Highly portable and accessible MRI technology will allow researchers to conduct field-based MRI research in community settings. Previous guidance for researchers working with fixed MRI does not address the novel ethical, legal, and societal issues (ELSI) of portable MRI (pMRI). Our interdisciplinary Working Group (WG) previously identified 15 core ELSI challenges associated with pMRI research and recommended solutions. In this article, we distill those detailed recommendations into a Portable MRI Research ELSI Checklist that offers practical operational guidance for researchers (...) contemplating using this technology. (shrink)

Socially extended knowledge has recently received much attention in mainstream epistemology. Knowledge here is not to be understood as wholly realised within a single individual who manipulates artefacts or tools but as collaboratively realised across plural agents. Because of its focus on the interpersonal dimension, socially extended epistemology appears to be a promising approach for investigating the deeply social nature of epistemic practices. I believe, however, that this line of inquiry could be made more fruitful if it is connected with (...) the critical notion of epistemic responsibility, as developed in feminist responsibilism. According to feminist responsibilists, at the core of epistemic responsibility is a critical disposition toward correcting epistemic injustice. This epistemic idea is highly relevant to the epistemological context of illness, where patient testimony is often disregarded. Hence, though restricted to the epistemological context of the experience of illness, this chapter delves into epistemic injustice and its robust mechanisms. I thus explore what responsible epistemic practices should involve in order to redress that injustice and how epistemic responsibility should be socially extended. The discussion proceeds as follows. First, by relying on Arthur Frank’s innovative work on illness narratives, I focus on chaotic bodily messages from patients overwhelmed by suffering and then explain why these messages should count as genuine narratives or testimonies despite their inarticulateness. Second, I elaborate on how epistemic injustice concerning such narratives (i.e., chaos narratives) is produced and reproduced, in particular how both a dominant sociocultural norm and our inherent vulnerability can contribute to its production and reproduction. Finally, I propose an extended form of epistemic responsibility that ameliorates this aspect. Laying particular emphasis on the epistemic role of mature empathy, I characterise the extended epistemic responsibility in terms of extended empathic knowledge. (shrink)

One of the most pervasive messages in modern advertising, both public and private, is that good health is something to strive for. Thus, the condition of our bodies and how the medical fraternity can impact on us is never far from our thoughts. Central to this interaction between doctor, patient, and society is a core group of terms that frame our discussions of sickness and health. Of particular interest to philosophers of medicine, the way we use and recognise the (...) differences between these terms has implications for how we decode the medical encounter. In this essay, three terms, disease, illness, and symptoms will be analysed to develop an argument for the continued separation and appreciation of them as distinct, although imbricated, concepts crucial to the performance of modern medicine. (shrink)

In this article I respond to Björn Hofmann’s criticism of some elements in my theory of health. Hofmann’s main objective is to question “Nordenfelt’s basic premise that you can be ill without having negative first-person experiences, and to investigate the consequences of abandoning the premise.” One of Hofmann’s critical points is that my theory of health does not lend voice to the individual. My response is essentially conducted in four steps: (1) I question the aim of conceptual analysis that Hofmann (...) proposes for the analysis of the notion of health. (2) I maintain that my analysis, in spite of Hofmann’s contention, lends voice to the individual. It does so via my notion of subjective illness but also via my notion of vital goal. (3) I argue that conditions, such as coma, paralysis and mania are salient instances of ill health and that these may become neglected if the use of the terms “ill” and “illness” is restricted to instances where negative subjective experiences are present. (4) I rehearse my main arguments for selecting disability as the core element of ill health and respond to Hofmann’s contention that persons who are in great pain can sometimes nevertheless perform perfectly. (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre's Being and Nothingness. The three steps identified by Sartre in this process are analysed, developed further and brought to a five- step model: pre-reflective experience of discomfort, lived, bodily discomfort, suffered illness, disease pondering, and disease state. To fall ill is to fall victim to a gradual process of alienation, and with each step this alienating process is (...) taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre's focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one's own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one's own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel about the ways of the lived body. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry (...) on Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

The very idea of mental illness is contested. Given its differences from physical illnesses, is it right to count it, and particular mental illnesses, as genuinely medical as opposed to moral matters? One debate concerns its value-ladenness, which has been used by anti-psychiatrists to argue that it does not exist. Recent attempts to define mental illness divide both on the presence of values and on their consequences. Philosophers and psychiatrists have explored the nature of the general kinds that mental illnesses (...) might comprise, influenced by psychiatric taxonomies such as the Diagnostic and Statistical Manual and the International Classification of Diseases, and the rise of a rival biological ‘meta-taxonomy’: the Research Domain Criteria (RDoC). The assumption that the concept of mental illness has a culturally invariant core has also been questioned. This book serves as a guide to these contested debates. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

