role moral bystanders play in the maintenance of the moral community, as well as the ways in which this role can be abused or overstepped. (shrink)

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

As medical technology becomes more sophisticate the ability to manipulate nature and manage disease forces the dilemma of when can becomes ought. Indeed, most bioethical discourse is framed in terms of balancing the values and interests and the benefits and burdens that inform principled decisions about how, when, and whether interventions should occur. Yet, despite advances in science and technology, one caregiver mandate remains as constant and compelling as it was for the earliest shaman—the relief of pain. Even when cure (...) is impossible, the physician's duty of care includes palliation. Moreover, the centrality of this obligation is both unquestioned and universal, transcending time and cultural boundaries.Although universally acknowledged, pain is a complex phenomenon for both the patient and the caregiver, influenced as much by personal values and cultural traditions as by physiological injury and disease. (shrink)

Jean Hampton argues that we can detect exploitation in personal relationships by thinking about what we would agree to were we to set aside the emotional benefits we receive from those relationships. Hampton calls her account "feminist contractarianism," but it has recently been critiqued as decidedly unfeminist, on the grounds that it is hostile to women's interests and women's values. Furthermore, Hampton's requirement that we imaginatively distance ourselves from our emotional connections to our loved ones--the key element in her contractarian (...) test--is simply ad hoc. In this essay, I will evaluate these objections and offer a new justification for Hampton's test. I conclude that feminist contractarianism is not only a useful tool for detecting exploitation in the family, it is also deserving of its feminist label. (shrink)

Do future generations of a wrongdoing group have a responsibility to preserve the memory of the past? If so, what manner of responsibility is it? In this essay, I critically examine the categories of forward-looking and backward-looking collective responsibility to see what they might offer to this discussion. I argue that these concepts of responsibility are ambiguous in ways that threaten to prevent important questions from being raised. I draw my examples from contemporary German practices of preserving the memory of (...) the Holocaust and World War II, especially the stolpersteine, which are memorial plaques for individual victims embedded in the sidewalks of German cities. (shrink)

IntroductionStrawsonian theories of moral responsibility, which aim to ground the phenomenon of moral responsibility in our practices of holding one another accountable for our actions, lead us to think more carefully about the content of those practices. Strawson and his followers have done much to explore the significance of the deontic reactive attitudes (resentment, indignation and guilt), which we tend to aim at wrongdoers.P. F. Strawson, "Freedom and Resentment," Proceedings of the British Academy, Vol. 48 (1962). See also, R. Jay (...) Wallace, Responsibility and the Moral Sentiments (Cambridge, MA: Harvard University Press, 1994); and Stephen Darwall, The Second-Person Standpoint: Morality, Respect and Accountability (Cambridge, MA: Harvard, 2006). In this essay, I am interested in the ways in which we express those attitudes. While it is plausible that experiencing a negative reactive attitude would be permissible in every case of blameworthy wrongdoing, few would agree that verbal .. (shrink)

Anyone who goes beyond procedural questions of a discourse theory of morality and ethics and, in a normative attitude … embarks on a theory of the well-ordered, or even emancipated, society will very quickly run up against the limits of his own historical situation.For some time now, a certain strand of contemporary critical theory has understood its task not as providing a substantive critique of power relations, let alone an alternative normative conception of what social relations might be, but as (...) how to justify critique as such: how to justify those elements which critique owes to its philosophical origins, albeit in a nonfoundationalist manner.1 This focus on—if not obsession with—the theoretical problem of... (shrink)

This article describes the connection between feminist theory and the canon of political thought. It explains that feminist approaches to the canon of political theory are characterized by deep ambivalence and the majority of canonical authors have mostly dismissed women as political beings in their own right and casted them instead as mere appendages to citizen man. The article suggests that the question of how to make political judgments about other cultures and practices that deeply affect women is particularly important (...) for feminist theory today. Globalization and the weakening of nation states have also pressed feminists to raise political demands with an eye to their multicultural and transnational significance. (shrink)

This essay asks whether restorative justice practices in criminal legal systems are consistent with the aims of a liberal state.