The casting of maize seeds is a tool used by contemporary daykeepers in the Ayöök area of Oaxaca, Mexico, which along with the prognostications and prescriptions of the 260-day calendar, helps to cure illnesses and afflictions. This divinatory practice was also employed by precolonial tonalpouhque, who were experts of reading the tonalamatl, the pictographic manuscripts with calendrical, ritual and oracular content, such as the now called Borgia Group codices. In this article maize divination will be described and analyzed, arguing that (...) maize divination results in images that can be read in a similar way to these codices. The reading of maize is approached here by employing the concepts of signs and symbols as described by Carl Jung and the notions of chronotope and dialogical narratives by Mijail Bakhtin. The Jungian understanding of divinatory practices as a means of gaining consciousness of oneself is also applied to argue in favor of the therapeutic capacity of reading maize, as it offers relief and triggers action. (shrink)

This paper aims at analysing the problem of remainder and regret in moral conflicts. Four different approaches are subject of investigation: a moral-theoretical strategy aimed at consistency; a narrative approach of moral coherence and open consensus; Plato's moral methodology of dialogue and aporetic resolution of moral conflicts and finally, an approach deduced from Greek tragedy of emotional resolution of moral conflicts. A central argument is that since there exists no theoretically convincing way of solving the problem of remainder (...) and regret, the attention should instead be directed towards finding alternative ways of coping with this problem. The three last approaches subject of investigation attempt - each in their own way - to do this. Teaching medical ethics to medical students and the burning issue of medical fallibility is used to demonstrate the relevance of these forms of resolution in a medical context. (shrink)

The experience of illness raises profound issues concerning the sense or non-sense of human existence as a whole: does life have meaning when it is marked by suffering? And what meaning would it bear, in this case? These questions are asked by both caregivers and recipients of care when they come into contact with limits, pain, and death. In this regard, the existential condition of homo patiens is ambiguous: it can lead either to nihilism and despair or to a higher (...) level of awareness and responsibility. Studies on resilience, post-traumatic growth, and meaning-making processes seem to suggest that in difficult situations the search for meaning comes most clearly to the fore, so that the possibility of finding meaning in life can be a protective factor and a key therapeutic resource, while meaninglessness increases weakness and vulnerability. But what is meant by “meaning” in the illness experience and how may it be integrated into one’s personal life story? This question is answered here in terms of narrative methods that can enhance healthcare practitioners’ capacity to approach their patients with sensitivity and deep understanding and guide them to find meaning in their lives, despite all. (shrink)

It has been hypothesized that psychedelic experiences elicit lasting psychological benefits by altering narrative selfhood, which has yet to be explicitly studied. The present study investigates retrospective reports (n = 418) of changes to narrative self that participants believe resulted from, or were catalysed by, their psychedelic experience(s). Responses to open-ended questions were analysed using inductive and deductive thematic coding and interpreted within agent-centred approaches to development and well-being. Themes include decentred introspection, greater access to self-knowledge, positive (...) shifts in self-evaluation processes, greater psychological and behavioural autonomy, and enhanced connectedness with others and the world. While this explorative qualitative study offers some initial support for the explanation that changes to narrative self are a cornerstone of psychedelics' therapeutic and transformative potential, methodological and recruiting limitations preclude the ability to make objective claims and generalizations. Future scientific research is necessary to further elucidate this hypothesized mechanism. (shrink)

