Fibromyalgia is a chronic pain disorder with a multifaceted nature and its biological, psychological and social aspects are strongly interconnected. Therefore, the integration of the different health disciplines is strongly recommended for its care. There is a growing number of interventions based on this principle but each of them is heterogeneous with regards to how the included disciplines are integrated with each other. With this regards, multidisciplinary and interdisciplinary programs are distinguished. The former are organized in order to treat the (...) various aspects of the syndrome using different perspectives and their various treatment components are usually provided separately by the different care providers. Conversely, interdisciplinary treatments are planned in order to foster a dialogue between the operators by providing a joint conduction of the treatment or scheduling plenary discussions about the cases. In the field of chronic pain, some authors are suggesting to move beyond these approaches and to plan transdisciplinary treatments, which would allow the professionals to move across their disciplinary boundaries. Although no examples of these interventions have been proposed for the treatment of fibromyalgia, there is a visible trend in the literature toward more holistic forms of care. (shrink)

Enactive approaches to psychiatry have recently argued for an understanding of psychiatric conditions based within relational interactions between individuals and their environments. A central motivation for these enactive approaches is the goal of social integration: the integration of a naturalistic approach to psychiatric conditions with their broader sociocultural dimensions. One possible issue, however, is whether appeals to the autonomy and authenticity of relationally constituted enactive individuals can provide a means of adjudicating between harmful and beneficial social constraints upon individual (...) behaviour. This paper seeks to provide enactive approaches to psychiatry with a possible means of evaluating normative influences of social contexts beyond direct interactions with relationally constituted individuals. Some of the most significant influences of the sociocultural dimension of psychiatric conditions consist not in direct interaction with individuals, but in setting the terms for interactions and interactants alike. Insofar as some social influences precede and predefine dyadic relations between individuals and their social context, these cannot be accounted for as features of interactions, but must be assessed as independent structures of the sociocultural dimension. I will provide one potential means for enactive models to assess social norms using Canguilhem’s distinction between health and pathology. I will argue that Canguilhem’s conceptualization of health in terms of adaptive normative structure provides a potential tool for social integration which strongly complements enactive approaches to psychiatry. (shrink)

Clinicians in their everyday practice of psychiatry face permanently the following epistemological and methodological problem: currently available psychiatric knowledge, like all types of scientific and technological knowledge, is general—at least in certain respects—in sharp contrast with the obvious particularities and even idiosyncrasies of each real individual mental patient they meet in the clinical encounter. This problem is admittedly the source of a permanent tension in the practice and above all in the philosophy of psychiatry. In the practice of (...) psychiatry, conscientious clinicians always try to find a necessarily pragmatic solution to this problem, mainly with the means of their psychiatric knowledge .. (shrink)

While calls to integrate ethics into computer science education go back decades, recent high-profile ethical failures related to computing technology by large technology companies, governments, and academic institutions have accelerated the adoption of computer ethics education at all levels of instruction. Discussions of how to integrate ethics into existing computer science programmes often focus on the structure of the intervention—embedded modules or dedicated courses, humanists or computer scientists as ethics instructors—or on the specific content to be included—lists of case studies (...) and essential topics to cover. While proponents of computer ethics education often emphasize the importance of closely connecting ethical and technical content in these initiatives, most do not reflect in depth on the variety of ways in which the disciplines can be combined. In this paper, I deploy a framework from cross- disciplinary studies that categorizes academic projects that work across disciplines as multidisciplinary, interdisciplinary, or transdisciplinary, depending on the degree of integration. When applied to computer ethics education, this framework is orthogonal to the structure and content of the initiative, as I illustrate using examples of dedicated ethics courses and embedded modules. It therefore highlights additional features of cross-disciplinary teaching that need to be considered when planning a computer ethics programme. I argue that computer ethics education should aim to be at least interdisciplinary—multidisciplinary initiatives are less aligned with the pedagogical aims of computer ethics—and that computer ethics educators should experiment with fully transdisciplinary education that could transform computer science as a whole for the better. (shrink)

This paper argues that in the case of mental illnesses whose somatic bases are not known or do not exist, a promising route to understand mental illness is to see it as the lack of a patient’s engagement with some moral values that are necessary for a good human life. The paper explains how the first-person perspective, which is constitutive for mental illnesses, makes it impossible to provide an adequate, third-person explanation of the pathological. Because of its irreducible first-personal nature, (...) mental illness must be understood in terms of a moral harm to the patient, and so an integration of ethics and psychiatry is required. This view is further illustrated with A. Kępiński’s idea of psychiatry as therapy with moral values. (shrink)

There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry (...) have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges. (shrink)

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and (...) physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered. (shrink)

The decision to involuntary hospitalize a patient underlines an inherent contradiction in psychiatry between the need for care and the lack of consent to care. The growing importance of respect for...

Psychiatry has come up as one of the most dynamic branches of medicine in recent years. There are a lot of controversies regarding concepts, nosology, definitions and treatments in psychiatry, all of which are presently under a strict scanner. Differences are so many that even the meaning of psychiatry varies amongst individual psychiatrists. For us, it is an art to practice psychiatry and give the patient what he needs. Still, it should be practiced with great caution (...) and utmost sincerity towards the patient, based on scientific knowledge and not to be guided by individual conceptions alone. Ethics in psychiatry forms an integral part of its basic concept and meaning, and a tight balance should be maintained between professional advancement and patient benefit. In recent years, the scope of psychiatry has enlarged considerably, with wide ranging influences from Sociology, Anthropology and Philosophy on the one hand, and Neurology and Medicine on the other. (shrink)

