Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose (...) a sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were (...) transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided. (shrink)

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be (...) “dead” would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

We examine two competing solutions to Benardete paradoxes: causal finitism, according to which nothing can have infinitely many causes, and the unsatisfiable pair diagnosis (UPD), according to which such paradoxes are logically impossible and no metaphysical thesis need be adopted to avoid them. We argue that the UPD enjoys notable theoretical advantages over causal finitism. Causal finitists, however, have levelled two main objections to the UPD. First, they urge that the UPD requires positing a ‘mysterious force’ that prevents paradoxes (...) from arising. Since such a force is implausible, the UPD is in trouble. Second, they employ recombination or patchwork principles to argue that paradoxical situations would be possible if causal finitism were false. Since such situations are not possible, causal finitism is true, and so a substantive metaphysical thesis is needed to avoid the paradoxes. We argue that the UPD proponent can successfully respond to these objections. (shrink)

Objective: To determine if the medical record might overestimate the quality of care through false, and potentially unethical, documentation by physicians.Design: Prospective trial comparing two methods for measuring the quality of care for four common outpatient conditions: structured reports by standardised patients who presented unannounced to the physicians’ clinics, and abstraction of the medical records generated during these visits.Setting: The general medicine clinics of two veterans affairs medical centres.Participants: Twenty randomly selected physicians from among eligible second and third year (...) internal medicine residents and attending physicians.Main measurements: Explicit criteria were used to score the medical records of physicians and the reports of SPs generated during 160 visits . Individual scoring items were categorised into four domains of clinical performance: history, physical examination, treatment, and diagnosis. To determine the false positive rate, physician entries were classified as false positive , false negative, true positive, and true negative.Results: False positives were identified in the medical record for 6.4% of measured items. The false positive rate was higher for physical examination and diagnosis than for history and treatment . For individual physician subjects, the false positive rate ranged from 0.098 to 0.397.Conclusions: These data indicate that the medical record falsely overestimates the quality of important dimensions of care such as the physical examination. Though it is doubtful that most subjects in our study participated in regular, intentional falsification, we cannot exclude the possibility that false positives were in some instances intentional, and therefore fraudulent, misrepresentations. Further research is needed to explore the questions raised but incompletely answered by this research. (shrink)

In psychiatry's transformation from an asylum-based to a community-oriented profession, false positive diagnoses became a major challenge to the validity of the diagnostic system. The shift to descriptive, symptom-based operationalized diagnostic criteria of DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder. Through selected examples, the degree of success with which DSM-III and DSM-IV have attended to the challenge of avoiding false positive diagnoses is examined. Conceptual analysis (...) of selected criteria sets, with a focus on counterexamples to the claim that DSM criteria imply disorder, is performed. Psychiatry has so far failed to systematically confront the problem of false positives. Flaws in criteria, which can be recognized even by lay people, remain unaddressed, despite the fact that the issue is purely conceptual and is not sensitive to any new research information. (shrink)

The view that the basic statements in some areas of language are never true or false absolutely, but only relative to an assessment-perspective, has been advanced by several philosophers in the last few years. This paper offers a critique of that position, understood first as a claim about our everyday concept of truth, and second as a claim about the key theoretical concept of an adequate empirical semantics. Central to this pair of critical discussions will be an argument that (...) the appeal of truth-relativism derives from a specific misconception: namely, that our ordinary concept of absolute truth is substantive — a form of metaphysical or epistemological determination. Building on this argument, the present paper aims to undercut relativism about truth both as a purely philosophical thesis and as an approach to the science of meaning. (shrink)

In this paper I shall try to analyse appropriate logic and actual methods as a preliminary to developing expert systems that will simulate clinical diagnosis. It is doubtful that all diagnoses address the same kind of problem and hence no one logic will suffice. Sometimes the signs and symptoms manifest an underlying disorder that cannot be observed directly (the substantialist model); sometimes there seems to be no underlying disorder and the diagnosis is a rearrangement of the data (the (...) nominalist model). In deciding their merits in the particular case, we must identify the sources of variation; what is meant by saying that the data are independent; and what can be meant by wrong diagnosis and misclassification. Problems arise in human diagnosis because the data may be false, even lies; because the known list of diseases is not exhaustive; and because the probability of multiple unrelated diseases increases with age. Special difficulties arise from homeostasis (which is fundamental in defining and understanding disease) because the primary disturbances may be hard to distinguish from the homeostatic responses to them. (shrink)

A central element of constitutivist accounts of categorical normativity is the claim that the ultimate foundation of the relevant kind of practical authority is sourced in certain tasks, features, and aims that every person inevitably possesses and inescapably has to deal with. We have no choice but to be agents and this fact is responsible for the norms and principles that condition our agency-related activities to have anunconditional normative grip on us. Critics of constitutivism argue that it is exactly because (...) of itsinescapability that agency is a powerless source of normative authority. I investigate why our intuitionsconcerning the appeal to inescapability point into such contrary directions. Why do we feel the attraction ofgrounding categorical normativity in phenomena that not even the skeptic can ignore, on the one hand, butseem to hold dear the principle that “ought implies need not,” on the other? Instead of fully developing thethird, neutral, way of conceptualizing the relationship between inescapability and normativity that theimpasse between constitutivists and their critics suggests, this paper diagnoses the disagreement at hand.That agency is inescapable does neither guarantee nor rule out its status qua source of categoricalnormativity. Both camps of the debate overlook this option and depict their opponents as adhering to animplausible perspective of how appeals to inescapability and unconditional normativity are related. Sincethe debate relies on a false dichotomy it is not surprising that its participants so often talk past each other. (shrink)

Benjamin Libet’s work paved the way for the neuroscientific study of free will. Other scientists have praised this research as groundbreaking. In philosophy, the reception has been more negative, often even dismissive. First, I will propose a diagnosis of this striking discrepancy. I will suggest that the experiments seem irrelevant, from the perspective of philosophy, due to the way in which they operationalize free will. In particular, I will argue that this operational definition does not capture free will properly (...) and that it is based on a false dichotomy between internal and external causes. However, I will also suggest that this problem could be overcome, as there are no obvious obstacles to an operationalization of free will that is in accord with the philosophical conception of free will. (shrink)