_Treating Dissociative and Personality Disorders_ draws on major theorists and the very latest research to help formulate and introduce the Relational/Multi-Motivational Therapeutic Approach, a new model for treating such patients within a clinical psychoanalytic setting. Supported by her fellow contributors, Antonella Ivaldi provides an overview of existing theories and evidence for their effectiveness in practice, sets out her own theory in detail and provides rich clinical detail to demonstrate the advantages of the REMOTA model as applied in a clinical (...) setting. The narratives in this book show how it is possible to integrate different contributions within a multidimensional aetiopathogenic treatment model, which considers the mind as a manifestation of the relationship between body and world. From a conceptual perspective, according to which consciousness emerges and develops in the interpersonal dimension, this book shows how it becomes possible to understand, in the therapeutic space, what stands in the way of sound personal functioning, and how to create the conditions for improving this. Treating Dissociative and Personality Disorders will be highly useful in addressing the particular clusters of symptoms presented by patients, stimulating therapists of different backgrounds to explore the complexity of human nature. On reading this book, it will become clear that theories can truly become useful instruments, if approached with a critical mind and with humbleness, in order to venture into what we do not know and will never know completely: the relationship with the other, unique and irreplaceable. Treating Dissociative and Personality Disorders provides an integrative and comparative new approach that will be indispensable for combining relational clinical knowing and motivational theories. It_ _will appeal to psychoanalysts and psychotherapists, especially those in training, clinicians of different backgrounds interested in comparative psychotherapy, as well as social workers and graduate and postgraduate students. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How Narrative Counts in Phenomenological Models of SchizophreniaThe author reports no conflicts of interest.Rosanna Wannberg (2024) offers an intriguing and novel critique of the predominant phenomenological model of schizophrenia, the ipseity disturbance hypothesis. According to this model, which was initially proposed by Sass and Parnas (2003), schizophrenia is best understood as arising from a disturbance or instability of minimal or basic self-hood, the sense of being present to (...) oneself and one's experiences (Henriksen, 2022). This disturbance appears as various experiential anomalies, sometimes termed "anomalous self (or world) experiences" or "self disorders," which include such phenomena as alienation from subjective processes, doubt in the existence of the world or one's own existence, fluidity of boundaries between self and others or self and world, and many other phenomena. Many of these have been captured in the Examination of Anomalous Self Experience (Parnas et al., 2005) and the Examination of Anomalous World Experience (Sass et al., 2017).At the same time, some research reveals the presence of self disorders in nonpsychotic conditions like panic disorder (Madeira et al., 2017) and depersonalization/derealization disorder (Sass et al., 2013). There are also competing phenomenological models that posit schizophrenia instead as a disturbance of dialogical self (Lysaker & Lysaker, 2002) or as a disruption of automatic perceptual processing (Uhlhaas & Mishara, 2007). Such works contain implicit critiques of the ipseity disturbance hypothesis that focus on the specificity of self disorders, or else on the specific nature of the underlying disturbance in schizophrenia.Wannberg's critique is distinct from these others: by considering the validity and function of recovery narratives, she raises crucial epistemological and ethical questions about the phenomenological approach to psychopathology, asking not only whose narrative counts, but how narrative counts. In particular, Wannberg questions a phenomenology that, she suggests, might find any ongoing symptoms as evidence of continued alterations of subjectivity, and that would then be dismissive of recovery narratives—a phenomenology that would prioritize the authority [End Page 71] of consciousness, as Wannberg puts it, over the authority of the person.It is worth stating here that the standard phenomenological response would not be to distrust or dismiss accounts of recovery. Ideally, phenomenological models, along with their ongoing theoretical developments and empirical work, are based on a deep respect for patients' experience and self-descriptions, striving to attend to experiences as they are lived without imposing pre-defined constructs that would limit or alter the experiences in a fundamental way (Nordgaard et al., 2013).Questions about the nature of recovery might be addressed within phenomenology by considering the difference between minimal (or basic) self and narrative (or extended) self, a more complex self-understanding or self-interpretation that is founded on the more basic, pre-reflective sense of being alive in the world (Gallagher, 2000; Parnas, 2007). According to proponents of the ipseity disturbance hypothesis, disturbances of basic self-hood can contribute to disturbances of narrative self, such as confusion about one's future goals or difficulties making sense of one's life history, though it is unlikely for disruptions that originate in the narrative self to trickle down to the minimal self (Henriksen, 2022). Such a view might similarly suggest that it would be unlikely for work on the level of the narrative self to lead to improvements in minimal self. Recovery, according to this approach, might best be viewed as an understanding of and compensation for alterations in basic self-hood, such that a person can develop a relatively solid narrative self that accounts for and manages disturbances of minimal self—while the minimal self may also grow more solid through various therapeutic interventions (Skodlar & Henriksen, 2019).Wannberg finds a more transformative possibility in Wittgenstein's grammatical approach, which is concerned with the function and rules of discourse. According to her grammar of recovery, recovery narratives are not only the product of a process of meaning-making and self-understanding, but they can create meaning and new realities. Furthermore, this process, according to Wannberg, has an inherently social and normative quality to it: the self-work that occurs in recovery and the recovery narrative involves the development of agency, autonomy, and responsibility in a social world... (shrink)

Taking post-traumatic stress disorder (PTSD) as an example, we present a concept for transdisciplinary cooperation between life sciences and humanities. PTSD is defined as a long-term persisting anxiety disorder after severe psychological traumata. Initially recognized in war veterans, PTSD also appears in victims of crime and violence or survivors of natural catastrophes, e.g., earthquakes. We consider PTSD as a prototype topic to realize transdisciplinary projects, because this disease is multifacetted from different points of view. Based on physiological and molecular biological (...) research to understand the causes of this disease, conventional academic medicine (to Western medicine) and pharmacology can offer a panel of drugs for treatment, albeit only with limited success. Hence, other treatment options are indispensable. Chinese medicine is frequently regarded as alternative to complement Western medicine. In fact, Chinese medicine offers a large array of both pharmacological and non-pharmacological treatments for PTSD patients. Narrative therapy represents a non-pharmacological approach combating PTSD both in Western medicine as well as in Chinese medicine to improve quality of life of affected patients. Narratives on traumatic experiences form a new genre of life writing in Asian American literature, whose excitement is considerably fueled by the tension between fictitious and very personal narratives taken from reality. Systematic academic reflections on narratives from PTSD patients in the field of Asian American studies may support the improvement of narrative therapy in medical practice. Chinese medicine has a strong philosophical background and may, therefore, serve as junction between life sciences with their strong rational and reductionistic way to generate new knowledge and more holistic approaches in traditional medicines and humanities. In this regard, Chinese medicine may represent a missing link between life science and life writing. (shrink)

Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the (...) pediatric oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations, the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of (...) AVH at 3 contextual levels: cultural, social, and historical; experiential; and biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; “front-loading” research in cognitive neuroscience; and suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. (shrink)