Introduction: Interdisciplinary, transdisciplinary and action research of a city in lockdown. As we write this chapter, most cities across the world are subject to a similar set of measures due to the spread of COVID-19 coronavirus, which is now a global pandemic. Independent of city size, location, or history, an observer would note that almost all cities have now ground to a halt, with their citizens being confined to their private dwellings, social and public gatherings being almost entirely forbidden, (...) and commercial areas being nearly devoid of visitors. Striking as these apparent similarities are, closer scrutiny would reveal important differences between cities and within cities – differences that can be highly relevant to consider when scholars are assessing the responses of cities to this pandemic or trying to predict the consequences of those responses. For example, the public health systems in some cities are better prepared than in others for coping with the increasing number of patients in life threatening conditions. Multigenerational households, which are associated with a greater risk for elderly members, are not equally common in all cities. Tourist destinations have taken a more severe economic hit from the lockdown than those cities which are economically less dependent upon this particular source of income. Communal celebrations in one city will result in a higher number of contagions and perhaps even deaths in this situation, whereas that same social fabric generally does contribute to a population’s health. The pandemic has also had unprecedented effects on differences and inequalities within cities. In cities in the United States, neighborhoods primarily inhabited by African Americans have been disproportionately affected by COVID-19 due to living and health conditions, yet also due to the fact they disproportionately perform vital jobs. Parks and green spaces are crowded, while city centers like Amsterdam’s Red Light District have suddenly lost the bustle of tourism, providing opportunities for citizens to reoccupy scarce public spaces and reclaim ownership. Clearly, such differences between cities are in many cases only discernible to the eye of an expert, possessing the necessary background knowledge to interpret the perceptible local changes caused by the global pandemic. Typically, drawing upon his or her disciplinary training, the expert also knows how to further probe the impact of the pandemic in an appropriate way. However, compared to the usual application of expertise, this crisis situation might, in an unusual way, test even experts. For the pandemic has created a unique situation, imposing unfamiliar constraints on the health, economic, social, and other conditions of cities, constraints that interact in sometimes unexpected ways with each other. Such interactions in turn force experts to collaborate across the boundaries commonly associated with disciplines, their concepts, theories, methods, and assumptions (Klein, 1996). These brief observations of how a virus pandemic can have differential impacts upon various cities, and what this exceptional situation might mean for the application of city methods, allow us to draw a few consequences for the current context of this chapter on interdisciplinary and transdisciplinary research. First, whenever we are investigating a complex and dynamic phenomenon it is by no means easy to determine which disciplinary perspectives are required to do justice to it. Indeed, the choice of useful disciplines can only be made after an initial overview of the situation and a preliminary selection of what appear to be the most important features of the situation. Relevance is key in guiding this selection process and scholars must remain open to the possibility that they may need to revise their earlier assessments of what is relevant and what is not. Second, if scholars from different disciplines were to study different features of a city in isolation, their ‘multidisciplinary’ account would miss important dynamic and complex interactions, such as those between a city’s demographics and geographical situation, its governance and economy. In other words, it is the integration of the perspectives of different disciplines that is crucial, as only then are such interactions taken into account. Indeed, this integration between disciplinary perspectives is what distinguishes an interdisciplinary from a multidisciplinary account. Thirdly, in addition to checking the relevance of disciplines and aiming for their integration, the outcome of interdisciplinary and transdisciplinary research has typically limited generalizability. Since a city is sensitive to a multitude of internal and external dynamical factors, in ways that partly rest upon its socio-cultural history, its investigation will often have the nature of a case study rather than be capable of leading to law-like insights (Krohn, 2010; Menken & Keestra, 2016). As can be seen from these three characteristics of ascertaining the relevance of different disciplinary contributions, the challenge of their integration, and the limited generalizability of their results owing to the specificity of interdisciplinary (ID) and transdisciplinary (TD) research, such research into ‘real world problems’ is clearly distinct from most monodisciplinary research. A consequence of this distinction is the absence of a general ID/TD methodology that can guide specific case studies. By contrast, the collaboration implied in such research requires researchers – and stakeholders, if they are involved – to reflect upon their potential contribution and the implicit assumptions associated with that. We will elaborate on this in the next section. Next, we offer several typologies of integration that urban scholars could employ for their research projects, after which we will offer a few brief analyses of initial collaborations of urban research. Finally, we discuss in more detail the process of the interdisciplinary research project. This will include a brief reflection upon the decision-making process that is implied in such projects. In sum, we aim to provide some guidance in conducting an ID/TD project, albeit not in the form of a definite methodology. (shrink)

Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift (...) in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel’s dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry. (shrink)

Referring to a problem-oriented research mode, transdisciplinarity faces the challenge of dealing with the complexity of real-world problems in a methodologically controlled manner. As the first st...

The integration of digital phenotyping in psychiatry promises unprecedented insights into mental health, particularly in college settings where mental well-being is a growing concern. The COVID-19...

In Enactive Psychiatry, de Haan puts forward the enactive approach as a promising theory to solve the integration problem in psychiatry by articulating the physiological, socio-cultural, experiential, and existential dimensions of human sense-making. The author provides a valuable and accessible introduction to the enactive theory, a rich analysis of the classical descriptivist-normativist debate, and a guideline for personalized diagnosis. However, the addition of the existential dimension to the enactive theory adds (ad hoc) tensions with regard to the life-mind (...) approach. (shrink)

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term (...) ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards. (shrink)

This book examines core issues related to legal insanity, integrating perspectives from psychiatry, law, and ethics. Various criteria for insanity are analyzed and recommendations for forensic psychiatric and legal practice are offered. Many legal systems have an insanity defense, in one form or another. Still, it remains unclear exactly when and why mental disorders affect a person’s moral or criminal responsibility. Questions addressed in this book include: Why should insanity be a component of our legal system? What should be (...) the criteria for an insanity defense? What would be the reasons for abolishing it? Who should bear the burden of proof? Furthermore, the book discusses the impact neurosciences may have on psychiatric and psychological evaluations of defendants as well as on legal decisions about insanity. (shrink)