Written in a jargon-free way, Body Matters provides a clear and accessible phenomenological critique of core assumptions in mainstream biomedicine and explores ways in which health and illness are experienced and interpreted differently in various socio-historical situations. By drawing on the disciplines of literature, cultural anthropology, sociology, medical history, and philosophy, the authors attempt to dismantle common presuppositions we have about human afflictions and examine how the methods of phenomenology open up new ways to interpret the body and to (...) re-envision therapy. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry (...) on Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

Philosophy of Medicine has for a long time been preoccupied with analyzing the concepts of health, disease and illness. Relatively speaking, the concept of medicine itself has received very little attention. This paper is a contribution to the relatively neglected debate about the nature of medicine. Building on the work of Alex Broadbent (Broadbent, 2018a, b), Chadwin Harris (Harris, 2018) and Thaddeus Metz (Metz, 2018), in this paper I question the persuasiveness of Broadbent’s account of the “core business” of (...) medicine, The Inquiry Thesis, and propose an alternative: a revised version of The Curative Thesis, which I coin The Best Available Intervention Thesis. Crudely, this suggests that Medicine is the sustained and organised effort to determine and prescribe the best available treatment (curative or preventative) for patients. (shrink)

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. (...) Research design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good. (shrink)

The article uses a producer-consumer theory from philosophy of mind and language to analyse the meaning of basic health concepts like disease, illness and sickness. The core idea of the producer-consumer perspective is that a person who has an incomplete understanding of a term can associate it with the same concept as a linguistic expert, if both of them are willing to defer to the same contextual or general norms of meaning. Using “disease” as an example, the article argues (...) that the producer-consumer theory implies that if patients were normally willing to defer to a standard expert concept of disease, it would be reasonable to assume that the concept of disease is this concept. However, it is empirically well documented that many patients are not willing to defer to health workers’ understanding of lay health concepts like “disease”. This means that the overall conceptual analysis of disease and other lay health concepts should be pluralistic—the concepts belong within what Wittgenstein calls different language-games. This conceptual pluralism is inconsistent with assumptions many theorists have made when attempting to develop general definitions of basic concepts of ill health. Furthermore, the pluralistic analysis has striking implications for how conceptions of meaning should be accepted as sound; participants in health discourses are entitled to use basic health terms like “health” and “illness” in accordance with their own language-games, and health workers should therefore acknowledge a diversity of meaning in patient communication. Nevertheless, health professionals can often secure a communicative platform of shared concepts by understanding patients’ language games, and by achieving contextual aims of agreement about meaning. (shrink)

For individuals whose mental illness impair their ability to accept appropriate care—the depressed, acutely suicidal mother, or the psychotic lawyer too paranoid to eat any food—statutes exist to permit involuntary hospitalization, a temporary override of paternalistic benefice over personal autonomy. This exception to the primacy of personal autonomy at the core of bioethics has the aim of restoring the mental health of the temporarily incapacitated individual, and with it, their autonomy.

In his influential theory of health Nordenfelt bases the concepts of health and illness on the notions of ability and disability. A premise for this is that ability and disability provide a more promising, adequate, and useful basis than well-being and suffering. Nordenfelt uses coma and manic episodes as paradigm cases to show that this is so. Do these paradigm cases (and thus the premise) hold? What consequences does it have for the theory of health and illness if it they (...) do not? These are the key questions in this article, which first presents the relationship between pain and disability in Nordenfelt’s theory and the paradigm cases he uses to argue for the primacy of disability over pain. Then, Nordenfelt’s concepts of illness are outlined, highlighting its presumptions and arguments. The main point is that if you do not have an action-theoretical perspective, it is not obvious that disability is the core concept for illness. The compelling effect of the paradigm cases presupposes that you see ability as the primary issue. To those who do not share this presumption, people in coma may not be ill. There are alternative well founded arguments for the primacy of first person experiences for the concept of illness. Hence, we need better arguments for the primacy of disability over first person experiences in illness, or first-person experience should be more primarily included in the concept of illness. (shrink)

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a defence (...) of the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses’ experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was (...) used for data collection and analysis. The process of ‘behaving as a nurse or not’ was identified as a core category. Four subcategories were identified: ‘receiving involuntary information’, ‘to take action or not’, ‘behaving as a mediator in the neighbourhood’ and ‘the freedom of choice’. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time. (shrink)