In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an ‘At-Risk Mental State’ (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk–benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns about the unnecessary harm (...) associated with such ‘false-positive’ results. These harms are especially pertinent when identifying psychosis risk individuals due to potential stigma and discrimination in a young clinical population. A dearth of high-quality evidence supporting interventions for ARMS patients raises further doubts about the benefit accompanying an ARMS disclosure. Despite ongoing discussion in the bioethical literature, these concerns over the ethical justification of disclosure to ARMS patients are not directly addressed in clinical guidelines. In this paper, we aim to provide a unified disclosure strategy grounded in principle-based analysis for ARMS clinicians. After considering the ethical values at stake in ARMS disclosure, and their normative significance, we argue that full disclosure of the ARMS label is favoured in the vast majority of clinical situations due to the strong normative significance of enhancing patients' understanding. We then compare our framework with other approaches to ARMS disclosure and outline its limitations. (shrink)

Hájek has recently presented the following paradox. You are certain that a cable guy will visit you tomorrow between 8 a.m. and 4 p.m. but you have no further information about when. And you agree to a bet on whether he will come in the morning interval (8, 12] or in the afternoon interval (12, 4). At first, you have no reason to prefer one possibility rather than the other. But you soon realise that there will definitely be a future (...) time at which you will (rationally) assign higher probability to an afternoon arrival than a morning one, due to time elapsing. You are also sure there may not be a future time at which you will (rationally) assign a higher probability to a morning arrival than an afternoon one. It would therefore appear that you ought to bet on an afternoon arrival. The paradox is based on the apparent incompatibility of the principle of expected utility and principles of diachronic rationality which are prima facie plausible. Hájek concludes that the latter are false, but doesn't provide a clear diagnosis as to why. We endeavour to further our understanding of the paradox by providing such a diagnosis. (shrink)

Causal finitism, the view that the causal history of any event must be finite, has garnered much philosophical interest recently—especially because of its applicability to the Kalām cosmological argument. The most prominent argument for causal finitism is the Grim Reaper argument, which attempts to show that, if infinite causal histories are possible, then other paradoxical states of affairs must also be possible. However, this style of argument has been criticized on the grounds of (i) relying on controversial modal principles, and (...) (ii) providing a false diagnosis of the paradoxes involved. In this paper, I develop a new kind of Grim Reaper argument immune to these criticisms. I show that, by using insights from the literature on time travel, causal finitists should instead argue that infinite causal histories are problematically inexplicable, as they entail the possibility of unexplained foiling mechanisms. The fruits of this paper are that (i) a novel supporting argument for the Kalām is developed, and (ii) along the way of building this argument, it is shown that the literatures on time travel and causal finitism are deeply and intimately connected. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values (...) when related to ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

Incredible discoveries from the fringes of the universe to the inner workings of our mindsÑall from nothing! It turns out that almost nothing is as curiousÑor as enlighteningÑas, well, nothing. What is nothingness? Where can it be found? The writers of the world's top-selling science magazine investigateÑfrom the big bang, dark energy, and the void to superconductors, vestigial organs, hypnosis, and the placebo effectÑand discover that understanding nothing may be the key to understanding everything: What came before the big bang, (...) and will our universe end? How might cooling matter down almost to absolute zero help solve our energy crisis? How can someone suffer from a false diagnosis as though it were true? Does nothingness even exist? Recent experiments suggest that squeezing a perfect vacuum somehow creates light. Why is it unfair to accuse slothsÑanimals who do nothingÑof being lazy? And more! Contributors Paul Davies, Jo Marchant, and Ian Stewart, along with two former editors of Nature and 16 other leading writers and scientists, marshal up-to-the-minute research to make one of the most perplexing realms in science dazzlingly clear. Prepare to be amazed at how much more there is to nothing than you ever realized. (shrink)

This paper argues that clinicians are sometimes justified in not testing diagnoses or in not subjecting them to a full battery of tests. In deciding whether to conduct a test, a clinician may consider and weigh several different factors, including her confidence in her initial diagnosis, the specificity and sensitivity of the test, the consequences of making a false diagnosis, the pain, harm, and inconvenience caused by the test, and the costs of the test to the patient (...) and society. This view suggests that diagnoses are fundamentally different from scientific hypotheses in that they are not always subjected to the same evidential standards. (shrink)

There are complex considerations when planning to disclose an attenuated psychosis syndrome diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non- and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and bolsters (...) communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non-disclosure advances nonmaleficence by limiting stigma and stress, and confusion in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo-diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help-seeking cases that do not transition but remain clinically relevant. (shrink)

_The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, (...) non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy, Religion, and Spirituality in Psychiatry. It includes topics like (a) relevance of philosophy to psychiatry; (b) psychiatry, religion, spirituality, and culture; (c) ancient Indian concepts and contemporary psychiatry; (d) Indian holism and Western reductionism; (e) science, humanism, and the nomothetic-idiographic orientation. The last part, called Final Goal, talks of the need for a grand unified theory. The whole discussion is put in the form of refutable points._. (shrink)

"Well over one half of this brilliant new Monograph constitutes a major sequel to Professor Grunbaum's highly influential 1984 book The Foundations of Psychoanalysis: A Philosophical Critique, which was labeled "magisterial" by Frank J. Sulloway, and "the most important book ever written on Freud's status as a scientist" by J. Allan Hobson. The importance of the present Monograph lies in the extent to which the author now goes beyond that earlier volume to offer new original ideas on fundamental themes." "Validation (...) in the Clinical Theory of Psycho-analysis: A Study in the Philosophy of Psycho-analysis contains Adolf Grunbaum's new basic critique of the psychoanalytic theory of transference in its role of an etiologic theory; it turns out that etiologic transference interpretations rest on fallacious causal inferences from so-called "meaning connections" between mental states: moreover, just these unsound inferences are the stock-in-trade of the "hermeneutic" reconstruction of psychoanalysis, which charges Freud with a "scientistic self-misunderstanding."" "This volume joins the issue with Marshall Edelson's defenses of the investigative viability of the single-subject case study method. As a spin-off from the import of the serious placebo challenge to psychoanalysis, this Monograph presents the author's widely recognized new account of the placebo concept across all of medicine and psychotherapy. Whereas Foundations of Psychoanalysis objected that Freud's dream theory was evidentially ill-founded, the burden of the present book is to give two new basic reasons for presuming the theory to be false. It also develops the import of the author's appraisal of psychoanalytic theory for the scrutiny of Freud's triadic psychology of religious belief in theism." "Since Sir Karl Popper's most detailed charge of pseudoscience against psychoanalysis in 1983 could not be examined for inclusion in the 1984 book, the present monograph shows in what ways it is wide of the mark as an incoherent diagnosis of the scientific liabilities of psychoanalytic theory. In addition, four important papers that had antedated Foundations by a few years and were scattered over diverse publications have been updated and integrated with the other chapters herein."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved. (shrink)