Despite a widely agreed necessity for agroecological transition, there are various substantial constraints that hinder the adoption of alternative, more sustainable, practices. We employ the niche management concept to examine the initial phases of transition in the local wine-growing niche in Israel, or specifically, the replacement of herbicides with the use of cover-crops combined with the practice of mowing of herbaceous growth using specialized trimming machines. Our goal is to uncover the triggers, drivers and agents of change in farming practices (...) within the agroecological system in which it happened, despite entrenched, widely recognized risk perceptions among farmers. The problem-oriented research design revolved around a transdiciplinary team that included ecologists and social scientists. We identified three groups of frontrunners who initiated, developed and sustained the adoption of the more sustainable agricultural practices. The two-year study focused on interviewing vineyard farmers who were transitioning to cover crops, and this qualitative research was paralleled with continuous ecological monitoring. The farmers believed that the risks inherent in the new practice, if any, were preventable and manageable. The transdisciplinary research design, which integrated farmers into the social and ecological research process, further assisted in facilitating a transition by creating a forum for stimulating communication between diverse stakeholders during the transition, increasing trust between actors from the various sectors and identifying key issues of concern (e.g., risk and associated costs) to better align the motives of farmers, wine-makers, and ecologists. The research design may have also contributed to the adoption of a more holistic view of the agroecological system by various stakeholders and the belief that one cultivation method clearly benefits the system, particularly in the long-term. We therefore conclude with key-insights on the role of the research itself in agroecological transition processes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Externalist Psychiatry, Mindshaping, and Embodied InjusticeMichelle Maiese, PhD (bio)Ongaro maintains that although enactivist approaches to psychiatry help to account for the integration of biological, psychological, and social factors, they gloss over an important distinction between patient-centered (bio and psycho) approaches and externalist (social) approaches to mental illness. The central problem is that they lack the means to account for the social causes of illness and do not (...) specify how social determinants can be addressed in the clinic. Since much of an organism’s interaction with the external world is social in kind, the implementation of externalist psychiatry could make the enactivist model truly biopsychosocial and usher in novel forms of treatment.According to Ongaro, this externalist orientation gives rise to an important question about ontology: what are the social causes of psychiatric illness made of, and how can these be conveyed in the clinic to facilitate treatment? A “shared social etiology” would allow for a “rich explanatory framework” that accounts for the social causes of mental disorder. For example, by pointing to spirit affliction as the social cause of mental illness, the Akha transform amorphous pains (which are difficult to capture naturalistically) into meaningful and familiar experiences. Such an approach involves combining a realist understanding of biopsychosocial integration with an anti-realist, social constructivist outlook on social etiology. For them, an illness that is explained as a rupture of a human-spirit relationship is experienced as a ‘problem in living’ that affects the person in an immediate and meaningful way, and can be treated via ritual action.Ongaro then considers social causation in a more familiar context, one where social determinants of mental illness include factors such as employment. Losing one’s job is a significant life event because it signals a change in social status and prompts feelings of uselessness. Ongaro characterizes these feelings of low subjective status as “socially constructed experiences that depend on collectively ingrained ideas about status, value, and self-realization that a person accepts—one could say ‘believes in’—by virtue of living in a particular society.” Because social worlds differ and what counts as social defeat is culturally specific, [End Page 333] social determinants of illness such as unemployment are either negligible or non-applicable in Ahka (non-capitalist) society.To acknowledge the impact of these social constructions, Ongaro maintains, clinical psychiatry should abandon its commitment to naturalism and embrace methodological constructivism instead. Methodological naturalism treats social causes as ‘real’ and holds that the social causes of disorder should be investigated using the scientific method; research focuses on social determinants, social stressors, and social capital. However, despite acknowledging that declining mental health correlates significantly with political and economic factors, Ongaro maintains that methodological naturalism when it comes to social causes will be insufficient to bring about meaningful changes in clinical practice. For one thing, individual psychiatrists lack the political power and economic resources to bring about the sorts of societal changes that are needed to address social determinants of health. Second, social determinants are probabilistic factors rather than definitive causes of mental disorder; psychiatric illnesses often do not have a well-defined cause or a clear-cut social trigger. Third, an explanation that points to ‘lack of social capital’ does “not possess the immediacy, emotional charge, and embodied meaning that could make them therapeutically effective in the same way that Akha explanations for spirit afflictions are.”Philosophically, Ongaro’s embrace of ‘methodological constructivism’ when it comes to social etiology entails a commitment to antirealism about social causation and fictionalism more specifically. Wilkinson (2022) notes that the core tenet of psychiatric fictionalism is that “when we engage in psychiatric discourse... we are not attributing a robust, objective property, but are instead engaging with a useful, perhaps even an indispensable, fiction” (p. 91). For Ongaro, this fiction consists in a meaningful explanatory narrative about the social causes of illness. However, if we take the notion of integration seriously, and characterize this integration naturalistically (as Ongaro does), then questions arise as to how these fictional narratives about social causes can impact people both biologically and psychologically, and thereby have such a powerful impact.I argue that an enactivist approach to treatment will be... (shrink)

The paper uses two historical examples, public health (1840-1880) and town planning (1945-1975) in Britain, to analyse the challenges faced by goal-driven research, an increasingly important trend in science policy, as exemplified by the prominence of calls for addressing Grand Challenges. Two key points are argued. (1) Given that the aim of research addressing social or global problems is to contribute to improving things, this research should include all the steps necessary to bring science and technology to fruition. This need (...) is captured by the idea of practical integration, which brings this type of research under the umbrella of collective practical reason rather than under the aegis of science. Achieving practical integration is difficult for many reasons: the complexity of social needs, the plurality of values at stake, the limitation of our knowledge, the elusive nature of the skills needed to deal with uncertainty, incomplete information and asymmetries of power. Nevertheless, drawing from the lessons of the case studies, it is argued that (2) practical integration needs a proper balance between values, institutions and knowledge: i.e. a combination of mutual support and mutual limitation. Pursuing such a balance provides a flexible strategy for approximating practical integration. (shrink)

In the last years, artificial intelligence (AI) safety gained international recognition in the light of heterogeneous safety-critical and ethical issues that risk overshadowing the broad beneficial impacts of AI. In this context, the implementation of AI observatory endeavors represents one key research direction. This paper motivates the need for an inherently _transdisciplinary_ AI observatory approach integrating diverse retrospective and counterfactual views. We delineate aims and limitations while providing hands-on-advice utilizing _concrete practical examples_. Distinguishing between unintentionally and intentionally triggered AI risks (...) with diverse socio-psycho-technological impacts, we exemplify a _retrospective descriptive analysis_ followed by a _retrospective counterfactual risk analysis_. Building on these AI observatory tools, we present near-term transdisciplinary guidelines for AI safety. As further contribution, we discuss _differentiated_ and tailored long-term directions through the lens of two disparate modern AI safety paradigms. For simplicity, we refer to these two different paradigms with the terms _artificial stupidity_ (AS) and _eternal creativity_ (EC) respectively. While both AS and EC acknowledge the need for a hybrid cognitive-affective approach to AI safety and overlap with regard to many short-term considerations, they differ fundamentally in the nature of multiple envisaged long-term solution patterns. By compiling relevant underlying _contradistinctions_, we aim to provide _future-oriented_ incentives for constructive dialectics in practical and theoretical AI safety research. (shrink)

The goal of the present Research Topic is to provide a forum where research groups, investigating teaching and teachers from multiple perspectives involving multidisciplinary (i.e., different disciplines working on different aspects of a problem independently within their disciplinary boundaries), interdisciplinary (i.e., restructuring and integrating existing disciplinary approaches to address problems relevant for all participating disciplines) and ideally transdisciplinary (i.e., seeking to integrate different lines of work from contributing disciplines to create new approaches or even new scientific disciplines) approaches (Hall, (...) 2018; Klein, 2017), can present and discuss the opportunities and challenges of such endeavors. The articles published in the research topic can be broadly classified into three categories: Conceptual reviews of transdisciplinary research on teaching and teachers, the results of transdisciplinary research projects, and methodological challenges and innovations related to transdisciplinary cooperation. Conceptual reviews of transdisciplinary researchThe Research Topic is initiated by Pea and Linn, who provide their personal perspectives on the emergence of the learning sciences as a transdisciplinary research community from the early 1970s to today. In line with the Research Topic’s aim, the paper illustrates how the specific approach of the learning sciences integrated approaches from disciplines as diverse as science education, psychology, an... (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way and (...) used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