A fundamental aim in caring practice is to understand patients' experiences of ill‐health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that (...) we do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness. (shrink)

The study investigated the influence of resilience and dispositional optimism on, first, emotional distress and, second, the intention to self-isolate, experienced by people with a lower and higher illness risk, during the lockdown imposed in Spain during the first COVID-19 wave. These effects were investigated against the background of the Health Belief Model. A convenience sample of N = 325 participants completed an online survey including an ad-hoc questionnaire measuring the HBM core factors: Perceived health threat, and perceived quarantine (...) benefits and costs. Self-efficacy and perceived social pressure were also measured. Based on reviews regarding pandemic outbreaks, quarantine benefits were conceptualized as the perceived effectiveness and solidary contribution of self-isolating in line with the quarantine protocols. Quarantine “psychosocial” costs were conceptualized as a composite of perceived boredom, loneliness, and economic concerns. Findings revealed an asymmetrical pattern of results so that people at higher risk were more distressed by the perceived severity of getting infected whereas people at lower risk were more distressed by the psychosocial costs. Moreover, resilience and optimism were more “protective” against distress within the lower and higher risk groups, respectively. In addition, quarantine benefits and self-efficacy promoted the intention to self-isolate within both groups. However, optimism hindered such intention. This finding is discussed in the light of links between dispositional optimism and optimistic bias; the underestimation of experiencing negative events, which can relax the perceived health risk. Based on these findings, communication campaigns should prioritize information about the effectiveness of the implemented preventive behaviors rather than the costs of not implementing them, and be cautionary in encouraging excessive optimism. (shrink)

In recent years limitations in the biomedical conceptualisation of health and illness have been well documented and a variety of alternative explanations produced to replace or supplement it. One such is Fredrik Svenaeus’s philosophy of medical practice, which is a development of Hans-Georg Gadamer and Martin Heideggers’ phenomenological and hermeneutical writings. This paper explores two texts, a short story by H. G. Wells, The Country of the Blind, and a poem by William Carlos Williams, Danse Russe to add further insight (...) into the ideas proposed by Svenaeus. Both texts were written before either Gadamer or Heidegger published their work. Analysis of the texts reveal examples of Heidegger’s understanding of ‘da-sein’, human-being, as the fundamental of human existence—how we relate to our ‘life-world’—together with its conditions including the tools we use to engage with and the moods that interpret the world. Emerging from this core relationship of being are the phenomena of health and illness, which are conceptualised as home-like (Heimischkeit) and un-home-like (Unheimlichkeit) being-in-the-world. In the texts the sense of home-like (and un-home-like) being is an ontological ‘web of significance’, to use Heidegger’s phrase, that creates, rather than results from a person’s psychological state. One factor that is not fully explicated in the philosophical accounts is the role that behaviour (as the physical-relating of a person) plays as a pre-requisite for agency, the ability to act in taken-for-granted ways. A person’s sense of authenticity, the extent to which someone makes their own choices rather than being led by what ‘others’ say, is linked with their ability to physically engage with and relate to their ‘life-world’. Finally, similarities between the ontological wholeness of poetry—the meaning structure of poetry—and of Dasein are noted. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Ralph Johnson argues that mathematical proofs lack a dialectical tier, and thereby do not qualify as arguments. This paper argues that, despite this disavowal, Johnson’s account provides a compelling model of mathematical proof. The illative core of mathematical arguments is held to strict standards of rigour. However, compliance with these standards is itself a matter of argument, and susceptible to challenge. Hence much actual mathematical practice takes place in the dialectical tier.

Cogency is the central normative concept of informal logic. But it is a loose evaluative concept and I argue that a generic notion covering all of the qualities of a well-reasoned argument is the most plausible conception. It is best captured by the standard RSA criterion: in a good argument acceptable (A) and relevant (R) premises provide sufficient (S) grounds for the conclusion. Logical qualities in a broad sense are affected by the epistemic qualities of the premises and “consequence” in (...) a broad sense exhibits an interplay of form and content. There are four proposals for the premise—conclusion relation: (i) no strictly logical connection (“non-logical” consequence); (ii) one type of connection only (deductivism); (iii) a few types of connection (deduction, induction, perhaps conduction and analogical reasoning); (iv) many types of connection (argumentation schemes). Deductivism is a serious option but in its strong version, as the discussion about petitio shows, it fails to establish that arguments which are not cogent are thereby invalid. And weak deductivism, very attractive from the pedagogical point of view, has some deficiencies (implausible hidden premises; preservation of truth, not probability). I argue that the idea of a counterexample, when we regard certain components of the argument as fixed and others as variable, is the best approach to the analysis of the illative core of every-day arguments (the approach of David Hitchcock on material consequence). (shrink)