BACKGROUND: Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential (...) alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. METHODS: In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, to analyse their accounts. FINDINGS: Between March 2, 2020, and Sept 30, 2020, 18 adults participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways, across multiple dimensions, and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. INTERPRETATION: Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective. FUNDING: FWO Flanders. TRANSLATION: For the Dutch translation of the abstract see Supplementary Materials section. (shrink)

One version of Moore’s Paradox is the challenge to account for the absurdity of beliefs purportedly expressed by someone who asserts sentences of the form ‘p & I do not believe that p’. The absurdity of these beliefs is philosophically puzzling, given that Moorean sentences are contingent and often true; and express contents that are unproblematic when presented in the third-person. In this paper I critically examine the most popular proposed solution to these two puzzles, according to which Moorean beliefs (...) are absurd because Moorean sentences are instances of pragmatic paradox; that is to say, the propositions they express are necessarily false-when-believed. My conclusion is that while a Moorean belief is a pragmatic paradox, it is not just another pragmatic paradox, because this diagnosis does not explain all the puzzling features of Moorean beliefs. In particularly, while this analysis is plausible in relation to the puzzle posed by characteristic of Moorean sentences, I argue that it fails to account for. I do so in the course of an attempt to formulate the definition of a pragmatic paradox in more precise formal terms, in order to see whether the definition is satisfied by Moorean sentences, but not by their third-person transpositions. For only an account which can do so could address adequately. After rejecting a number of attempted formalizations, I arrive at a definition which delivers the right results. The problem with this definition, however, is that it has to be couched in first-person terms, making an essential use of ‘I’. Thus the problem of accounting for first-/third-person asymmetry recurs at a higher order, which shows that the Pragmatic Paradox Resolution fails to identify the source of such asymmetry highlighted by Moore’s Paradox. (shrink)

A number of philosophers have claimed that non-evidential considerations cannot play a role in doxastic deliberation as motivating reasons to believe a proposition. This claim, interesting in its own right, naturally lends itself to use in a range of arguments for a wide array of substantive philosophical theses. I argue, by way of a counterexample, that the claim to which all these arguments appeal is false. I then consider, and reply to, seven objections to my counterexample. Finally, as a (...) way of softening the blow, I show how the counterexample itself suggests a plausible diagnosis of why this claim has seemed so plausible to so many. (shrink)

This narrative ethics exploration stems from my happy prostate-specific antigen (PSA) story, though it should not have been, as I annually refuse my family physician’s recommendation to purchase PSA screening. The reason for my refusal is I teach ethics to medical students and of course must walk the talk, and PSA screening is not publicly funded in the province of Ontario, Canada. In addition, I might have taken false comfort in ‘but all you need is a good index finger’ (...) to detect prostate cancer, expounded by a senior physician at a national medical conference in 2010, and applauded by the large audience of physicians. I was compelled to begin this exploration out of survivor guilt, although I will not be a survivor for long, and as a mea culpa to the men similarly situated to me in having late diagnosis of prostate cancer, aggressive tumours and multiple metastases, but who unlike me are dead because they did not experience the physician–educator-based exceptionisms and coincidences that permit me to still be alive. Although my PSA story will always be a happy story, even when my life ends in a few years, the initiation of public funding of PSA screening for all men over 50 would make my PSA story an even happier story. (shrink)

"Well over one half of this brilliant new Monograph constitutes a major sequel to Professor Grunbaum's highly influential 1984 book The Foundations of Psychoanalysis: A Philosophical Critique, which was labeled "magisterial" by Frank J. Sulloway, and "the most important book ever written on Freud's status as a scientist" by J. Allan Hobson. The importance of the present Monograph lies in the extent to which the author now goes beyond that earlier volume to offer new original ideas on fundamental themes." "Validation (...) in the Clinical Theory of Psycho-analysis: A Study in the Philosophy of Psycho-analysis contains Adolf Grunbaum's new basic critique of the psychoanalytic theory of transference in its role of an etiologic theory; it turns out that etiologic transference interpretations rest on fallacious causal inferences from so-called "meaning connections" between mental states: moreover, just these unsound inferences are the stock-in-trade of the "hermeneutic" reconstruction of psychoanalysis, which charges Freud with a "scientistic self-misunderstanding."" "This volume joins the issue with Marshall Edelson's defenses of the investigative viability of the single-subject case study method. As a spin-off from the import of the serious placebo challenge to psychoanalysis, this Monograph presents the author's widely recognized new account of the placebo concept across all of medicine and psychotherapy. Whereas Foundations of Psychoanalysis objected that Freud's dream theory was evidentially ill-founded, the burden of the present book is to give two new basic reasons for presuming the theory to be false. It also develops the import of the author's appraisal of psychoanalytic theory for the scrutiny of Freud's triadic psychology of religious belief in theism." "Since Sir Karl Popper's most detailed charge of pseudoscience against psychoanalysis in 1983 could not be examined for inclusion in the 1984 book, the present monograph shows in what ways it is wide of the mark as an incoherent diagnosis of the scientific liabilities of psychoanalytic theory. In addition, four important papers that had antedated Foundations by a few years and were scattered over diverse publications have been updated and integrated with the other chapters herein."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved. (shrink)