Heart and Soul is a collection of essays which examine those concepts and questions which are at the heart of both psychotherapy and philosophy. Topics discussed include the nature of the self, motivation and subjectivity, the limits of certainty and subjectivity in interpersonal situations, and the scope of narrative, dialogue and therapy itself. Looking at the work of key figures such as Wittgenstein, Socrates, Kierkegaard, Foucault, Lacan and Klein, contributors draw on a wide range of philosophical approaches and (...) examine how they can deepen our understanding of the processes involved in different types of psychotherapy in a wide range of clinical settings. Each chapter includes a summary of the implications to clinical practice of the ideas discussed. Contributors: Joady Brennan, John M. Heaton, Jeremy Holmes, Joan Hurd, Paul Sepping, Geraldine Shipton, Paul Sturdee, Digby Tantam, Myra Thomas, Emmy van Deurzen, Werdie van Staaden, John Wheway, and Catherine Wieder. (shrink)

Abstract“Patient-centred care” is the recent response to the malaise produced in the field of health care from the point of view both of a technical mentality and the paternalistic model. The interest in the story-telling approach shown by both the humanities and the social sciences has favoured a “narrative turn” in medicine too, where the new ethics of therapeutic relationship consider the hermeneutic method a means by which to integrate evidence and subjectivity, scientific data and patient experience. The (...) aim of this paper is to show how Ricoeur’s theory of “threefold mimesis” makes a conceptual contribution to the use of narrative interviews in nursing and also be successfully transferred into and applied in the field of healthcare in general. First, the paper examines how this narrative approach might open up new possibilities for the acquisition of in-depth knowledge of patients’ life experiences, a condition indispensable for the improvement of the quality of care. Secondly, it highlights how this Ricoeurian method seems capable of provide an opportunity for healthcare professionals to review their own understanding of the caregiver-patient therapeutic relationship, beginning with their confrontation with the patient’s world as revealed by the narrative they provide. (shrink)

To practice compassion, the recognition, understanding, and alleviation of patient suffering are of utmost importance. Nursing literature provides ample guidance about the nature and meaning and patients’ views about compassion and physical and psychological suffering. However, missing is the discussion about how nurses can achieve a deeper awareness of patients’ suffering to practice compassion. This paper aims to describe the relational inquiry nursing approach and illustrate how this approach can enable nurses to develop a deeper awareness of patient suffering. The (...) relational inquiry approach encompasses two components: a relational consciousness and inquiry as a form of action. Relational consciousness requires the nurses to focus on the concrete situations and relationships as well as recognize the intrapersonal, interpersonal, and contextual factors affecting the situations. The interpersonal factors are among and between the individuals, intrapersonal factors are within the individuals, and contextual factors are the hidden factors influencing the individuals and situations. Inquiry as an action requires a critical analysis of the experiences of individuals, situational contexts, and knowledge to inform the nursing care modalities and actions. This approach encourages nurses to use the philosophies of hermeneutic phenomenology, critical theory, and pragmatism. The phenomenological worldview allows nurses to interpret their own and patients’ experiences, the critical theory worldview allows nurses to examine the influence of social and cultural factors, and pragmatism allows nurses to question their prior knowledge and develop new knowledge in each situation. The relational inquiry approach allows nurses to develop a deeper understanding of patient suffering through building a therapeutic and trustworthy relationship, active listening, focusing on the details, and engaging in broad and situations specific inquiries to understand the patient narrative of suffering. Two case exemplars are shared to demonstrate how relational inquiry allowed nurses to move beyond recognizing physical suffering and understand patients’ emotional and psychological suffering. (shrink)

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy. Patients’ experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup’s and Ricoeur’s philosophy, and Mattingly’s and Frank’s narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and (...) cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one’s own. (shrink)

This is a systematic case study of the assessment and treatment of Anna, a woman presenting with posttraumatic stress disorder following a drug-facilitated sexual assault that occurred over twenty years earlier. She was also diagnosed with avoidant personality disorder. Treatment with cognitive therapy for PTSD and social phobia was supplemented by imagery rescripting of memories of childhood trauma within a schema therapy approach. The study documents how her intrusive memories of the rape were potentiated by early maladaptive schemas that developed (...) in response to abusive and neglectful parenting. Within a broader narrative, three examples of IR are described which show how, as an emotion-focused intervention, this approach discloses deeper memories and emotional states that are distressing and traumatic and allows them to be transformed through a healing process that is organic and displays what Bohart and Tallman call “self-organizing wisdom.”. (shrink)

ABSTRACT:While the literature on psychedelic medicine emphasizes the importance of set and setting alongside the quality of subjective drug effects for therapeutic efficacy, few scholars have explored the therapeutic frameworks that are used alongside psychedelics in the lab or in the clinic. Based on a narrative analysis of the treatment manual and post-session experience reports from a pilot study of psilocybin-assisted treatment for tobacco smoking cessation, this article examines how therapeutic frameworks interact with the psychedelic substance (...) in ways that can rapidly reshape participants' identity and sense of self. We identified multiple domains relating to identity shift that appear to serve as smoking cessation mechanisms during psilocybin sessions, each of which had an identifiable presence in the manualized treatment. As psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics. (shrink)