Introducción: Alude a que la salud pública tiene causas multifactoriales con alta connotación social. Objetivo: presentar una estrategia de superación transdisciplinaria para la actualización teórico-metodológica de los profesionales de la salud. Método: se determinaron los fundamentos teóricos de diferentes enfoques y tendencias en gestión de proyectos de investigación. Se concibió una estrategia de superación basada en los principios y conceptos de los estudios de la complejidad, la metodología de la Teoría de la Red de Actores, las ideas de la dirección (...) organizacional y de las premisas de la perspectiva transdisciplinaria. Resultados: se presenta una estrategia educativa para incrementar la capacidad de adaptarse a cambios, de generar conocimientos y de aumentar el desempeño integral que supone cualidades como son: la creatividad, el tratamiento de los valores y el trabajo en equipo. La estrategia contiene cursos de posgrado, pregrado y emergentes, adiestramientos, asesorías, talleres, la participación en eventos y la producción de publicaciones. Conclusiones: se aplicaron los principios y conceptos de los estudios de la complejidad, la metodología de la Teoría de la Red de Actores, las nuevas ideas de la dirección organizacional, así como las premisas de la perspectiva transdisciplinaria para elaborar una estrategia dirigida a la actualización epistemológica de los profesionales de la salud en la gestión de proyectos de investigación. La estrategia y sus interconexiones con los diversos factores para lograr una transformación, aprovecha la coordinación global no dirigida ni controlada por ningún subsistema de la que emergen propiedades nuevas, que garantizan su identidad, estructura, funcionamiento, sinergia y robustez. Introduction: Public health has multifactorial causes of high social connotation. Objective: The objective of this work is to present a strategy for transdisciplinary theoretical and methodological advancement of health professionals. Method: Theoretical foundations of various approaches and trends in research project management were determined. An advancement strategy was conceived based on the principles and concepts of the Complexity Theory, the methodology of the Actor-Network Theory, the ideas of the Organizational Development Theory and the premises of the transdisciplinary approach. Results: A resulting educational strategy is presented to increase the capacity of public health professionals to adapt to changes, to generate knowledge within the field and to increase overall performance in the workplace. This advancement strategy assumes qualities such as: creativity, ethical values and teamwork. The strategy includes postgraduate and undergraduate courses, as well as courses on emerging topics, training and consulting activities, workshops, participation in scientific events and publishing. Conclusions: The principles and concepts of the Complexity Theory, the Actor-Network Theory methodology, the ideas of the Organizational Development Theory, as well as the premises of the transdisciplinary perspective were considered to elaborate a strategy aimed at the epistemological advancement of public health professionals as it relates to the management of research projects. The strategy and its interconnections with the various factors that lead to transformation take advantage of the global coordination neither directed nor controlled by any subsystem from which new properties emerge, guaranteeing their identity, structure, functioning, synergy and strength. (shrink)

Psychiatry is rapidly changing. The authors review the history of psychiatry in the United States, its gradual integration into medicine and society, and the dialectic between its “biologic” and “mentalist” outlooks. After describing the current state of the profession and its knowledge base, they discuss the likely future of the field: psychiatry's projected mode of practice and economics; its future as a science for understanding human behavior; its expected boundaries with other treatment disciplines; its anticipated relationship with (...) academia and with the community at large; and internal issues for the profession. Unprecedented internal and external pressures on the field are likely to require important reconceptualizations of psychiatry both by its members and by the rest of the American public. (shrink)

The aim of this paper is to highlight the rationale behind the use of data from neuroscience, particularly neuroimaging, in psychiatric legal expert procedures and their interference with the mind-brain problem.The critical argument is that the employment of mental health evaluation of the defendants and/or witnesses as collected with clinical assessment methods in court proceedings should not be considered irrespective to the data from neuroscience. Essentially, neuroscience methods belong to the domain of nomothetic (natural explanatory) knowledge, whereas clinical evaluation methods (...) in psychiatry belong to the domain of intra- and inter-subjective narratives. There exists an explanatory gap between those two groups of disciplines which concerns the ability to translate and integrate data across diverse methodological and terminological systems. Furthermore, it depends largely on the implicit positions in the mind-brain debate and the brain-to-behavior connections, which reflect on the professional and legal reasoning in terms of prioritizing certain solutions or approaches over another in the expert judgements. There are described those tacit positions adopted in the mind-brain debate by different traditions in psychiatry, with special emphasis on reductive and non-reductive forms of physicalism.In conclusion, a cognitive pluralist stance is adopted which sets priority for the supervenience theory of mind. (shrink)

Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and (...) life sciences, and that an appropriate (non-reducible) integrative principle - addressing a property of the whole system under study - is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Grounding Psychiatry in the Body and the Social WorldLaurence J. Kirmayer, MD, FRCPC, FCAHS, FRSC (bio)The sensing body is like an open circuit that completes itself only in things, in others, in the surrounding earth.—David Abram (2012)Giulio Ongaro has written an interesting set of papers that aim to advance our thinking about ‘externalist’ (i.e., social) approaches to psychiatry by rehearsing an enactivist account of mental disorder and (...) elaborating an ethnographic example of social explanation rooted in a different cultural ontology and system of healing. I am completely onboard with his calls for more attention to the social world in psychiatric theory, research, and practice. What is especially novel in his work is the use of ethnographic research to inform philosophical thinking about psychiatry.Despite my enthusiasm for this effort, I have three concerns with his argument that I can only briefly outline in this commentary: i) the lack of attention to a large body of work in social epidemiology, psychosomatics, and cultural psychiatry that speaks directly to the goals of the biopsychosocial (BPS) approach and that vitiates much of the recent critique of that model; ii) the use of an ethnographic example to idealize an ‘externalist’ system of medicine that patently cannot address the many social structural and sociophysiological processes that psychiatry needs to understand; and iii) most importantly from a philosophical perspective, the fact that the enactivist framework he endorses actually breaks down the distinctions between internalist/externalist psychiatry and naturalist/constructivist ontologies around which he organizes his critique and proposed remedy (Kirmayer & Ramstead, 2017).Integration and the BPS ApproachOngaro’s first paper begins by acknowledging the recent critiques of the BPS approach that claim the BPS leaves vague or underspecified the ways in which the biological, psychological and social domains interact to give rise to mental disorders and how they can be included in systematic case formulation to guide assessment and treatment [End Page 315] intervention. Ongaro notes that current efforts to elaborate an embodied, enactivist approach to psychiatry hold the promise of outlining a more systematic approach to the relationship between levels or domains in the BPS. However, he argues this still leaves psychiatry with excessive emphasis on ‘internalizing’ explanations that appeal to biological or psychological processes within the person to characterize mental disorders. He suggests that this needs to be complemented by an externalizing approach that gives due weight to social processes. The dominant approaches leave the social world underspecified and he notes psychiatry lacks an “ontology of the social.”To some extent, this recent critique—not by Ongaro but by some of the authors he cites—reveals a lack of familiarity or engagement with a rich literature in social epidemiology, psychosomatics and sociosomatics that has long demonstrated the close links between social and physiological processes (Krieger, 2021). This research has produced multiple examples of these relationships detailing their mechanisms and dynamics in ways that do not privilege internal processes. There is no problem identifying many specific instances of these links; for example, research has examined how exposure to racism and discrimination results in increased risk for psychiatric disorders (Kirkbride et al., 2024). We have listed many other such mechanisms related to depression in a recent paper (Gómez-Carrillo & Kirmayer, 2023). This work does not yield a single overarching model or explanation but reveals diverse kinds of mechanisms that interact in a multilevel system that includes both dynamic and linguistic modes (Gómez-Carrillo et al., 2023). Integration occurs in the functioning of this system and cannot be captured in any monolithic theory. This is not a limitation of the BPS, simply a reflection of the complexity of human beings.Can we have a general theory of the links between dimensions or domains in the BPS or will it always remain a piecemeal account that depends on the details of specific systems? Given the many different kinds of processes involved, it seems unrealistic to expect a totalizing theory. If so, both research and clinical work need practical ways to assess the myriad pathways and processes involved in psychiatric disorders in order to formulate cases efficiently, identify a manageable subset of factors to consider in a... (shrink)