While it is widely acknowledged that psychology is in the throes of a replication ‘crisis’, relatively little attention has been paid to the role theory plays in our evaluation of replications as ‘failed’ or ‘successful’. This paper applies well-known arguments in philosophy of science about the interplay between theory and experiment to a contemporary case study of infants’ understanding of false belief (Onishi and Baillargeon [2005]), and attempts to replicate it. It argues that the lack of consensus about over-arching (...) theories informing both the concepts under study and the methodologies used to track them means that researchers disagree over which experiments constitute replications of the original. The second part of the paper places this specific debate within a broader discussion of the replication crisis as a crisis of ‘theory’, developing work by Muthukrishna and Henrich ([2018]) and Bird ([2018]). Bird argues that the lack of agreed over-arching theories in psychology means that a high rate of replication failure is to be expected; this paper agrees with his diagnosis but challenges his proposal that more replication will resolve the problem. (shrink)

The chapter is divided into three separate parts. In the first part I critically discuss Adorno's interpretation of Heidegger's concern with the question of Being. Central to this interpretation is Adorno's view that Being, for Heidegger, resonates with onto‐theological or metaphysical accounts of the highest and most general being – that of Plato's ideas, or Aristotle's substance. In various steps, looking at several key claims of Heidegger, I argue that this approach is misguided. Heidegger draws a clear and philosophically justified (...) distinction between his conception of Being and the Platonic vision of essence. The second part identifies a strand of Adorno's critique that does not depend on the onto‐theological reading. This is the critique of fetishization and reification – Adorno's view that Heidegger falsely seeks to imbue his thinking and diagnosis of modernity with a veneer of the timeless and transcendental. Adorno, I suggest, justifiably introduces his dialectical procedure as a means to correct this tendency: Concepts, he claims, should be viewed and analyzed in terms of the non‐identity between themselves and the states of affairs to which they purport to refer. In clear contrast to the Heideggerian call for some kind of essential or necessary reference – words that magically yet “necessarily” pick out their object, and that thereby aspire to overcome the fateful split between word and object (or subject and object) – Adorno insists on difference, differentiation, and absence, a historically indexed self‐reflection. In the final part I propose a reading of Heidegger that takes heed of Adorno's warnings against fetishization and reification. While far from trying to efface the decisive differences between the two thinkers, I highlight moments in Heidegger that lend themselves to a dialectical interpretation. I argue that these are moments of remembrance – moments in which human practice anticipate a more reconciled relation between subject and object. (shrink)

The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic and metaphysical assertions that were either false, ad hoc, or confused. Epistemically, the project was not successful in explaining away remaining brain functions, complex reflexes as “spinal,” the risk and lack of utility of the (...) apnea test, the ignored and often present confounders of central endocrine dysfunction and high-cervical-spinal-cord injury, the limitations of ancillary tests, or the cases of reversibility of some findings of brain death/death by neurologic criteria. Metaphysically, the World Brain Death Project variously suggested different concepts of death that were not supported with argument. Concepts offered included simply restating the criterion of brain death/death by neurologic criteria; personhood, without recognizing it is a higher-brain concept; and emergent functions of the organism as a whole, without specifying what these might be, if not biologic anti-entropic integration that actually remains after brain death/death by neurologic criteria. The World Brain Death Project only offered confused metaphysical discussion, and gave no reason why the state they described as brain death/death by neurologic criteria should be considered death itself. The main epistemic and metaphysical problems with brain death/death by neurologic criteria remain untouched by the World Brain Death Project. (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)

When parents face the distressing news during pregnancy that their baby is affected by a serious medical condition that will likely lead to the baby’s death before or soon after birth, they experience a range of complex emotions. Perhaps paradoxically, one common response is that of hope. Navigating such hope in antenatal interactions with parents can be difficult for healthcare professionals. That can stem from a desire to accurately communicate prognostic information and a fear of conveying ‘false hope’ to (...) families. In this paper, we examine the role that hope plays when parents and healthcare professionals are grappling with a confirmed antenatal diagnosis of a life-limiting condition. We assess what it means to hope in this context and consider the different types of hopes held by both parents and healthcare professionals as well as why hopeful thinking might be helpful and not harmful. We propose ‘hope pluralism’ as a concept that might allow healthcare professionals to accommodate a multitude of parental and professional hopes, even where these conflict. Finally, we offer some practical suggestions for how professionals should evaluate and respond to hope in situations that might (from the outside) appear hopeless. (shrink)

In the tradition of Western medicine that goes back to Hippocrates, we teach medical students to see beyond the disease and to consider the patient as a whole—to take into account the broader context of family, lifestyle, and environmental exposures. For instance, when measuring blood pressure to diagnose hypertension, family history and situational stress must be considered. Moreover, repeated measurements at multiple time points must be performed to avoid a false-positive diagnosis due to temporary fluctuations of blood pressure. (...) The diagnosis then provides, in adherence to standard-of-care guidelines, the indication for antihypertensive therapy. The recommendations have been... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ideal of Shared Decision Making Between Physicians and PatientsDan W. Brock (bio)IntroductionShared treatment decision making, with its division of labor between physician and patient, is a common ideal in medical ethics for the physician-patient relationship.1 Most simply put, the physician's role is to use his or her training, knowledge, and experience to provide the patient with facts about the diagnosis and about the prognoses without treatment and (...) with alternative treatments. The patient's role in this division of labor is to provide the values—his or her own conception of the good—with which to evaluate these alternatives, and to select the one that is best for himself or herself. As a rough guide to practice, this is a reasonable conception; most of the time it is likely to produce sound treatment decisions. However, as an ideal it is too simplistic, and is subject to several challenges that I will explore in this paper.Some challenges relate to the physician's role. This facts/values division of labor seems to assume that the physician can and should provide the facts about treatment alternatives in a value-neutral form. But some have questioned whether the sciences on which medicine is based are, or can be, value free. Moreover, the concepts of health and disease, and of the normal and pathological, are held by many to be value laden. And even if it is possible for physicians to provide only value-neutral facts to the patient, should the physicians' role be restricted in this way?Other challenges that I will present in the paper are to the patient's role [End Page 28] as provider of the values for the evaluation of the different treatment alternatives. One defense of this role is based on the claim that physicians are not in a position to know reliably what is in a patient's best interests (Buchanan, forthcoming). I believe at least as influential—even if often not explicitly stated—is an extreme subjectivism about values that assumes that the patient's own ultimate values, which define his or her own conception of the good, are incorrigible. By incorrigible, I mean they cannot be mistaken. In the standard case in which treatment is pursued for the patient's benefit, this extreme subjectivism is thought to support the patient's values guiding treatment decision making and treatment. I will explore this incorrigibility claim and will argue that on each of the main philosophical conceptions of the good for persons it is indefensible and should not be the basis for shared treatment decision making.Underlying this view of the physician-patient division of labor are assumptions and beliefs about the nature and relation of facts and values, and science and ethics, that are largely the legacy of a logical positivism that has long since been rejected by most philosophers. It is time that these unstable foundations for our normative ideal of the physician-patient relation were finally removed and replaced with more defensible underpinnings.Two Models of the Physician-Patient RelationshipPositivists insisted on a relatively sharp distinction between descriptive or empirical claims and science, on the one hand, and evaluative claims and ethics, on the other.2 Descriptive statements and the claims of science were to be true or false according to whether they in fact correctly described and explained the world. By remaining properly descriptive or empirical, science could, at least in principle, be entirely value neutral or value free.In its more extreme versions, positivism held that ethical judgments lacked cognitive content, but were instead expressions of emotions or attitudes, and as such could be neither true nor false, correct or mistaken. Because no evaluative statements were held to be logically entailed by any descriptive or empirical statements, moral reasoning was thought to be properly understood not as reasoning but as attempts at nonrational persuasion.3 Many drew from this an extreme subjectivism in ethics along the lines of what I have called above the incorrigibility thesis—there is no meaningful sense in which an individual's ultimate values defining his or her own conception of the good life could be mistaken, false, or unfounded.These... (shrink)