It is presently unclear whether a distinct “rural ethics” of navigating professional boundaries exists, and if so, what theoretical approaches may assist practitioners to manage overlapping relationships. To be effective clinicians while concurrently partaking in community life, practitioners must develop and maintain safe, ethical, and sustainable therapeutic relationships in rural and remote healthcare. A narrative review was conducted identifying a significant body of qualitative and theoretical literature which explores the pervasiveness of dual relationships for practitioners working in (...) rural and remote healthcare. Rather than viewing dual relationships as ethically unacceptable, much contemporary work focusses on the lived experiences of healthcare workers and explores what approaches may be available that both protect the therapeutic relationship while recognizing the unique nature of rural and remote healthcare practice. We conclude that practitioners must have a means of operating within a contextually informed ethics of professional boundaries. Drawing on pre-existing work, one schema is proposed that could form the basis for further engagement through interactive teaching sessions, professional development, mentoring, or guidelines. (shrink)

BackgroundRemotely provided psychotherapy due to the COVID-19 pandemic became common. One of the most significant changes related to providing online psychotherapy services is that clients no longer travel to their sessions.AimsIn the article we are interested in the narrated experience of the absence of journey to psychotherapy sessions. We study clients' stories of past journeys and how their absence, resulting from the change of the mode of therapy provision, is coped with and replaced by other activities in their narratives.MethodsThe study (...) takes a constructionist approach to discourse and focuses on the lexico-grammatical form of the notes. The data come from 12 semi-structured interviews with people who declared attending remote psychotherapy sessions after the national lockdown had been introduced.ResultsIn the collected data, the physical journey is constructed not only as travel time, solitude which can be used for reflection, but, importantly, as an active process which ends with a resolution. In contrast, in narratives of the time before an online session, constructions of unfettered agents are replaced with those of people whose actions are hedged and qualified.ConclusionWe argue that in the informants' narratives the journey to psychotherapy is meaningful and is part of the therapeutic process. We propose that it is a time of passing between two states—one before therapy and one in session. The journey therefore is experienced as a process of change, and not only a process of traveling. (shrink)

This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of illness narrative, an alternative phronesis approach to medical ethics influenced by Charles Taylor’s account of the interpretive nature of human agency and language is examined. To this end, the (...) account of interpretive medical responsibility previously described by Schultz and Carnevale as "clinical phronesis" (based upon Taylor’s notion of "strong" or "radical evaluation") is reviewed and expanded. The thesis of this paper is that illness narrative has the ability to benefit patients as well as the potential to cause harm or iatrogenic effects. This benefit or harm is contingent upon how the story is told and understood. Consequently, these tales are not simply "nice stories," cathartic gestures, or mere supplements to scientific procedures and decision making, as suggested by the objectivist approach. Rather, they open the agent to meanings that provide a context for explanation and evaluation of illness episodes and therapeutic activities. This understanding provides indicators (guides) for right action. Hence, medical responsibility as clinical phronesis involves, first, the patient and provider’s coformulation and cointerpretation of what is going on in the patient’s illness narrative, and second, the patient and provider’s response to interpretation of the facts of illness and what they signify–not simply a response to the brute facts of illness, alone. The appeal to medical responsibility as clinical phronesis thus underscores the importance of getting the patient’s story of illness right. It is anticipated that further elaboration concerning the idea of clinical phronesis as interpretive illness narrative will provide a new foundation for medical ethics and decision making. (shrink)

This article draws on feminism and post-structuralism to theorize a narrative framework for developing and critiquing therapeutic practices with women who have experienced child sexual abuse. I argue that both objectivism and relativism provide poor guides for conducting therapy and that it is only through situating our knowledges precisely that more liberatory therapy practices may be developed. This approach, termed ‘visible therapy’, is used to directly and explicitly challenge normative constructions of women, child sexual abuse and therapy. I (...) argue that it is necessary to explicate the embedded assumptions produced through practices of abuse, and which serve to construct children's experiences of that abuse, in order to ward against their reproduction within therapy relationships. I demonstrate that it is through situating and explicating the operations of power that the authenticity of experience and identity may be questioned and women's ongoing positioning as guilty victims may be challenged. Thus, I am concerned not with who women ‘really are’ but with how they come to know and be known through practices of both abuse and therapy. This, then, is about making the tactics of abuse and therapy visible. Problems are not located within individuals, but rather within the narratives which situate both past and current relationships but which, through reiteration, obscure their own social production. I conclude that it is only when categorical identity is no longer assumed that progressive therapy practices with women who have been sexually abused can be developed and maintained. (shrink)

Qualitative inquiry into eating disorders is burgeoning, offering valuable and innovative insights into various aspects of the condition. This study used life‐history interviews with 20 women who had recovered from anorexia nervosa, bulimia nervosa or both and who had remained healthy. The interviews focused on the women's narratives and experience rather than a diagnostic therapeutic model. Three themes of control, connectedness and conflict emerged as significant in the development, experience of, and recovery from an eating disorder. The development of (...) the condition was attributed to a lack of control, a sense of non‐connectedness to family and peers and extreme conflict with significant others. Recovery occurred when the women re‐engaged with life, developed skills necessary for conflict resolution and rediscovered their sense of self. Rather than viewing the development of, and recovery from an eating disorder as separate and discrete events, the data from the life‐history interviews suggest they are better viewed as one entity — that is, the journey of an individual attempting to discover and develop their sense of self. This perspective challenges some current constructs of eating disorders; it is not a condition in and of itself but a symptom of deeper issues that if addressed, when the individual is ‘ready’ to make that choice, will lead to recovery. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

_Therapeutic Approaches in Psychology_ is a simple introduction to the many psychological therapies in use today, including cognitive-behavioural, humanistic and psychodynamic approaches.