This study highlights an innovative educational project entitled ‘Dynamic Teaching through Communication Skills’ as well as forming part of joint initiative for Erasmus + Communities and Students Together (CaST) 2019-1-UK01-KA203-061463. The pilot study shows that there are many ways to approach teaching across the disciplines with Engaged Learning. The proposal includes discussions on the practical methodologyof integrated content and language in higher education. While bringing real worldproblem solving into the Health Engineering degree, the chapter underscores aspects of persuasion and pitch (...) development within the paradigm of English as a LinguaFranca. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its (...) supporters. It is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

In this paper, I explain why evolutionary psychiatry is not where the next revolution in psychiatry will come from. I will proceed as follows. Firstly, I will review some of the problems commonly attributed to current nosologies, more specifically to the DSM. One of these problems is the lack of a clear and consensual definition of mental disorder; I will then examine specific attempts to spell out such a definition that use the evolutionary framework. One definition that deserves (...) particular attention, is one put forward by Jerome Wakefield. Despite my sympathy for his position, I must indicate a few reasons why I think his attempt might not be able to resolve the problems related to current nosologies. I suggest that it might be wiser for an evolutionary psychiatrist to adopt the more integrative framework of “treatable conditions”. As it is thought that an evolutionary approach can contribute to transforming the way we look at mental disorders, I will provide the reader with a brief sketch of the basic tenets of evolutionary psychology. The picture of the architecture of the human mind that emerges from evolutionary psychology is thought by some to be the crucial backdrop to identifying specific mental disorders and distinguishing them from normal conditions. I will also provide two examples of how evolutionary thinking is supposed to change our thinking about some disorders. Using the case of depression, I will then show what kind of problems evolutionary explanations of particular psychopathologies encounter. In conclusion, I will evaluate where evolutionary thinking leaves us in regard to what I identify as the main problems of our current nosologies. I’ll then argue that the prospects of evolutionary psychiatry are not good. (shrink)

Phenomenon of transdisciplinarity was put into the fore of analysis rather recently. In the article an attempt is made to find out whether it is possible to attribute this phenomenon not only to a science of the 21st century, or we have here the case where some scientific realities come to the attention of researchers with certain delay and has its value for the culture in general? It is possible to judge even the emergence of a kind of cognitive revolution (...) affecting both science culture. We need to find out what is meant by a transdisciplinarity, and how it differs from the inter- or multiransdisciplinarity. In the study the method of historical reconstruction, combining elements of presentism and antiqurism, was implemented. This method allows us to interpret historical events in the context of a specific level of knowledge, and at the same time to evaluate them in terms of modern ideas related to transdisciplinarity, inter- and multidisciplinarity. System-structural method, focused on an integrated analysis of the dynamics of development of cognitive processes in culture was implied as well, and the method of comparative analysis, which is aimed at comparing different but conceptually similar processes in various areas of conceptual art practice. It is in the framework of paradigm adopted a tacit agreement among scientists about the validity and effectiveness of research methods and techniques of inquiry. Within the paradigm, which presupposes certain fundamental principles, goals, and certain values shared by the scientific community, the novel sprouts of radical ideas once emerge. The scientific revolution here means a radical revision of the admissibility of accepted and proven methods, goals and values that are common to the members of the scientific community. Typically, new theories and concepts proposed and already mastered new scientific community, which is gradually replacing its representatives on the key command altitudes. The kernel of scientific community in fact is a style of thinking that is emerged in the context of a particular discipline, and then experience expansion in the form of discursive practices at a wide space of science and culture due to the novel cognitive schemes open the way to synthesize various research domains into a certain integrity. There is no question of the scientific revolution in the sense of Kuhn, since any significant goals and values of the scientific communities are not affected. Nevertheless, in some sense cognitive revolution taking place, the revolution of transdisciplinary type. The adoption of a new style of scientific thinking often gives rise to new types of objects and directions of cognitive activity, a new type of explanation that require new types of research proposals and cultural activities. Thus, the main idea of this article is that along with the Kuhn type scientific revolutions, transdisciplinary type scientific revolutions are conceivable, and even transdisciplinary cognitive types. This revolutions manifests in a change in style of reasoning, and it results in the expansion of this style to wide space of science and culture through the cognitive schemes and techniques, which enables to synthesize research and art activity in some integrity. Adoption of a new way of reasoning and the transition to new discursive practices generates new types of research facilities, new mechanisms of explanation, new cultural blueprints and instruments. Cognitive activity, based on a new style of thinking, involves multidisciplinarity, formation of new scientific and cultural institutions, and, therefore, causes a noticeable social change. Based on an analysis of interdisciplinary, multidisciplinary and transdisciplinary processes in modern science and culture the authors claim that it is namely transdisciplinarity would determine the face of science and culture in the medium term, and will form the basis for the convergence of science, technology, art, and consciousness studies in general. (shrink)