Confabulation is a symptom central to many psychiatric diagnoses and can be severely debilitating to those who exhibit the symptom. Theorists, scientists, and clinicians have an understandable interest in the nature of confabulation—pursuing ways to define, identify, treat, and perhaps even prevent this memory disorder. Appeals to confabulation as a clinical symptom rely on an account of memory’s function from which cases like the above can be contrasted. Accounting for confabulation is thus an important desideratum for any candidate theory of (...) memory. Many contemporary memory theorists now endorse Constructivism, where memory is understood as a capacity for constructing plausible representations of past events. Constructivism’s aim is to account for and normalize the prevalence of memory errors in everyday life. Errors are plausible constructions that, on a particular occasion have led to error. They are not, however, evidence of malfunction in the memory system. While Constructivism offers an uplifting repackaging of the memory errors to which we are all susceptible, it has troubling implications for appeals to confabulation in psychiatric diagnosis. By accommodating memory errors within our understanding of memory’s function, Constructivism runs the risk of being unable to explain how confabulation errors are evidence of malfunction. After reviewing the literature on confabulation and Constructivism, respectively, I identify the tension between them and explore how different versions of Constructivism may respond. The paper concludes with a proposal for distinguishing between kinds of false memory—specifically, between misremembering and confabulation—that may provide a route to their reconciliation. (shrink)

Screening for prostate cancer with the prostate-specific antigen blood test is controversial, as evidence to date has not demonstrated such screening does more good than harm. While the potential benefit of PSA screening on reducing prostate cancer mortality has not been documented in randomized trials, many risks of PSA screening have been well documented. These risks include a substantially higher risk of a prostate cancer diagnosis over a screenee’s lifetime, false-positive and false-negative test results, possible complications from (...) biopsies done in response to suspicious test results, and substantial risks of side effects from subsequent prostate cancer treatments. Nevertheless, PSA screening is widespread in the United States, and many physicians in a national survey reported supporting routine PSA screening as well as getting PSA tests themselves, despite the lack of evidence. (shrink)

Philosophical interests of Joseph Życiński in the domain of the philosophy of science were focused on the debate concerning the nature of science and philosophy of science that followed the Einstein-Planck revolution in science. The unexpected discovery of the philosophical, extra-scientific presuppositions in science, as well as of the extra-rational factors determining the way these presuppositions are accepted in science were to be explained within the meta-scientific framework. It is the aim of this paper to present ˙ Życiński’s diagnosis (...) of this post-revolutionary situation in the philosophy of science as well as his critique of the metascientific answers to this challenge. The reasons will be given why all those answers are put under two dichotomous rubrics of _internalism_ and _externalism_. It will be also explained how Życiński intends to supersede this false in his opinion opposition with a new concept of the doxatic rationality. However, the details of the metascientific proposal of Życiński will be given only in the subsequent paper. In order to perform the aim of the paper the metatheoretic tools set out by Popper will be used. (shrink)