The Self and its Disorders develops a philosophical and interdisciplinary approach to the formulation of an “integrative” perspective in psychiatry. In contrast to some integrative approaches that focus on narrow brain-based conceptions, or strictly on symptomology, this book takes its bearings from embodied and enactive conceptions of human experience and builds on a perspective that understands self as a self-pattern—a pattern of processes that include bodily, experiential, affective, cognitive-psychological, reflective, narrative, intersubjective, ecological, and normative factors. It provides a (...) philosophical analysis of the notion of self-pattern, framed in terms of dynamical organization. It then draws on phenomenological, developmental, clinical, and experimental evidence to propose a method for studying the effects of psychopathologies on the self-pattern, and includes discussions of network theory, predictive processing models, and the role of narrative. This book explores the hypothesis that psychiatric disorders are self-disorders, and includes specific discussions of schizophrenia, anxiety disorders, depression, borderline personality disorder, obsessive compulsive disorder and autism spectrum disorder, as well as traumatic effects of torture and solitary confinement. Other topics include diagnostic classification, symptom overlap, and transdiagnostic complexity. Several chapters explore a variety of philosophical issues that relate to therapeutic approaches, including deep brain stimulation, meditation-based interventions, and the use of artificial intelligence and virtual reality. (shrink)

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: (...) pulse; quality; and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches. These clinical case examples are introduced here and several more are included in the Supplementary Material. A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach. (shrink)

This study reconceptualizes violence as the violation of value-laden boundaries through a close reading of the Death and the Displacement of Beauty trilogy by feminist philosopher of religion Grace M. Jantzen. Given the inherent normativity of the concept, it is difficult to imagine how violence could avoid simply becoming a tool in the hands of the powerful who would define it in polemical or coercive ways. But Jantzen’s work runs counter to a fatalistic treatment of the term by seeking the (...) redemption of the present and a therapeutic approach to the violent pathologies of philosophy. Through a radical reconfiguration of the relationship between mortality and natality, Jantzen both diagnoses and critiques the death-obsessed moral imaginary of modernity. In response, I argue that Jantzen’s sophisticated methodological resistance to an ontology of violent displacement provides an important counter-narrative to the violent metanarratives of modernity that order origins and ends in absolutizing, universalizing, and totalizing ways. (shrink)

Is it possible to approach quantum theory in a 'therapeutic' vein that sees its foundational problems as arising from mistaken conceptual presuppositions? The book explores the prospects for this project and, in doing so, discusses such fascinating issues as the nature of quantum states, explanation in quantum theory, and 'quantum non-locality'.

Our country has celebrated democracy for more than a decade now, the democracy in which everyone enjoys all the basic human rights, including the right to an abortion. Public and private hospitals and some traditional healers are engaged in this act where some give preabortion and post-abortion counselling to their patients whilst others do not. It becomes a serious question of course to ask whether those patients who did not receive counselling, cope with life after the experienced trauma. By the (...) looks of things it seems very clear that the people who commit abortion have a special need for help in order to cope with life thereafter. Another question now is whether the little counselling that they receive in the hospital before and after an abortion is satisfactory to their individual needs. That is why the author’s focus is on the method or approach which the author thinks will better help the patients who find themselves in such a traumatic situation. The concentration is on the narrative-hermeneutical approach as one of the applicable approaches from the author’s point of view. (shrink)

Psychological assessment has long been reported as a key component of clinical psychology. This paper examined and shed light on the complexities surrounding the clinical significance of therapeutic approach to treatment Planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed the underlying themes: 1) a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2) explained the (...) conceptual meaning of clinical significant change in therapeutic assessment, 3) used initial theory to explain the therapeutic mechanisms of change in clinical practice, 4) analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the lay-man and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as “changed” or “unchanged” on the basis of clinical significance criteria. (shrink)

The article The Therapeutic Approach to Military Culture: A Music Therapist’s Perspective, written by Nicole Drozd, was originally published online on 16 May 2020 with Open Access under a Creative Commons Attribution license 4.0.

