American orthodox medicine consolidated its professional authority in the early 20th Century on the basis of its unbiased scientific method. The centerpiece of such a method is a strategy for identifying truly effective new therapies, i.e., the randomized clinical trial (RCT). A crucial component of the RCT in illnesses without established treatment is the placebo control. Placebo effects must be identified and distinguished from pharmacological effects because placebos produce actual but unexplained therapeutic successes. The blinding necessary for a proper placebo-controlled (...) RCT therefore introduces an epistemic bias into orthodox medicine: therapeutic successes that rely upon a direct link between knowing and healing, such as placebo effects, are discarded in favor of therapeutic successes that rely upon an indirect link between knowing and healing, such as pharmacological interventions. Where the capacity to produce therapeutic results once validated the method of clinical medical science, now method validates results. The clinical consequences of this method of testing therapies include a diminished vision of the therapeutic potential of the doctor-patient relationship and of the potential human resources available for healing. Keywords: doctor-patient relationship, epistemology, placebo effect, professionalization, randomized clinical trials CiteULike Connotea Del.icio.us What's this? (shrink)

Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profession itself.

[opening paragraph]: Reading the article by Naudin et al. on Husserlian reduction in psychiatry prompted me to review a few chapters of my intellectual autobiography. I entered graduate school enamoured with Husserl, believing him a potent and necessary antidote to the hubris of the ‘natural attitude’ expounded by natural science. But I left graduate school believing that Husserl was too wrapped up in the debate as to whether reality was objective or subjective. Hence I ask in response to Naudin et (...) al.: must we take on Husserl's Cartesian baggage only to shed it as we move from trascendental subjectivity to the life world to narrative? The Husserlian apparatus seems a needlessly complicated and convoluted tool for exploring the essentially social deficit of the schizophrenic. Perhaps the most valuable contribution of phenomenology to psychiatry is its assiduous cultivation of ‘beginner's mind’ as it is often spoken of in Zen practice. (shrink)

Claude Bernard's concept of the internal environment ( milieu intérieur ) played a crucial role in the development of experimental physiology and the specific medical therapeutics derived from it. This concept allowed the experimentalist to approach the organism as fully determined yet relatively autonomous with respect to its external environment. However, Bernard's theory of knowledge required that he find organismic functioning as the result of an external necessity. He is therefore unable to explain adequately the origin or operation of organismic (...) autonomy. A more complete conception of biological autonomy must include a theory of knowledge that can accommodate the organism as a source of discrimination and determination. Only in this way will it be possible to see organisms as active as well as reactive, as ordering as well as ordered. This shift in perspective is crucial if medicine is to be able to characterize, for example, susceptibility to disease. A cognitive sense of the organic interior is proposed as an alternative to Bernard's internal environment. Keywords: biological autonomy, Claude Bernard, epistemology, internal environment ( milieu intérieur ) CiteULike Connotea Del.icio.us What's this? (shrink)

As a product of natural selection, pain behavior must serve an adaptive function for the species beyond the accurate portrayal of the pain experience. Pain behavior does not simply refer to the pain experience, but promotes survival of the species in various and complex ways. This means that there is no purely respondent or operant pain behavior found in nature.