Free-will incompatibilism has become a motte-and-bailey doctrine (Shackel 2014), and is currently being maintained by standard motte-and-bailey strategies. In this paper, I explain why incompatibilism has a motte-and-bailey structure and why philosophers who do not aim to dismantle it are complicit in both the maintenance of this problematic doctrine and the normalization of a host of bad practices engaged in by those who actively exploit it. To solidify the diagnosis, I provide a paradigmatic motte-and-baileying case that has been ongoing (...) for over a decade. Specifically, I discuss how motte-and-baileying has generated widespread confusion surrounding the logical structure and conclusion of manipulation arguments. Even more specifically, I look at Mele's so-called "Zygote Argument for incompatibilism". I point out that Mele currently conflates under two distinct arguments with different logical forms and substantively different conclusions under that heading, and explain how this has needlessly impeded progress in the free-will debate. The original variant of the Zygote Argument was invalid because it aimed to establish that determinism precludes (destroys, undermines, is antagonistic to) free will, but its supported a far weaker non-explanatory conclusion. In direct response to this invalidity objection, Mele took his critic's suggestion to change the conclusion of his argument to the thesis that free will and determinism are perhaps spuriously associated -- but he also covertly changed his preferred definition of 'incompatibilism' to pick out the non-explanatory conclusion of the new variant of the Zygote Argument which allowed him to continue speaking AS IF his argument was still an argument for incompatibilism according to his original definition of 'incompatibilism'. It is not simply that Mele made these changes or that he failed to mention in print that he made them (despite having over a decade to do so), but that he has actively attempted to discredit his critics by insisting--contrary to fact--that those who do not use his negative definition of 'incompatibilism' are using the term in a nonstandard and nontraditional way that he has "never had any use for" and there is some kind of connection (which he does describe) between the invalidity objection to his original argument that the definition of 'incompatibilism' one prefers. Oddly, Mele has mentioned only one "invalidity objection" in print, but this objection is direct at the revised Zygote Argument--even though no one had ever pressed an invalidity objection to his new argument (the form of which is patently valid). As a direct result of Mele's evasive behaviors (covertly redefining jargon to cover changes to the form/conclusion of his argument), many people--including Mele's own former graduate students--have published articles in which they fail to recognize that Mele changed his argument and redefined terms, thereby perpetuating the false narrative that the new Zygote Argument has the same "incompatibilist" conclusion as the original (which, notably, had the same conclusion as its predecessor, Pereboom's Four-Case Argument). Moreover, Mele has not even ONCE corrected those who "misdescribe" his revised argument as concluding that determinism is antagonstic to (precludes, undermines, rules out, etc.) free will. For example, Mele never corrects those who mistakenly claim that the revised Zygote Argument has the same "incompatibilist" conclusion as Pereboom's, nor has Mele ever mentioned that he now defines the term 'incompatibilism' differently than Pereboom--since Pereboom since uses this term to refer to the explanatory conclusion of the original Zygote Argument, which had the same explanatory conclusion of his Four-Case Argument. To further throttle his critics, Mele has obliquely suggested that the invalidity objection to his original Zygote Argument works only if one accepts his critic's idiosyncratic definition of 'incompatibilism' -- a patently false charge (since the term 'incompatibilism' doesn't even appear in his arguments) and one that has needlessly confused his audience. Indeed, other philosophers have now made this false and quite indefensible accusation explicitly in print, thereby helping Mele and others to continue motte-and-baileying with impunity. I close by preemptively responding to strategies commonly used by motte-and-bailey apologists to suppress legitimate criticisms of their equivocation and well-poisoning strategies (e.g. "Philosophers are allowed to define their technical terms however they like" and "the motte/bailey divide is a distinction without a difference") which have hitherto kept their philosophical audience from participating in a legitimate discussion about why tracking the distinction between the the "motte" thesis (a negative, arguably spurious association claim) and the "bailey" thesis (a positive explanatory claim) is not trivial, but is instead one that is absolutely essential to making progress in the free-will debate. Of course, a single critic cannot (almost by definition) undermine a motte-and-bailey doctrine once it has been established. As such, even if every diagnosis in this essay is accurate, it will not change the discourse. The motte-and-baileying will continue, and the debate will remain in needless deadlock, until a critical threshold of OBSERVERS learn about the motte/bailey distinction and ask apologists for motte-and-bailey incompatibilism to stop their motte-and-baileying. -/- Manuscript available upon request, plz gmail me: kristin.mickelson.42@. (shrink)

In a recent paper, Dennis Whitcomb argues that omniscience is impossible. But if there cannot be any omniscient beings, then God, at least as traditionally conceived, does not exist. The objection is, roughly, that the thesis that there is an omniscient being, in conjunction with some principles about grounding, such as its transitivity and irreflexivity, entails a contradiction. Since each of these principles is highly plausible, divine omniscience has to go. In this article, I argue that Whitcomb's argument, if sound, (...) has several unacceptable consequences. Among others, it implies that nobody knows that someone has knowledge, that, for most of us, all of our beliefs are false, and that there are no truths. This reductio all by itself provides sufficient reason to reject the argument. However, I also provide a diagnosis of where precisely the argument goes wrong. I argue that Whitcomb's crucial notion of grounding actually covers two distinct relations and that the principle of transitivity is true only for cases in which one of these relations holds rather than both of them. (shrink)

‘Time’ has been central to Zygmunt Bauman’s theory of modernity and his subsequent account of its solid and liquid variants. The experience of time in these accounts announces the coming of new opportunities, but it also signals a corrosion of our moral sensitivity. In this article, I assess Bauman’s contribution to the sociology of time and the centrality of our temporal character for his philosophical anthropology. There is a unique chance to be moral in liquid modernity, by unshackling the outdated (...) and habitual ethics of the past. The danger, however, lays in an increasingly ‘hurried life’, where a ‘nowist’ culture demands endless answers to the most banal of choices, often before these choices have even arrived. I argue that for Bauman the historical power of culture is to raise the ‘ought’ above the ‘is’. This results from our character as temporally-aware creatures. In our liquid modern times, the haste of life and its individualizing forces shift the character of that temporal awareness, endowing us with a false set of needs crafted by the market. The project of humanity itself has become, in Bauman’s diagnosis, subservient to maintaining the goals of the market. (shrink)

Research shows that a high majority of parents receiving prenatal diagnosis of intellectual disability terminate pregnancy. They have reasons for rejecting a child with intellectual disabilities—these reasons are, most commonly, beliefs about quality of life for it or them. Without a negative evaluation of intellectual disability, their choice makes no sense. Disability-based abortion has been critiqued through virtue ethics for being inconsistent with admirable moral character. Parental selectivity conflicts with the virtue of acceptingness and exhibits the vice of wilfulness. (...) In this paper I claim that, beyond failures of moral virtue, disability abortion often involves failures of epistemic virtue on the part of parents. I argue two things: parents believe something false, or at least contested, about life with intellectual disability—and they do so because they are not epistemically conscientious. I first explain why a central motivation for disability abortion—that it prevents harm to the child—is mistaken. I next give a brief account of intellectual virtue and culpable ignorance. I then indicate why many parents fail to be intellectually virtuous when choosing to terminate pregnancy. I focus on elimination of intellectual disability and have little to say about physical and sensory impairments. (shrink)