The medical specialty of psychiatry should possess a basic science in which pathologies are considered deviations from normal brain physiology. Historically, psychoanalytic pathogenesis was considered separately from brain physiology. It was not scientific because observations could not be refuted. Countering this, Eli Robins's legacy stemmed partly from his having been damaged by a psychoanalyst. It eschewed pathogenesis. Attempting to integrate psychiatry with medicine more generally, Robins and colleagues refocused on empiricism, although they acknowledged the brain's centrality. Here I (...) hold that the term biology used in the context of psychiatry should broadly encompass social facets of organismal function. The term sociophysiology may best describe the central basic science of psychiatry because it alludes to brain functions used for the person's social realm. Disruptions of such functions result in deviant behaviors and unpleasant feelings which psychiatrists diagnose and treat. Future study encompassing top-down and bottom-up research should include genome-neural-behavioral analyses. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Future Is Political and TransdisciplinaryAwais Aftab (bio)Philosophy, psychiatry, & psychology (PPP) is a transdisciplinary oasis, one of the few journals in mental health care that facilitate a meaningful dialogue between philosophers, psychiatrists, psychologists, and scholars from related disciplines. The fact that PPP successfully provides such a space is of no small importance, especially from my perspective as a psychiatrist. The multidisciplinary nature of the undertaking has (...) been a central aspect of the identity of the journal from the very beginning. PPP has maintained this transdisciplinary inclusive spirit over the years, and its editorial and advisory boards remain richly representative, but the challenge of ensuring continued participation of clinicians is not insubstantial. After all, the point is not token participation, but a robust and transformative interdisciplinary engagement. Clinicians have much to contribute to philosophical debates, however, such capacity for dialogue requires sustained cultivation (Aftab & Waterman, 2021), and forces in medical education have led to a situation where comparatively fewer psychiatrists have the interest or the ability to engage in such rigorous dialogue with philosophers. Philosophy of mental health has grown and specialized exponentially since the mid-90s. Keeping up with this literature is difficult even for philosophers, it is no small feat for full-time clinicians.This means that PPP and its affiliate organizations have a responsibility to take a more active role in supporting educational initiatives to ensure that future generations of psychiatric clinicians are able to contribute to philosophical debates, and that philosophy of psychiatry does not become divorced from clinical and practical concerns. My advice to clinicians based on my experience would be two-fold: first, it is essential to acquire a basic familiarity with the philosophy of psychiatry literature. Aftab and Waterman (2021) offer a sample list of reading recommendations. At the time of this writing, the International Network for Philosophy and Psychiatry is also undertaking efforts to develop curricula aimed at clinicians. Second, it is important to find ways to interact with others in the philosophy of psychiatry community. Formal avenues to do so include the annual meetings of the Association for the Advancement of Philosophy and Psychiatry and the Philosophy Special Interest Group of the Royal College of Psychiatrists, among others. There are also various online communities active on social media that many find helpful.In recent years, we have seen an unprecedented enthusiasm and support for inclusion of lived experience in mental health care. This is a welcome and much needed development, but we are only just beginning to scratch the surface of [End Page 5] how to philosophically navigate this inclusion. Frameworks such as standpoint epistemology and epistemic justice offer us starting points (Knox, 2022), but much remains to be worked out (Aftab, 2022). There are notable philosophical challenges, such as ascertaining the limits of lived experience, and the biases and errors to which it is vulnerable; the application of scientific method and philosophical criticism to lived experience; methods to resolve disagreements when different forms of lived experience contradict each other; handling discrepancies between knowledge from lived experience and knowledge from other sources be handled; and analyzing the intersection of politics of lived experience with other differentials of power. I anticipate that these topics will be of central importance to the field and to the journal in the coming years.It is also vital that philosophy of psychiatry engage with the sociopolitical dimensions of madness (Kalathil & Jones, 2016). The failure of philosophy to do so in a meaningful way has already been articulated powerfully by commentators such as Nev Jones (2022). An important aspect of acknowledging philosophy's failures in this regard comes from the notion of "elite capture," recently popularized by Olúfẹ́mi O. Táíwò (2022). It refers to how progressive philosophical ideas such as standpoint epistemology are co-opted by the "elite" to serve their own ends. Discussions on social media have already begun to point out that concepts in philosophy of psychiatry such as "epistemic injustice" show signs of elite capture by the psychiatric establishment, resulting in token participation but no systemic changes. Philosophy of psychiatry needs to tackle its own vulnerability to co-option. This will require creative forms of philosophizing and engagement with... (shrink)

Genetic information and technologies are increasingly important in health care, not only in technologically advanced countries, but world-wide. Several global factors promise to increase future demand for morally conscious genetic health services and research. Although they are the largest professional group delivering health care world-wide, nurses have not taken the lead in meeting this challenge. Insights from feminist analysis help to illuminate some of the social institutions and cultural obstacles that have impeded the integration of genetics technology into the discipline (...) of nursing. An alternative model is suggested - the transdisciplinary model - which was developed initially by a nurse and introduced in the 1970s into the delivery of health care and social services for children with developmental disabilities. This holistic model enables all health care professionals to have an equal voice in determining how genetic health care will be globalized. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Toward a Fictionalist Psychiatry?Sam Wilkinson, PhD (bio)I am deeply sympathetic to what Giulio Ongaro (2024a, 2024b, 2024c) writes in these three excellent interlocking papers. I will argue that there is a slightly more efficient way of approaching these issues. It involves adopting fictionalism rather than externalism (although fictionalism can accommodate externalist insights). Fictionalism is something that Ongaro briefly, and approvingly, mentions, in the final paper, but there is (...) an implicit realism in the initial approach. I am not sure there is much disagreement, however, and perhaps we end up in the same place, having approached from different starting points. The fictionalist approach is largely compatible with all of the substantive things Ongaro wants to say, but is, strictly speaking, in tension with the most natural interpretation of externalism, namely, construed as a form of descriptivism and realism (two notions I unpack later).Externalism, Evaluativism, and Social IntegrationA major theme of the first paper is that mainstream internalist Western psychiatry is bad at integrating the social dimension of mental illness. I agree. Furthermore, recent externalistic (enactive and predictive processing) approaches, while better, are still lacking in that they collapse the “social” into the “psychosocial.” Again, I agree. But my diagnosis (excuse the pun) is slightly different. The social dimension of illness concerns in large part the evaluative nature of illness, not the need to descriptively, causally capture a complex, objectively real phenomenon called “illness.”Having said this, in integrating this evaluative social dimension, we need to tread carefully lest we fail to meet the “demarcation challenge” (Murphy, 2008). This concerns the challenge of demarcating different kinds of problem. Humans have always had problems, for which they have needed help, accommodation, allowances made, and so on, but how do you distinguish mental health problems, from other kinds of problems? How do you distinguish money woes, or marital strife, both of which certainly cause unhappiness, or even psychological states that look like psychiatric symptoms (e.g., anxiety, low mood), from properly mental health problems?The biomedical “internalist” says: Easy! Either there is something objectively wrong with you, or there is not. However, notice that this is exactly [End Page 337] what externalists can say too, to the extent that they are trying to describe and define disorder in value-free terms. The only difference is that the internalist will talk about what is wrong within the biological boundaries of the organism, whereas the externalist will go beyond that.Externalism about a particular phenomenon, if it is to be a non-trivial position, needs to be sensitive to the distinction between cause and constitution (or what Adams & Azaiwa [2001] call “coupling-constitution confusion”). We see this in externalism about the mind in general. In the Extended Mind Hypothesis (Clark & Chalmers 1998), the claim is not that Otto’s notebook causally contributes to Otto’s mind (his belief about where MOMA is). Nobody would deny that. The interesting claim is that the notebook is constitutive of his belief: it is literally part of his mind. Similarly, nobody is denying that external (e.g., social) factors cause mental health problems, the question is: Do they constitute those problems? Externalism takes this question seriously and answers in the affirmative, at least in some cases. But the articulation of this has to be nuanced.Suppose I have crippling anxiety over financial concerns. Anxiety can be a mental health problem, but if, in this case, you transferring money into my bank account makes my anxiety disappear, then one might think this is not a mental health problem. It is a money problem. Or is it? Enter fictionalism (Wilkinson, 2022).Fictionalism is the view that calling someone mentally ill is not describing them as having a particular property, but involves something like engaging in a fiction, a fiction that has been constructed in order to encourage certain courses of action. According to fictionalism, given the facts, there is a lot of wiggle room about how we are to think of, and respond to, people’s problems.To borrow some insights from meta-ethics, when we examine normative discourse (one canonical domain being ethics) we can ask: what does the discourse do? And what... (shrink)