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on COSOs (...) in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embracing and enhancing their status as civic associations, COSOs may advance the goals of the social movement that spawned them and avoid predictable obstacles to further growth and development. (shrink)

The first part of this essay argues that the specification of rationality operating in Manifest Rationality does not allow for the inclusion of the dialectical tier as a necessary component of a rational product. It next considers Perelman's conception of "reasonableness" as an alternative to Johnson's structural sense of rationality. Adopting a contextually rich conception of rationality, like that of Perelman, allows Johnson to insist that a rational product must consist of both an illative core and a dialectical (...) tier. (shrink)

How should we deal with mental disorder - as an "illness" like diabetes or bronchitis, as a "problem in living", or what? This book seeks to answer such questions by going to their roots, in philosophical questions about the nature of the human mind, the ways in which it can be understood, and about the nature and aims of scientific medicine. The controversy over the nature of mental disorder and the appropriateness of the "medical model" is not just an abstract (...) theoretical debate: it has a bearing on very practical issues of appropriate treatment, as well as on psychiatric ethics and law. A major contention of this book is that these questions are ultimately philosophical in character: they can be resolved only if we abandon some widespread philosophical assumptions about the "mind" and the "body", and about what it means for medicine to be "scientific". The "phenomenological" approach of the twentieth-century French philosopher, Maurice Merleau-Ponty is used to question these assumptions. His conception of human beings as "body-subjects" is argued to provide a more illuminating way of thinking about mental disorder and the ways in which it can be understood and treated. The conditions we conventionally call "mental disorders" are, it is argued, not a homogeneous group: the standard interpretation of the medical model fits some more readily than others. The core mental disorders, however, are best regarded as disturbed ways of being in the world, which cause unhappiness because of deviation from "human" rather than straightforwardly "biological" norms. That is, they are problems in how we experience the world and especially other people, rather than in physiological functioning - even though the nature of our experience cannot ultimately be separated from the ways in which our bodies function. This analysis is applied within the book both to issues in clinical treatment and to the special ethical and legal questions of psychiatry. Written by a well known philosopher in an accessible and clear style, this book should be of interest to a wide range of readers, from psychiatrists to social workers, lawyers, ethicists, philosophers and anyone with an interest in mental health. (shrink)

Ralph Johnson has proposed a “two tiered” conception of argument, comprising of the illative core and the dialectical tier. This paper's two-part thesis is that (i) the dialectical tier is best understood as an epistemic requirement for argument, and (ii) once understood epistemically, the dialectical tier requirement can be defended against the leading objections.

The core of this special issue of Arts and Humanities in Higher Education emerged from the Broken Narratives and the Lived Body conference held in 2016. The ‘Broken Narrative’ essays included in this issue open up a critical space for understanding and theorising illness narratives that defy a conventional cognitive ordering of the self as a bounded spatial and temporal entity. Here, we discuss how narratives might be ‘broken’ by discourse, trauma, ‘ill’ lived bodies and experiences that exceed linguistic (...) representation. We trouble distinctions between coherent and incoherent narratives, attending to what gaps, silences and ‘nonsenses’ can convey about embodied illness experiences. Ultimately, we suggest that ‘breaks’ are in fact a continuation of embodied narration. This is shown in the ‘Art and Trauma’ forum of essays, which reveal how narrative silences can ‘infect’ other embodied subjects and be transformed, achieving musical or visual representation that allow us to apprehend the ‘constitutive outside’ of narratives of illness or trauma. (shrink)

The core aims of the Global Health Impact Project include incentivizing pharmaceutical companies for socially conscious production and promoting socially conscious consumption among consumers. Its backbone is a metric that computes the amount of illness burden alleviated by a pharmaceutical drug. This essay aims to assess the connection between values and numbers in the Global Health Impact Project. Specifically, I concentrate on two issues, the anonymity of illness burden and the distribution of health benefits. The former issue asks whether (...) we should treat the illness burden of every person the same. The latter issue asks among whom health benefits should be fairly distributed. Examination of these issues begs for clarification of some of the key concepts of the Global Health Impact Project, such as the definition of essential medicines and the significance of national borders. Although this essay focuses on the two particular metric issues in the Global Health Impact Project, its core argument is applicable to other metrics for ethically motivated initiatives—to construct a metric for an ethically motivated initiative, it is not only important to articulate underlying concepts and values, but it is also important to operationalize them, so they are consistently reflected in the metric. (shrink)