Culture can broadly be defined as “the values, norms, and assumptions that guide human action”. In contrast with the broader civilian society, the experiences and environments within the military community create a unique cultural subset. The United States armed forces are unified by their primary mission to provide external defense, security, and protection, and each branch shares a unique core set of values and norms. Because this culture is so complex and unique, it can sometimes be a challenge for many (...) civilian professionals to work with this community, so having a strong competency in understanding military culture, as well as knowledge of specific conflicts and wars, one is not only able to begin to understand the lives and personalities of our soldiers but also able to recognize that this culture aids in survival. This paper will demonstrate and discuss the importance of competency in military culture when practicing music therapy or other interdisciplinary approaches within the process of group therapy with veterans. Other topics covered will include: issues of social transmission as it relates to transitioning into civilian society; the importance of being a witness to veterans’ stories; and facilitators’ ethical responsibilities when working with this population. (shrink)

본 연구는 한국인의 삶과 행동을 이끌고 규정하는 한국인의 가치관과 한국적 가치의 탐구에서 출발했다. 이를 위해 통시적 관점에 근거한 한국의 전통가치와 미래 한국사회에 요구되는 미래 지향적 가치를 살펴보고, 양자 간의 소통과 융합의 맥락에서 한국적인 핵심 가치의 일부를 재구성하고자 했다. 본 연구의 방법론으로 인문치료적 접근을 원용하였는데, 이는 한국적 가치의 원형과 변용(변형), 더 나아가 왜곡된 지점을 확인하고 미래지향적인 전망 속에서 한국적 가치를 재구성하는 데 친화력이 있다고 보았다. 본 연구에서 일심(一心)을 한국적 가치의 원형 중 하나로, 화(和)와 효(孝)와 충(忠)을 한국적 가치의 재정립 사례로 제시하고자 하였다. (...) 한국인의 심층의식에 뿌리내린 ‘일심’은 불성(佛性)이자 유교의 인(仁), 동학의 동귀일체(同歸一體) 등으로 표현될 수 있으며, 그것은 한국인을 하나 되게 하는 문화적 유전자로 간주될 수 있다. ‘화’의 가치는 타자와의 올바른 관계 맺기라는 원론적 의미로부터 시작하여 사회 공동체와의 관계, 더 나아가 자연과의 관계에서 상생과 조화의 원리로 기능할 수 있다. ‘효’의 가치는 사회생활과 인간관계의 근본이자 공부와 학문의 출발점이며, 공동체에 대한 책임의 원천으로서 효는 사상과 이념과 종교를 넘어선 인간관계의 근본 원리이다. ‘충’의 가치는 자신에 대한 성실, 맡은 일에 대한 충실, 올곧은 태도, 올바름과 공평함, 불의에 대한 저항, 나라사랑을 지향한다. (shrink)

A commentary on a special report, titled Narrative Ethics: The Role of Stories in Bioethics, that appeared with the January‐February 2014 issue.

The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the ‘experimental’ nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even ‘willfully obstructive’. In an attempt to resist such impressions, this paper will seek to provide an (...) accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a ‘continuity’, rather than as a series of distinct ‘moments’ or ‘events’. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent ‘turn’ to ‘narrative’ as a psychotherapeutic approach and for contemporary mental health care's growing interest in ‘social constructionism’. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing. (shrink)

The ubiquitin–proteasome system (UPS) is the major proteolytic pathway that degrades intracellular proteins in a regulated manner. Deregulation of the UPS has been implicated in the pathogenesis of many neurodegenerative disorders like Alzheimer's disease, Parkinson's diseases, Huntington disease, Prion‐like lethal disorders, in the pathogenesis of several genetic diseases including cystic fibrosis, Angelman's syndrome and Liddle syndrome and in many cancers. Multiple lines of evidence have already proved that UPS has the potential to be an exciting novel therapeutic target for (...) the treatment of these diseases. Here I review how aberrant functions of various genes have implicated UPS in many human disorders including neurodegeneration and cancers. I also discuss the finding that some proteasome inhibitors possess a therapeutic potential as drugs against many such diseases. BioEssays 30:1172–1184, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic (...) models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

The claim presented here is that aesthetic considerations are an essential part of place narrative, and are thus essential to ethical environmental decision-making. Holland’s narrative-based approach to nature conservation is taken as a starting point from which an argument is developed to show how his approach can be extended to include the aesthetic. Aesthetic experience of place is important because it gives us knowledge by acquaintance of the place, because it gives meaning to our relationship to the place, (...) and because it reveals and gives insight to meaningful relationships within the place. The narrative approach allows these experiences and meanings, which are problematic to other approaches, to be captured and included in environmental decision-making. (shrink)

Simon Friederich’s Therapeutic Approach to quantum theory (QT) sheds new light on the status of the quantum state. In particular, Friederich presents revisionary ideas on how to exactly differentiate objective from subjective elements of the theory and thereby improves upon previous stabs at an epistemic interpretation of quantum states. The book not only provides interesting perspectives for the cognoscenti but is also written with sufficient care and free of unnecessary technicalities so as to be accessible and worth reading for (...) the physical layman interested in the foundations of QT. The main achievement of the book is an innovative outline for interpreting quantum states epistemically while avoiding many problems of previous attempts. (shrink)