Addressing “wicked” socio-ecological problems necessitate the integration of knowledge and methods from multiple disciplines. Transdisciplinarity (TD) is one such strategy; its focus is to enhance the comprehensiveness, robustness, and relevance of science via cross-disciplinary team science (CDTS). What separates TD from other forms of CDTS (e.g., multidisciplinary, interdisciplinary) is the meaningful inclusion of a diverse set of nonacademic stakeholders. In collaboration, the TD team draws on tacit and explicit knowledge to co-develop new understandings of vexing “real-world” problems. However, guidance for (...) TD is scant and it leaves open, for instance, questions about how to develop an appropriate team, acquire essential team-based skills, manage the costs of participation, develop individual and group readiness, and satisfy organization expectations, while also attempting to build the trust-based relationships that are fundamental to the approach. Needed are “boundary players” with multi-dimensional skills who transcend the science, facilitate cooperation, and reduce transaction costs. (shrink)

The emerging field of responsible management learning is characterized by an urgent need for transdisciplinary practices. We conceptualize constellations of transdisciplinary practices by building up on a social practice perspective. From this perspective, knowledge and learning are ‘done’ in interrelated practices that may span multiple fields like the professional, educational, and research field. Such practices integrate knowledge across disciplines and sectors in order to learn to enact, educate, and research complex responsible management. Accordingly, constellations of collaborative transdisciplinary (...) practices span the three layers of the responsible management field: Professional responsible management, responsible management education, and responsible management research. We apply this framework to map both recent responsible management learning publications and contributions to this special issue. We notice that although the responsible management field’s aspiration for transdisciplinarity is high the degree to which it has been realized is low. This results in our proposal for a research agenda, which points out impediments to transdisciplinary, and research directions for the responsible management learning field. We also highlight theoretical implications of our conceptual framework for the larger transdisciplinarity discussion. (shrink)

Hallucination lies at an intriguing border between psychiatry and philosophy. Although Behrendt & Young (B&Y) tie their proposal to Kantian transcendental idealism, other philosophical positions are equally consistent. Cognition is underconstrained by reality not only in hallucination but also in autism and dreaming. Sensory underconstraint is insufficient to encompass schizophrenia. There is also a breakdown in integrative capacity on the cognitive side. From a wider clinical perspective than schizophrenia, there can be underconstraint or overconstraint in sensory and cognitive (...) functionalities. (shrink)

Hoping to expand upon public philosophy endeavors within higher education, the following captures the story behind the course Dialogue, Integration, and Action. The course has yielded a number of innovative pedagogical tools and engagement strategies likely to be of value to philosophy instructors seeking to explore a more participatory, experiential educational approach. As a transdisciplinary, community-engaged philosophy class, it engages students in the theories and practices of deliberative democracy and activism, encouraging the development of dialogic skills for their personal, (...) professional, and civic lives. By documenting the community-instructor-student collaborative design of the university course; the feminist pragmatist philosophic commitments underlying its design; the community-led and student-facilitated dialogue and the subsequent public report, as well as the impact of this work on the students, the community partner, and the instructor, the article highlights the benefits and the challenges of undergraduate philosophic engagement that emerges from and responds to place-based needs. (shrink)

For three decades Jeremy Holmes has been a leading figure in psychodynamic psychiatry in the UK and across the world. He has played a central role in promoting the ideas of John Bowlby and in developing the clinical applications - psychiatric and psychotherapeutic - of Attachment Theory in working with adults. Drawing on both psychoanalytic and attachment ideas, Holmes has been able to encompass a truly biopsychosocialperspective. As a psychotherapist Holmes brings together psychodynamic, systemic and cognitive models, alert to (...) vital differences, but also keenly sensitive to overlaps and parallels. This volume of selected papers brings together the astonishing range of Holmes' interests and contributions. The various sections in the book cover: An extended interview - covering Holmes' career and philosophy as a psychodynamic psychiatrist 'Juvenilia' - sibling relationships, the psychology of nuclear weapons, and the psychodynamics of surgical intervention. Psychodynamic psychiatry: Integrative and Attachment-Informed A psychotherapy section inwhich he develops his model of psychotherapeutic change 'Heroes' - biographical pieces about the major influences including, John Bowlby, Michael Balint, David Malan, Jonathan Pedder and Charles Rycroft. 'Ephemera' - brief pieces covering such topics as frequency of psychodynamic sessions and fees. Attachments: Psychiatry, Psychotherapy, Psychoanalysis - The Selected Works of Jeremy Holmeswill be essential and illuminating reading for practitioners and students of psychiatry and psychotherapy in all its guises. (shrink)

This article illustrates the practical usefulness of transdisciplinary work for practical theology by showing how input from an occupational therapist informed my understanding and interpretation of the story of Hannetjie, who had been sexually abused as a child. This forms part of a narrative practical theological research project into the spirituality of female adult survivors of childhood sexual abuse. Transdisciplinary work is useful to practical theologians, as it opens possibilities for learning about matters pastors have to face, but (...) may not have knowledge about. A short retelling of Hannetjie’s story is given to provide information about the context of the research. Next, the transdisciplinary process that was followed is mentioned, and the questions that the transdisciplinary team had to respond to are discussed. Following that, I focus more specifically on the occupational therapist’s answers, and the knowledge gained from her contribution, as an example of how a co-researcher from a divergent discipline can inform a theological study. In this case, knowledge was shared about sensory integration and how the brain processes traumatic stimuli, such as sexual abuse. Lastly, the interrelationship between Hannetjie’s body stories, mind stories and spirit stories is discussed to show how the learning received from occupational therapy affected my thinking about Hannetjie’s stories and the relationships between them. Thus, it is concluded that transdisciplinary work has great value for practical theology, especially in the pastor’s daily work with people who are struggling with difficult stories, because we cannot listen to people’s spirit stories in isolation. They are inextricably intertwined with all our stories about ourselves. (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)