This article considers the proposals of the final report of the Commission on Religious Education (CoRE 2018) and its controversial conclusion that the law should require religious education to include teaching about non-religious worldviews alongside religions, presumably in equal measure. Attention is given both to Trevor Cooling’s recent defence of CoRE’s proposals against already expressed criticisms and to additional criticisms, that of the abstract nature of a worldview as a highly ramified, philosophical concept, which is educationally ill-suited to (...) the interests and intellectual capabilities of many pupils, and that of the failure of the proposals to indicate in what ways they overcome current systemic weaknesses. It is concluded that religious education should not be reconceptualised as the study of religious and non-religious worldviews nor should it adopt a framework that construes religions primarily as worldviews. (shrink)

In this paper, I respond to papers on my Manifest Rationality (2000) by Leo Groarke, Hans Hansen, David Hitchcock, and Christopher Tindale presented at the meetings of the Ontario Philosophical Society, October 2000. From the many useful challenges they have directed at my position, I have chosen to focus on two. The dominant issue raised by their papers concerns my definition of argument, and particularly problems with the idea of a dialectical tier. I have selected that as the first strand. (...) Second, several have raised questions that deal with the relationship between logic, rhetoric and dialectic. That is the second strand. (shrink)

This essay attempts to give definitions and identity conditions for the two predominant senses of ‘Argument’ currently in use, the one involving reasons for a conclusion and the other denoting an expressed disagreement with ensuing verbal behaviour by two parties. I see Johnson's new concept of ‘Argument’, as developed in his book Manifest Rationality, as a hybrid of the two common senses of ‘Argument’, and, accordingly, I try to define and give the identity conditions of Johnson-arguments. Finally, I disagree with (...) Johnson on the nature of the definition he thinks he has proposed, and I conclude with observations suggesting that his logical perspective has dialectical and rhetorical components. (shrink)

The aim of this study is to describe how hermeneutic photography and one application of hermeneutic photography in particular, namely the photo-instrument, can be used as a health care intervention that fosters meaning (re-)construction of mental illness experiences. Studies into the ways how patients construct meaning in illness narratives indicate that aesthetic expressions of experiences may play an important role in meaning making and sharing. The study is part of a larger research project devoted to understanding the photostories that result (...) from groups of psychiatric patients using the photo-instrument. Within a focused ethnography approach we employed a qualitative design of a single case study. Text analysis of photostories was combined with observational data. Data were analyzed using hermeneutic theory. Participant observations were used for triangulation and complementarity. The interaction and collaboration between health care professionals and patients in the context of a photo group emerged as core concept that underlies the photo-instrument. The interaction triggered a reframing of meaning in the patient’s illness narrative that offered new perspectives on positive identity growth. The role of visualizing meaning in images was found to lend a dynamic power to the process and triggered a dialectic between real life circumstances and imagination played out in the context of situated action. The findings suggest that a positive reframing of meaning in illness narratives is facilitated by the photo-instrument. (shrink)

Dans ce texte, nous proposons un cadre, qui vise à intégrer les contributions des approches constructionnistes et biologiques dans un domaine précis, celui des maladies mentales. Pour ce faire, nous utiliserons quelques propositions récentes faites par des philosophes de la biologie — plus spécifiquement les idées avancées par les tenants de la « théorie des systèmes développementaux » ainsi que la notion d’« enracinement génératif » .In this paper, we are proposing a framework to integrate the core insights of (...) the constructivist and biological approaches of mental illness. In order to do so, we will use some recent propositions by philosophers of biology, specifically ideas put forth by «developmental system theory» and the notion of «generative entrenchment». (shrink)

Emotion plays a crucial role, both in general human experience and in psychiatric illnesses. Despite the importance of emotion, the relative lack of objective methodologies to scientifically studying emotional phenomena limits our current understanding and thereby calls for the development of novel methodologies, such us the study of illustrative animal models. Analysis of Drosophila and other insects has unlocked new opportunities to elucidate the behavioral phenotypes of fundamentally emotional phenomena. Here we propose an integrative model of basic emotions based on (...) observations of this animal model. The basic emotions are internal states that are modulated by neuromodulators, and these internal states are externally expressed as certain stereotypical behaviors, such as instinct, which is proposed as ancient mechanisms of survival. There are four kinds of basic emotions: happiness, sadness, fear, and anger, which are differentially associated with three core affects: reward (happiness), punishment (sadness), and stress (fear and anger). These core affects are analogous to the three primary colors (red, yellow, and blue) in that they are combined in various proportions to result in more complex “higher order” emotions, such as love and aesthetic emotion. We refer to our proposed model of emotions as called the “ Three Primary Color Model of Basic Emotions.”. (shrink)