The reasons for judgment by the Supreme Court of Canada on the appeal in Mabior (2012 SCC 47) fail to address or resolve a number of significant questions. The reasons acknowledge the fundamental role of sexual consent in protecting sexual autonomy, equality, and human dignity, but do not use the law of consent as a tool to assist the Court in crafting a fresh approach to the issue on appeal. Instead the Court adopts the same general approach to analysis of (...) the elements of aggravated sexual assault committed by fraud it used in 1998 in Cuerrier. Fifteen years later, it should be possible to re-conceptualize the problem in a more straightforward manner that reflects Charter values, fundamental common law principles, recent developments in sexual assault law, and the limitations and uncertainties of current HIV treatment and diagnosis. -/- Ironically, the two pronged legal test ultimately proposed by the Court -- non-disclosure of HIV-positive status and a “realistic possibility of transmission,” is likely to give false confidence to individuals who adhere to a regime of anti-retroviral treatment, use good quality latex condoms, and routinely conceal their HIV-positive status from their sexual partners. Research shows that HIV viral loads fluctuate widely in response to a myriad of factors. An inevitable consequence of reliance on the Mabior test will be accused who are shocked to find themselves charged under s. 273, charges that would not apply had they disclosed their HIV-positive status to their sexual partner(s). There are further practical consequences. Non-disclosure will tend to increase the risk of transmission because non-HIV-positive sexual partner(s) will not fully appreciate the actual hazards of improper condom use. As a direct result, careless sexual practices will be more common. And finally, the decision will not contribute to reducing the social stigma that haunts the lives of those who are HIV-positive -- even those who are skilled at deceit. That stigma will not be reduced or eliminated by a ruling that can be seen as tacitly validating stigmatization and fear by appearing to permit infected individuals to pretend they are not HIV-positive when they know or suspect this to be false. Deceit harms the human dignity of the deceived and deceiver alike, and does nothing to build authentic social trust and cohesion. For all these reasons, the problem on appeal in Mabior requires a different approach. This article proposes one. (shrink)

Most promising responses to skepticism fall into “Moorean” or “rationalist” camps. Mooreans believe that some apparently circular forms of reasoning allow us to have justification to believe that skeptical hypotheses are false. Rationalists believe that we have a priori justification to believe that skeptical hypotheses are false. It can seem that anti-skeptics are stuck choosing between fishy circular reasoning and mysterious a priori justification. I present a new difficulty for rationalism by focusing on skeptical scenarios wherein our faculties (...) of a priori reasoning are untrustworthy. In dealing with these scenarios, rationalists end up having to embrace the same sorts of circular reasoning that Mooreans use to deal with more familiar skeptical scenarios. As a result, there is no viable diagnosis of what's wrong with Moorean reasoning that does not also apply to rationalism: both anti-skeptical approaches are in the same boat when it comes to embracing circular reasoning. (shrink)

Biomedical science suffered a loss of trust during the Covid‐19 pandemic. Why? One reason is a crisis fueled by confusion over the epistemology of science. Attacks on biomedical expertise rest on a mistaken view of what the justification is for crediting scientific information. The ideas that science is characterized by universal agreement and that any evolution or change of beliefs about facts and theories undermines trustworthiness in science are simply false. Biomedical science is trustworthy precisely because it is fallible, (...) admits error, adjusts to new information, and, most importantly, is practical. Successful diagnosis and cure demarcate the boundaries of warranted knowledge. The other reason is sociological. As the pandemic made all too clear, the loss of faith in scientific experts was due to the failure of most of them to engage in regular public dialogue, reflecting a failure to recognize the obligation that science has to bolster trust in its work and findings by concerted public engagement. (shrink)

BonJour argues that there can be no basic empirical beliefs. But premises three and four jointly entail ‘BonJour’s Rule’ — one’s belief that p is justified only if one justifiably believes the premises of an argument that makes p highly likely — which, given human psychology, entails global skepticism. His responses to the charge of skepticism, restricting premise three to basic beliefs and noting that the Rule does not require ‘explicit’ belief, fail. Moreover, the Rule does not express an epistemic (...) duty. Finally, his argument against this fails since it is false that if an experiential state has representational content, then it is in need of justification. I venture the diagnosis that BonJour mistook the representational content of a cognitive state for the assertive functional role of a belief. Foundationalism may well be false, but not for BonJour’s reasons. (shrink)

A 1971 paper by Roman Suszko, ‘Identity Connective and Modality’, claimed that a certain identity-free schema expressed the condition that there are at most two objects in the domain. Section 1 here gives that schema and enough of the background to this claim to explain Suszko’s own interest in it and related conditions—via non-Fregean logic, in which the objects in question are situations and the aim is to refrain from imposing this condition. Section 3 shows that the claim is (...) class='Hi'>false, and suggests a diagnosis as to why it might have been made, in terms of quantifier scope distinctions as they bear on schematic formulations. In between, Section 2 discusses an issue brought up by this discussion but not involving the mistaken claim itself, and shows that Suszko was familiar with two different ways to set an upper or lower finite bound to the domain—a contrast which some contemporary readers may associate with David Lewis. (shrink)