This article contrasts the Caseness and Narrative approaches for treating individuals who are psychiatrically labelled. In Caseness a "mental health professional" negatively values those symptoms believed to be caused by a physical pathology. In the subsequent labeling of the "patient" a transfer of ownership of the person's body to the "medical system" occurs. Intervention ensues, by coercion and force if deemed necessary, to stop symptom expression. In contrast, the Narrative approach looks upon periods of distress as potentially (...) transformative experiences within the context of a life story. The complexity captured by a "narrative web," the emphasis on a dynamic self able to make choices, and a sense of closure are among the properties that Narrative highlights. This approach also helps redress the power disparity inherent in Caseness by letting the distressed person establish the discourse from which a dialogue can ensue. This article argues that the Narrative approach provides a more humane and healing context for people who are psychiatrically labeled. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.1 (2001) 39-40 [Access article in PDF] Remembering Feminisms:A Response to the Commentary Erica Burman I am grateful to Gwen Adshead for outlining the broader arguments surrounding feminist critiques of science and their relevance for mental health, particularly in forensic contexts. As she highlights, the debates about the status of accounts of memory hinge upon contested concepts of objectivity and the problem of discursive and (...) provisional (but also necessary) claims to external reality, these being debates to which feminists have actively contributed. There are four additional points I would like to make in response to her comments.Firstly, while I am in general agreement with her presentation of feminist positions in relation to scientific theory and method--and this does largely reflect a current consensus within feminist approaches--it is important not to overstate this consensus. Feminist debates about science, method, and claims to truth are precisely debates. There is no unitary feminist approach. Key arguments between feminists concern, for example, whether to lay claim to (forms of "strong") subjectivity rather than objectivity (see Harding 1986, Hollway 1989, Griffin et al. 1998) or whether to re-work criteria for objectivity to takeaccount of well-known gender biases (Eichler 1988).In my analysis of feminist approaches to "false memory syndrome" (FMS), I wanted to highlight the diversity of feminist positions in order to indicate something of the interconnections between feminist and other political, theoretical, and cultural analyses--ranging from the modernist and empiricist to the postmodernist and constructionist. Hence, while I agree with Adshead that much feminist analysis seems unremarkable since its impact on cultural practice has been so great, I would argue that her account glosses over the many different feminist positions mobilized within the debate around "false/recovered memories." There are widely different views, for example, about the status of evidence/science. Another key area of debate is the role of psychiatric diagnosis between those who subscribe to and those who reject the "terms of art" of psychiatric diagnostic categories.This may sound like a mere effort to attest to the rigor and rationality of feminist scholarship, including feminist re-workings of these terms. However, to come to my second point, there is a material consequence of this closer attention to the conditions for, and reception of, specific feminist analyses. For the debate about "false" or "recovered" memories goes beyond questions about the circulation of the roles of victim versus perpetrator that surround claims of credibility, legitimacy, manipulation, or gullibility. [End Page 39]Thus, Laura Brown and I (1997) and Jan Haaken (1998) have suggested that in order to understand how the current debates surrounding (women's) reported memories could have come about, we need to analyze what has happened through, and what the stakes have been in, the (limited) institutionalization of feminism within models and practices of therapy. This involves attending to the particular forms of feminism that have been included and excluded: For example, how far do therapeutic models accept, and how far do they problematize, the forms and functioning of families? We also need to consider the broader societal response (or backlash?) to a feminized/therapeutic culture, including consequences of the confounding of the therapeutic with the feminized. In particular, Haaken draws attention to the gender essentialism that pervaded second wave (1960s and 1970s) U.S. feminist therapies. This essentialism, she argues, has fueled a failure to interrogate power dynamics (including therapeutic dynamics) between women that make possible displacements of transferential dynamics to an outside party, whether past or present.My third point concerns the ever closer relationship between the therapeutic and legal arenas reflected within the career of FMS. Adshead's reference to a film narrative to highlight competing versions of legal knowledge puts me in mind of how FMS--as a potent cocktail of psychiatric labeling, familial conflict and abuse, and litigation--is the U.S. television courtroom drama writ large. It may be the case that, as Adshead argues, I fail adequately to address the complexity of legal process, with its assumptions about what makes certain accounts more credible or legitimate than others... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hildegard: Medieval Holism and ‘Presentism’—Or, Did Sigewiza Have Health Insurance?Jerome L. Kroll (bio)Keywordsholistic healing, presentism, Hildegard of Bingen, medieval medicineSuzanne Phillips and Monique Boivin have published an article examining Hildegard of Bingen’s (1098–179) treatment and cure of Sigewiza, a possessed woman. The purpose of their article is to demonstrate Hildegard’s holistic, or biopsychosocial, approach to healing as a model that we in the twenty-first century have lost but would (...) do well to recover. Several questions come to mind:What is Hildegard’s model?Have we lost it?Is it something we wish to emulate?The basics of the case history is that a noblewoman, Sigewiza, is ill or possessed of an evil spirit. Attempts by her local abbot and community to send her on pilgrimages or otherwise to cure or exorcise her, even with Hildegard’s recommendation, have only short-lived success, after which Sigewiza’s illness or demon returns. Finally, the abbot asks Hildegard to take the noblewoman into her Benedictine monastery, and after a suitable time and various interventions, Sigewiza is permanently (presumably) cured. The arduous process of effecting this cure has left Hildegard weak and ill herself, a pattern of poor physical health from which Hildegard suffered all her life.Phillips and Boivin claim that this is an early example of conceptualizing and utilizing a bio-psychosocial model to treat a complex illness. Hildegard, well known for her medical and pharmaceutical knowledge, applies the proper dietary changes to correct Sigewiza’s humoral (biological) imbalance. She treats the psyche and its partner, the soul, by long hours of discussion with Sigewiza and verbal duels with her demon, as well as by exorcising the demon, and she includes the social aspects of treatment by bringing Sigewiza into the Benedictine community of sisters as a participating member. Which of these three modalities may be sufficient for a cure depends upon the medieval literary genre in which the case appears. If in a medical text, then the proper dietary treatment and application of compounds to neutralize and correct the offending humoral imbalances would be the therapeutic agents. In medieval hagiography, [End Page 369] the biological modality is never sufficient and often ridiculed, because the entire thrust of the text is to demonstrate the futility of medical (secular) ministrations and the effectiveness of saintly intervention in producing a cure, whether or not exorcism is technically part of the process. In Sigewiza’s case, perhaps because of the stubbornness of the possessing demon or because of other factors attached to Sigewiza’s condition, the three (biopsychosocial) modalities are utilized. It seems that Sigewiza has a treatment-resistant illness.The narrative follows a familiar topos in saint’s lives (Kroll and Bachrach 2005). Attempts to cure a demoniac by prayers, pilgrimages, intercessions of other local saints or reputedly holy persons, and sometimes by physicians (when available) are to no avail. The sufferer is brought, amidst great fanfare and public attention (a media event), to the holy woman who is the central figure of the particular Vita, and the sufferer is promptly, or protractedly, cured. In such an account, the holiness of the holy woman is further demonstrated and her reputation, shrine, and influence are duly extended and enhanced. The holy person, with humility, attributes the intercession and cure to the power of God, or Jesus or Mary or a particular patron saint, but the crowd of onlookers and the audience of the Vita understand that God (or Jesus or Mary) has in fact granted the miracle cure as a way of demonstrating the holiness of this holy person in contrast to those who previously tried to cure the ill person. The abbot who ‘referred’ Sigewiza to Hildegard, and the previous saints’ shrine to whom Sigewiza was brought, although generally acknowledged as being of fine character or respectability, had to suffer the ignominy of their petitions being rejected to dramatize the special regard in which Hildegard is held.Although we can say that the “purposes” for which Hildegard’s hagiographer includes such anecdotes is to demonstrate her holiness and her importance in God’s eyes, this does not stop us, nine centuries later, from using such... (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