Social “construction,” “constructionism” and “constructivism” are terms in wide use in the humanities and social sciences, and are applied to a diverse range of objects including the emotions, gender, race, sex, homo- and hetero-sexuality, mental illness, technology, quarks, facts, reality, and truth. This sort of terminology plays a number of different roles in different discourses, only some of which are philosophically interesting, and fewer of which admit of a “naturalistic” approach—an approach that treats science as a central and successful (if (...) sometimes fallible) source of knowledge about the world. If there is any core idea of social constructionism, it is that some object or objects are caused or controlled by social or cultural factors rather than natural factors, and if there is any core motivation of such research, it is the aim of showing that such objects are or were under our control: they could be, or might have been, otherwise. (shrink)

This book draws on core concepts coined by Adorno, such as identity thinking, the culture industry, and his critique of the autonomous and rational subject, to address the ills that plague neoliberal capitalist societies today. These ills range from the risk of a return to totalitarian tendencies, to the global rise of the far-right, and anti-feminist conceptions of motherhood. Subsequent chapters outline the ways in which Adorno's thought can also be seen to redress the challenges of modern societies, such (...) as the critical function of artworks, and the subversive potential of slow-food and popular music. The important underlying concern of the book is to highlight the continuing relevance of Adorno, both in dealing with the failures of neo-liberal capitalist societies, and in his applicability to a wide range of disciplines. (shrink)

"Infectious Nietzsche is simply one of the most interesting and engaging works to appear on Nietzsche’s philosophy in years." —David Allison Krell explores health, illness, and creativity in the life and thought of Friedrich Nietzsche. Drawing on a varied literature of philosophical reflections on health, and analyzing Nietzsche’s confrontation with traditional values, Krell skillfully engages the legacy of Platonism and Western metaphysics that is at the core of Nietzsche’s thought. Nietzsche’s genealogical critique, his doctrine of eternal recurrence of the (...) same, and the Nietzschean physiology and psychology of decadence are principal foci. Anyone interested in a philosophical reflection on questions of genius and pathology, and all readers of Nietzsche, will find Krell’s new book compelling reading. (shrink)

Abstractα/β barrels have an ill‐defined origin. Evidence exists which favours their divergent evolution from a common ancestral barrel and convergent evolution to a stable fold. However, recent sequence and structural information for the flavin oxidase/dehydrogenase family of barrel enzymes indicate that sub‐families of α/β barrels have evolved divergently. The modular fusion of barrel domains with core structures from other gene families has also contributed to the evolution of related but catalytically distinct enzyme molecules within each sub‐family of the flavin (...) oxidases/dehydrogenases. An analysis of the structures and sequences of the flavin oxidases/dehydrogenases has now enabled studies focusing on the evolutionary origins and modular assembly of this important family of proteins to be initiated. (shrink)

There are at least three core principles that define the chance role: ill the Principal Principle, l21 the Basic Chance Principle, and l31 the Humean Principle. These principles seem mutually incompatible. At least, no extant account of chance meets more than one of them. I ofier an account of chance which meets all three: L~-chance. So the good news is that L~-chance meets ill — l31. The bad news is that L~-chance turns out unlawful and unstable. But perhaps this (...) is not such bad news: L~-chance turns out to at least approximate plausible additional core principles concerning lawfulness and stability. And perhaps there is better news: one may treat 'chance' as vague, in a way that allows every core principle of chance to be met. (shrink)