There have always been some uninhabitable places, but in the last century human beings have produced many more of them. These anti-landscapes have proliferated to include the sandy wastes of what was once the Aral Sea, severely polluted irrigated lands, open pit mines, blighted nuclear zones, coastal areas inundated by rising seas, and many others. _The Anti-Landscape_ examines the emergence of such sites, how they have been understood, and how some of them have been recovered for habitation. The anti-landscape refers (...) both to artistic and literary representations and to specific places that no longer sustain life. This history includes T. S. Eliot’s _Wasteland_ and Cormac McCarthy’s _The Road_ as well as air pollution, recycled railway lines, photography and landfills. It links theories of aesthetics, politics, tourism, history, geography, and literature into the new synthesis of the environmental humanities. _The Anti-Landscape_ provides an interdisciplinary approach that moves beyond the false duality of nature vs. culture, and beyond diagnosis and complaint to the recuperation of damaged sites into our complex heritage. _This is the first volume in the new series _Studies in Environmental Humanities_._. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Which Kind Is It?Andy Hamilton (bio)Keywordshuman kinds, mild cognitive impairment, multiple personality disorder, practical kinds, social constructionThere is much stimulating material in the Graham and Ritchie's paper (2006), concerning not just disease-classification but also the ethics of diagnosis. My concern is with the way in which they adduce Ian Hacking's views in the philosophy of science in support of their own. The authors quote with approval (...) his "dynamic nominalism" and its influence on Zachar's concept of "practical kinds." Hacking's view, as the authors quote it, is that "People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised" (1995, 21). The act of classifying changes both the classifier and the subject of classification, resulting in facts and categories that are both socially created and real. Hacking calls this "the looping effect of human kinds," and comments that "Multiple personality [disorder] is an almost too perfect illustration of this feedback effect" (1995, 21). The authors comment that Zachar (2000) builds on Hacking's position, discarding essentialist notions of classification that are limited to inherent biological properties, and turning instead to "practical kinds—nonarbitrary cultural artifacts intended to meet pragmatic needs (e.g. therapeutic, predictive prognostic, labeling effects, and physiology)" (Graham and Ritchie 2006, 36). Practical kinds, they believe, offer a way out of the clinical approach focused on mild cognitive impairment (MCI) as a precursor to, or mild form of, Alzheimer's disease. The inclination of the authors, as I read them, is to treat MCI as a practical or human kind, and not, like Alzheimer's disease, as a natural kind.My concern is whether the "looping effect of human kinds" can be transferred to the case of MCI from Hacking's original case study in Rewriting the Soul, multiple personality disorder (MPD). Hacking wished there to undermine the traditional debate over whether MPD is a "social or psychiatric artifact." He claims, correctly I think, that the presupposition behind the question "Is MPD a real disorder as opposed to a product of social circumstances?" should be rejected. The fact that a disorder is a product of social circumstances does not make it less real (1995, 12). On the looping of human kinds, Hacking comments that "The concept of child abuse [implicated in MPD] may itself be so made and molded by attempts at knowledge and intervention, and social reaction to these studies, that there is no stable object, child abuse, to have knowledge about." This is a "no fact of the matter" response, and it [End Page 51] is based on the recognition of conceptual change. He later adds that child abuse "is a real evil, and it was so before the concept was constructed. It was nevertheless constructed. Neither reality nor construction should be in question" (1995, 61, 68). However, Hacking's conclusions about the reality of MPD express only a muted skepticism. Utilitarian skeptics approach this question by asking, "What is the most effective treatment?" Hacking writes that "in their hearts [such skeptics] suspect that the outcome of multiple therapy [therapy that condones or even encourages the development of multiples in the patient] is a type of false consciousness" (1995, 267). The skeptics about MPD are making a moral judgment, he believes; but on whether that moral judgment is correct, he is silent, although the suspicion must be that he agrees with it.How do these considerations apply to the case of MCI? Graham and Ritchie rightly note that classifying a subject as suffering from MCI, and informing them of the diagnosis, will affect them adversely—it will cause suffering not least because there is at present no cure. However, it must surely be conceded that any disease at all—physical or mental—is a social entity insofar as it involves behavioral ascriptions to the subject concerning their incapacity. The authors also note the vested interests—especially from the pharmaceutical industry—in developing a diagnostic category of MCI. These interests are present in the development of any significant diagnostic... (shrink)

In a series of very influential works, Tim Williamson has advanced and defended a much discussed theory of evidence containing, among other claims, the thesis that, if one knows P, P is part of one's evidence. I argue that K ⊆ E is false, and indeed that it is so for a reason that Williamson himself essentially provides in arguing against the thesis that, if one has a justified true belief in P, P is part of one's evidence: together (...) with a very plausible principle governing the acquisition of knowledge by non-deductive inference based on evidence, K ⊆ E leads, in a sorites-like fashion, to what would seem a series of unacceptably bootstrapping expansions of one's evidence. I then develop some considerations about the functions of and conditions for evidence which are suggested by the argument against K ⊆ E. I close by discussing the relationship of the argument with anti-closure arguments of the style exemplified by the preface paradox: I contend that, if closure is assumed, it is extremely plausible to expect that the diagnosis of what goes wrong in the preface-paradox-style argument cannot be used to block my own argument. (shrink)

Tras un breve recuerdo del debate centenario sobre la filosofía cristiana, el autor discute la nueva propuesta de Alasdair MacIntyre de mejorar una «filosofía católica» en el contexto de nuestra moderna crisis en la relación entre fe y razón. El autor comparte el diagnóstico sobre nuestra situación presente en las universidades de investigación y sobre su exclusión pragmática de la filosofía y la teología, las cuales, en el mejor caso, son reducidas a disciplinas especializadas sin relevancia para otras disciplinas, y, (...) en la mayoría de los casos, son simplemente expulsadas del ámbito de la investigación científica. La propuesta dialéctica de MacIntyre en Tres versiones rivales de la ética y en Dios, Filosofía, Universidades, aparte de otras obras menores, se examina críticamente y se presenta como una forma nueva de comprometer a los pensadores católicos y no católicos en una confrontación abierta y fructífera, en lugar de nuestro confinamiento actual en mundos cerrados de investigación falsamente científica. After a brief recollection of the century long debate about Christian philosophy, the author discusses Alasdair Maclntyre’s new proposal to enhance a «Catholic philosophy» in the context of our modern crisis of the relationship between faith and reason. The author shares the diagnosis about our present daj situation of research universities and their pragmatic exclusion of philosophy and theology, which, in the best case, are reduced to specialized disciplines with no import for other disciplines, and, in most cases, are just expelled from the realm of scientfic research. Maclntyre’s dialectical proposal in «Three Rival Versions of Moral Enquiry» and in «God, Philosophy Universities», and in some other minor works, is critically examined and presented as a new way to engage Catholic and non Catholic thinkers in an open and fruitful confrontation, in stead of our present confinement in closed worlds of falsely scientific research. (shrink)

Jan Patocka’s idea of Europe can be viewed as a continuation of Edmund Husserl’s reflections on the issue. Still, the differences are numerous and worthy to be studied, especially in today’s critical times for Europe’s future. Patocka doubts the teleological, rationality-based determination of Europe’s identity, and, following that, the diagnosis of Europe’s current crisis as a deficiency in rationalization, which could be in its turn overcome by a surplus of rationalization. Patocka’s early differentiation from Husserl’s intellectualist account of European (...) humanity will lead to an integral, phenomenology-inspired philosophy of the European civilization. For Patocka, the prevailing of the “hegemonic” against the “universalist” Europe means a fall behind the standards of European humanity, to that of the mere biological level, as specified by today’s preponderant economy-oriented discourse. For him, the seeming victory of the “hegemonic” over the “universalist” Europe is false, because it already contains the seeds of its self-destruction. (shrink)