In lieu of an abstract, here is a brief excerpt of the content:Integrating the Parts of the Biopsychosocial ModelMichael A. Westerman (bio)Keywordsbiopsychosocial approach, pragmatism, participatory framework, functionalist accounts, mind-body-behavior integrationEngel’s (1977, 1980) call for replacing the biomedical model with his biopsychosocial approach pointed in the right direction. Bradley Lewis recognizes this, but argues that Engel’s framework does not provide us with everything we need to develop the biopsychosocial approach. Lewis attempts to add what is missing by reinterpreting Engel as a (...) pragmatist. As I see it, he is on the right track. We need to add something more to Engel’s position, and Lewis’s reinterpretation is an intriguing attempt to respond to this need. Nevertheless, I believe Lewis’s article only takes us so far. Something is still missing. In what follows, I identify what is missing, make suggestions about additional steps we can take to remedy the situation, and raise the possibility that pragmatism can be helpful in this venture in ways that Lewis does not consider.It should come as no surprise that it will take a lot to accomplish Engel’s objectives, because those goals are extremely ambitious. For one thing, Engel offered his biopsychosocial model as an alternative framework for all of medicine, not just psychiatry. Furthermore, he believed that it was not enough to augment the technological focus of the biomedical model by simply tacking onto it more humane concern with the patient as a person and more attention to the patient–physician relationship (although he certainly advocated changes along those lines). Engel maintained that psychosocial factors play an intrinsic role in the etiology of disease, its assessment, and treatment. He based his biopsychosocial model on general systems theory because he believed that it provides a framework for dealing with disease in a way that reflects this view.This is where Lewis enters the arena. He endorses Engel’s goal of developing a biopsychosocial approach to medicine and psychiatry, but he takes issue with Engel’s belief that we can reach this goal by following along the lines of general systems theory. Indeed, he claims that Engel’s biopsychosocial model was “doomed from the start” because of this idea. At a later point, I will turn to Lewis’s arguments against employing a systems theory framework. I first consider what Lewis proposes we bring to the biopsychosocial endeavor in its place.Lewis argues that pragmatism can get us where we want to go and that it makes sense to reinterpret Engel as a pragmatist because there [End Page 321] are a number of noteworthy similarities between pragmatism and Engel’s work. First, Lewis points out that both Engel and the pragmatists believed that inquiry should start with real problems, that is, with something that is not working. Another similarity is that, like the pragmatists, Engel believed that it is important to be aware of the impact theories and philosophical perspectives have on the ways we deal with problems, even though their influence may not be readily apparent. The third similarity Lewis points to is that even though Engel at times justifies beliefs by taking recourse to idealized notions about “The Method” of science (which, Lewis notes, parallels Peirce’s own early idealization of science), Engel ends up holding the pragmatists’ view that the justification of beliefs rests on their usefulness. Finally, Lewis argues that Engel and the pragmatists (in particular, Dewey) have similar views of nature, or the world, in that they believe nature can be characterized by a hierarchy of “levels” (Engel) or “plateaus” (Dewey).What do we gain from lewis’s reinterpretation?There is a lot to recommend this new reading of Engel. I agree with Lewis that Engel did not provide us with all the tools we need for developing his biopsychosocial approach. I also think that Lewis is right when he asserts that, in particular, we have to place Engel’s ideas about the biopsychosocial model in the context of a richer philosophical perspective. In addition, Lewis has identified a number of interesting similarities between Engel’s work and pragmatism. Hence, there is a basis for reinterpreting him as a pragmatist—and, in my opinion, this brings in a philosophical perspective that does indeed... (shrink)

Though addiction is a complex empirical phenomenon, some of the most pressing questions about it concern how we should evaluate agents who are living with it. To that end, a fruitful methodology is to tease out from our best sciences consequences at the level of moral psychology. Taking account of epidemiology, behavioral science, animal studies and, chiefly, neuroscience, I argue for a view according to which addiction involves dysfunctional motivational states (which I call “hybrid intentions”) as well as cognitive distortions. (...) This argument can be made without needing to settle the traditional debate about whether addiction is a disease. (shrink)

Delusions are currently characterised as false beliefs produced by incorrect inference about external reality (DSM IV). This inferential conception has proved hard to link to explanations pitched at the level of neurobiology and neuroanatomy. This paper provides that link via a neurocomputational theory, based on evolutionary considerations, of the role of the prefrontal cortex in regulating offline cognition. When pathologically neuromodulated the prefrontal cortex produces hypersalient experiences which monopolise offline cognition. The result is characteristic psychotic experiences and patterns of thought. (...) This bottom-up account uses neural network theory to integrate recent theories of the role of dopamine in delusion with the insights of inferential accounts. It also provides a general model for evolutionary psychiatry which avoids theoretical problems imported from evolutionary psychology. (shrink)

The detailed analysis allows to discern seven kinds of integration, namely: I₁ consisting in the synthesis of scientific disciplines from their elements, including disciplinary unification I₁; I₂ inclusion of a science in (reduction to) another, more general; I₃ - links between different sciences, especially establishing of common elements; I₄ - interdisciplines bridging various sciences; I₅ - combination of two (or more) disciplines into a new (complex) science; I₆ - a general approach to several domains or multidisciplinary unification; I₇ - (...) class='Hi'>transdisciplinary sciences about relations of the same type in various traditional domains. These kinds of integration are interwoven with processes of differentiation, viz. D₁ - internal differentiation of the sciences resulting of I₁; D₂ - interdisciplinary differentiation concomitant I₄, and D₃ - specialization of I₇ sciences in several sections. As a result integration and differentiation are combined in the pairs I₁ - D₁, I₇ - D₃, and D₂ - I₄. The processes of integration (and differentiation) may be presented schematically in the following (not strictly isolated one of another) sequence: in the 17th century started I₁ followed by D₁, and in the last decades by I₁'; during the 18th and the 19th c. cases of I₂ and I₃ appear; I₄ (together with D₂) is unfolding since the late 19th century. Finally, I₇ (and D₃), as well as I₅ and I₆ pertain to the latter half of our century. Representative are for one thing I₁, I₄, and I₇ outlining the main stages of integration and at the same time connected with respective kinds of differentiation. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial (...) and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)