Heidegger's connection with Nazism is well known and has been exhaustively debated. But we need to understand better why Heidegger believed National Socialism to be the best cure for the ills of modern society. In this book Christopher Rickey examines the internal logic of Heidegger's ideas to explain how they led him to become a powerful critic of liberalism and a Nazi supporter. Key to Rickey's interpretation is the radically antinomian conception of religiosity he finds at the core of (...) Heidegger's challenge to modernity. Heidegger responds to the crisis of modernity with a philosophy attuned to the fundamental need for humans to live with the proper stance toward the divine. Inspired by Lutheran and mystical theology, Heidegger outlines an essentially religious conception of authentic human being. Like his radical Lutheran forerunners, Heidegger politicizes the radical strains of Luther's theology to create a potent revolutionary brew: the revolution of the saints. Rickey traces out the ways in which these currents fundamentally shape Heidegger's thought: the Lutheran background to his critique of modern science and the technological rationality it spawns; his transformation of Aristotle's prudential conception of practical wisdom into the total revelation of being that lays the basis for revolutionary political action; and his mystical and sectarian understanding of authentic community. Rickey shows how this political-theological vision forms the basis of Heidegger's concrete political action, and concludes with an analysis of the fundamental problems this vision poses to our political thinking today. (shrink)

Dominic Murphy in several influential publications has formulated and defended what he calls the strong medical model of mental illness. At the core of this project is the objectivist requirement of classifying mental illness in terms of their aetiologies, preferably characterised by multilevel mechanistic explanations of dysfunctions in neurocomputational processes. We are sympathetic to this project and we devise an argument to support it based on a conception of psychiatric kinds. Murphy has, moreover, maintained that there are some open (...) issues concerning the applicability of his program to antisocial personality disorders and psychopathy. We argue that, as a matter of fact, there are already plausible and well-motivated classificatory proposals for these types of disorders that accommodate well within Murphy's strong medical model. (shrink)

Caring is at the core of what nurses and other health professionals do. But caring encompasses more than simply looking after people's physical health needs. People requiring any health service will have psychological needs that affect their feelings, thoughts, and behaviour. Good psychological care can even help improve physical health outcomes. An Introduction to Psychological Care in Nursing and the Health Professions explains and promotes the importance of psychological care for people when they become physically ill, giving a sound (...) theoretical basis to ensure care is evidence-based. It encourages the reader to think about the effects of illness and disability on patients, and to understand what can be done to identify and minimise any difficulties they might be experiencing in these areas. The chapters cover: the meaning and elements of care and holistic care; a model of psychological care in practice; the personal qualities and skills of carers that best underpin psychological care delivery, and how these might be enhanced; the knowledge needed for effective psychological caregiving; psychological care as it might be practised in a range of health care settings. This text contains key learning points, practical activities, reflective exercises and case illustrations. It is ideal for student and practising nurses, and health professionals who would like to improve their care for patients in this essential area. (shrink)

Politics in America are polarized and trivialized, perhaps as never before. In Congress, the media, and academic debate, opponents from right and left, the Red and the Blue, struggle against one another as if politics were contact sports played to the shouts of cheerleaders. The result, Ronald Dworkin writes, is a deeply depressing political culture, as ill equipped for the perennial challenge of achieving social justice as for the emerging threats of terrorism. Can the hope for change be realized? Dworkin, (...) one the world's leading legal and political philosophers, identifies and defends core principles of personal and political morality that all citizens can share. He shows that recognizing such shared principles can make substantial political argument possible and help replace contempt with mutual respect. Only then can the full promise of democracy be realized in America and elsewhere. Dworkin lays out two core principles that citizens should share: first, that each human life is intrinsically and equally valuable and, second, that each person has an inalienable personal responsibility for identifying and realizing value in his or her own life. He then shows what fidelity to these principles would mean for human rights, the place of religion in public life, economic justice, and the character and value of democracy. Dworkin argues that liberal conclusions flow most naturally from these principles. Properly understood, they collide with the ambitions of religious conservatives, contemporary American tax and social policy, and much of the War on Terror. But his more basic aim is to convince Americans of all political stripes--as well as citizens of other nations with similar cultures--that they can and must defend their own convictions through their own interpretations of these shared values. (shrink)

The notion of minimal, basic, pre-reflective or core self is currently debated in the philosophy of mind, cognitive sciences and developmental psychology. However, it is not clear which experiential features such a self is believed to possess. Studying the schizophrenic experience may help exploring the following aspects of the minimal self: the notion of perspective and first person perspective, the ‘mineness’ of the phenomenal field, the questions of transparency, embodiment of point of view, and the issues of agency and (...) ownership, considered as different and less fundamental than the feeling of mineness. Two clinical vignettes of patients with the diagnosis of schizophrenia will be presented: the first one, illustrating early illness stages, and the second case, of chronic schizophrenia, symptomatically marked by persistent hallucinations. Through their analysis, we will discuss the experiential dimensions of minimal self. (shrink)