This paper offers a different approach to writing about oneself—Stanley Cavell's idea of philosophy as autobiography. In Cavell's understanding, the acknowledgement of the partiality of the self is an essential condition for achieving the universal. In the apparently paradoxical combination of the 'philosophical' and the 'autobiographical', Cavell shows us a way of focusing on the self and yet always transcending the self. The task requires, however, a reconstruction of the notions of philosophy and autobiography, and at the same time the (...) destabilising of our conceptions of self and language. Cavell seeks to achieve this through the idea of finding one's voice, understood as an autobiographical exercise. This necessitates both negotiation of the inheritance from the past and innovation for the future, initiation into the language community and deviation from it. What this amounts to, in ways that the paper seeks to explain, is a process of the self and language in translation. This is a sense of 'translation' that is broader than the conventional understanding of the term. Such a conception can, it is argued, exercise a therapeutic effect on the self, destabilising the myth of self-identity. The implications of this account for the contemporary vogue for narrative in educational research, as well as for classroom practice, are considered. (shrink)

Interferons (IFNs) are a diverse group of cytokines whose potent antitumor effects have piqued the interest of scientists for decades. Some of the most sustained clinical accomplishments have been in the field of myeloproliferative neoplasms (MPNs). Here, we discuss how both historical and novel breakthroughs in our understanding of IFN function may lead to more effective therapies for MPNs. The particular relevance and importance of modulating the novel IFN‐regulated ULK1 pathway to optimize IFN responses is highlighted.

Several studies have established the prevalence of discrimination upon the basis of weight in healthcare; however, these studies lack the element of human experience that makes addressing the issue vital to both individual and public health. Narrative medicine is an interdisciplinary field that utilizes powerful narrative skills and creativity to address the needs of those who seek and deliver healthcare, promoting healing, and self-reflection for both patients and physicians. This paper seeks to re-evaluate key studies regarding the issue (...) of weight discrimination in healthcare through the lens of narrative medicine. In doing so, it further integrates the aspect of human experience into the study of medical ethics in order to improve the lived experience of overweight individuals in medicine. (shrink)

A large amount of research in mental health care relates to the notion of trust, as a possible common factor in psychopathology, and as a common dimension of psychotherapeutic alliance, underlying the various therapeutic methods. Such hypotheses call for a more detailed analysis of this notion of trust. The paper seeks to shed light on this issue by confronting the clinical and phenomenological approaches. We propose to focus on three issues at stake: 1/ the issue of the existence (...) of a tacit or pre-reflective trust, which can be defined by a phenomenological method. 2/ the issue of a foundation of trust in empathy, which questions the debates about empathy in phenomenological works. 3/ the issue of a structural self-opacity, brought to light through the paradoxical structure of trust, and that we propose to tackle with the notions of attestation and narrative identity. (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)