Pike, Gregory K Eugenics is not usually a topic for polite conversation. The first thought that typically springs to mind is Hitler's euthanasia programme, the master race and the attempted extermination of the Jews. However, an examination of the social history of eugenics reveals that in practice it operated in many other contexts, and its conceptual meaning is much broader. And while that social history has usually been confined to the late 19th and early 20th centuries, the core ideas (...) in eugenics have been part of dreams about the human condition for millennia. It is therefore not surprising to find various modern practices, some driven by new technology, subsumed under the rubric of eugenics. Eugenics as an idea is certainly resilient, even if at times it has been elusive. Indeed, perhaps it is resilient because it is elusive. In summary, eugenics is powerful yet poorly understood. Because it appeals to utopian dreams of a better future, where humans can be freed from their 'biological slavery', as Margaret Sanger put it, it remains pervasive even if cryptic. The new eugenics is sanitised, framed as autonomous choice, and unlike the ill-informed version of the 20s and 30s or the nasty Nazi variety. But it is nonetheless potent and its various manifestations are expressions of powerful ideas that remain firmly embedded in the collective human consciousness. (shrink)

According to Bayertz the core meaning of solidarity is the perception of mutual obligations between the members of a community. This definition leaves open the various ways solidarity is perceived by individuals in different communities and how it manifests itself in a particular community. This paper explores solidarity as manifested in the context of families in respect of caregiving for a family member who has become dependent because of disease or illness. Though family caregiving is based on the same (...) perception of mutual obligation as the solidarity that supports welfare arrangements in society, the manifestation of solidarity in families is different. Solidarity that underpins welfare arrangements is based on a perception of mutual obligation towards an anonymous dependent other and is enforced by the government. Solidarity in families is directed towards a concrete other and is based on free choice, albeit often accompanied by a strong sense of personal duty. In this paper we try to distinguish between solidarity as a sociological concept and as a moral concept. An important moral element of solidarity, as expressed in families, is the need for recognition of family caregivers, not only of their concrete practical efforts, but also of their own identity as caregivers and as individuals. We illustrate this argument by referring to examples in the Nuffield Council on Bioethics report Dementia : ethical issues, about the experiences of family caregivers in dementia care and the importance for them of recognition of their role. (shrink)

This paper is divided into two parts: in part one I give some examples from a study of how patient or client perspectives on treatment and life with cancer are “discovered”, addressed, included and shaped within cancer research and treatment after World War 2. In this first part I draw on analyses from my Ph.D. thesis about the concept of quality of life and psycho-social research on cancer, in which I focused on the development and interrelationships between (1) welfare state (...) forms of governance, (2) the practice of cancer treatment and its relation to research, and (3) client’s relations to treatment regimes and a life with cancer. I argue that the client’s perspective is represented in medical practice in many different, and often problematic, ways. A core problem is that this perspective is often represented from a third-person point of view, not from a direct first-person point of view. I find a number of reasons for this. The lack of first-person involvement is not isolated to medical practice but is also obvious in psycho-social practice that evolves in the relation to medical treatment and research in the last part of this century. The conflict around this is reflected in psychological theories about illness and disease that are formulated in this period. In the second part of the article I discuss the directions in which psychological theory has to develop in order to contribute to the recognition and involvement of first-person perspectives in medical treatment and research. The aim of this discussion is not limited to understanding how we as subjects handle everyday life with biological changes of bodily function. (shrink)

This thesis attempts to show that Georg Lukacs' Marxist theory of realism is best understood, not as a self sufficient body of theory, but in the context of his pre- Marxist theory of literature and his,role in the Communist movement, A comparison of the theory expounded in "Die Seele and die Fonaen" and "Die Theorie des Romans" with the main positions of "Geschichte und Kiassenbewusstsein" reveals that it was remarkably easy for Lukacs to accommodate his literary theory within the newly-acquired (...) philosophy. An examination of Lukacs' career shows that his move to Marxism was motivated by a search for the practical instrument to implement the ideal which was the mainspring behind both his own life and, in his theory, all great literature, namely, the classical ideal of harmony. The resulting change in emphasis from aesthetics to political action led, in the thirties, to the attempt to synthesize both in a cultural campaign. Political pressure, combined with the genuine belief that the excesses of Stalinism were the acceptable price of resistance to the overriding threat of fascism, resulted in the employment of a rigid determinism, deplored ill others, which was incompatible with the core of his understanding of literary realism. The creation of realism was, however, for both the pre- Marxist and the Marxist Lukacs, ultimately inexplicable in materialist terms. (shrink)