Introduction: Although deep brain stimulation often improves levodopa-responsive gait symptoms, robust therapies for gait dysfunction from Parkinson's disease remain a major unmet need. Walking speed could represent a simple, integrated tool to assess DBS efficacy but is often not examined systematically or quantitatively during DBS programming. Here we investigate the reliability and functional significance of changes in gait by directional DBS in the subthalamic nucleus.Methods: Nineteen patients underwent unilateral subthalamic nucleus DBS surgery with an eight-contact directional lead in the most (...) severely affected hemisphere. They arrived off dopaminergic medications >12 h preoperatively and for device activation 1 month after surgery. We measured a comfortable walking speed using an instrumented walkway with DBS off and at each of 10 stimulation configurations at the midpoint of the therapeutic window. Repeated measures of ANOVA contrasted preoperative vs. maximum and minimum walking speeds across DBS configurations during device activation. Intraclass correlation coefficients examined walking speed reliability across the four trials within each DBS configuration. We also investigated whether changes in walking speed related to modification of step length vs. cadence with a one-sample t-test.Results: Mean comfortable walking speed improved significantly with DBS on vs. both DBS off and minimum speeds with DBS on. Pairwise comparisons showed no significant difference between DBS off and minimum comfortable walking speed with DBS on. Intraclass correlations were ≥0.949 within each condition. Changes in comfortable walk speed were conferred primarily by changes in step length.Conclusion: Acute assessment of walking speed is a reliable, clinically meaningful measure of gait function during DBS activation. Directional and circular unilateral subthalamic DBS in appropriate configurations elicit acute and clinically significant improvements in gait dysfunction related to PD. Next-generation directional DBS technologies have significant potential to enhance gait by individually tailoring stimulation parameters to optimize efficacy. (shrink)

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

'Gender Hurts' examines the wider social and political context and implications of the phenomenon of transgenderism. Jeffreys and Gottschalk propose that gender in western culture is socially constructed as the basis of male domination and that the concept of gender has the potential to hurt many.

In introducing the reactive attitudes “of people directly involved in transactions with each other,” P. F. Strawson lists “gratitude, resentment, forgiveness, love, and hurt feelings.” To show how our interpersonal emotional practices of responsibility could not be undermined by determinism’s truth, Strawson focused exclusively on resentment, specifically on its nature and actual excusing and exempting conditions. So have many other philosophers theorizing about responsibility in Strawson’s wake. This method and focus has generated a host of quality of will theories of (...) responsibility. What I show in this paper is that if Strawson—and his followers—had focused on hurt feelings instead of resentment, not only would quality of will theories of responsibility be disfavored, but none of our other theories of responsibility could adequately account for them. I conclude by exploring what a conundrum this poses for our methods and starting points in theorizing about responsibility. (shrink)

Some of our most fundamental moral rules are violated by the practices of torture and war. If one examines the concrete forms these practices take, can the exceptions to the rules necessary to either torture or war be justified? Fighting Hurt brings together key essays by Henry Shue on the issue of torture, and relatedly, the moral challenges surrounding the initiation and conduct of war, and features a new introduction outlining the argument of the essays, putting them into context, and (...) describing how and in what ways his position has modified over time. The first six chapters marshal arguments that have been refined over 35 years for the conclusion that torture can never be justified in any actual circumstances whatsoever. The practice of torture has nothing significant in common with the ticking bomb scenario often used in its defence, and weak U.S. statutes have loop-holes for psychological torture of the kind now favoured by CIA in the 'war against terrorism'. The other sixteen chapters maintain that for as long as wars are in fact fought, it is morally urgent to limit specific destructive practices that cannot be prohibited. Two possible exceptions to the UN Charter's prohibition on all but defensive wars, humanitarian military intervention and preventive war to eliminate WMD, are evaluated; and one possible exception to the principle of discrimination, Michael Walzer's 'supreme emergency', is sharply criticized. Two other fundamental issues about the rules for the conduct of war receive extensive controversial treatment. The first is the rules to limit the bombing of dual-use infrastructure, with a focus on alternative interpretations of the principle of proportionality that limits 'collateral damage'. The second is the moral status of the laws of war as embodied in International Humanitarian Law. It is argued that the current philosophical critique of IHL by Jeff McMahan focused on individual moral liability to attack is an intellectual dead-end and that the morally best rules are international laws that are the same for all fighters.Examining real cases, including U.S. bombing of Iraq in 1991, the Clinton Administration decision not to intervene in the 1994 Rwandan genocide, NATO bombing of Serbia in 1999, and CIA torture after 9/11 and its alternatives, this book is highly accessible to general readers who are interested in the ethical status of American political life, especially foreign policy. (shrink)

Both of the main points in Professor Murphy's paper seem to me clearly and effectively argued.1 It is incontrovertible that some people find hurtful the use of medical technologies to avoid the birth of children who, in the present order of things, would be disabled. No result from the philosophy of language, or anywhere else for that matter, can plausibly show otherwise. Indeed, even to speak of ‘legitimately interpreting’ events that cause one pain as ‘hurtful’, as Murphy does, seems a (...) shade too conciliatory to any who has the temerity to doubt this matter: typically, at least, I don't interpret a state of affairs as hurtful. I experience it so—or not.He's quite right to point out as well that the fact that someone's actions cause another to feel hurt does not, on its own, imply much of anything about the action's propriety. There are many serious people who are deeply distressed by others' reproductive choices that have nothing to do with disability: terminating a pregnancy for any reason causes some people considerable pain. Yet there seems no reason whatever to regard that pain, considered on its own, as a reason that—at least in general terms—should bear on a person's decision concerning whether or not to give birth to the fetus that she is gestating.Expressivist arguments, so understood, then, seem to have had their measure taken. If anyone had the temerity to think that no one is hurt by choices to avoid or end pregnancies because they might lead to the birth of a child who would be disabled, they can drop that thought right now. On the other hand, if someone thought that the hurt suffered by such people constitutes a serious reason for restricting what others can find out about their potential or actual pregnancies, or …. (shrink)

Jesus embodies for the Christian the model of true service, which should be discernibly distinct from secular service. Even for non-Christian services, the Church offers relevant models and teaching. Contemporary service structures often lose sight of the dignity of served and server, and have grown dependent upon technology and technique, straying outside the realm of relationality. An example of this within certain service fields is reliance on physical and mechanical restraints to restrict movement, causing harm to recipients and to the (...) relationship between server and served. Such techniques overshadow the nature of Christian service, which is personal, relational, and communal. Catholic social doctrine, and many personalist frameworks, build on the pillars of dignity, responsibility, and subsidiarity. Rules alone will not be protective against service-mediated harm; however, principled servers can protect vulnerable people, particularly when guided by a concern for the common good, fraternity and solidarity. (shrink)

Social rejection is cold and hurtful, but how and why it is formed remains under-investigated. Our study offers one possible explanation from the rejector’s perspective by developing a moderated mediation model on the emotional antecedent and consequence of social rejection. Specifically, envious individuals use social rejection to complement their inferiority, further triggering their negative affect. Drawing on social comparison theory, we conducted an experience sampling methodology investigation of 55 frontline workers through a 10-workday-survey. As predicted, daily envy is positively associated (...) with daily social rejection. Daily social rejection is positively related to daily negative affect. Furthermore, daily social rejection mediates the relationship between daily envy and daily negative affect. These effects are more robust for females than males, including the impact of envy on social rejection and the impact of envy on negative affect via social rejection. We suggest the recipient and the rejector make psychological and behavioral adjustments accordingly. We also recommend that future research extend our current study methodologically and theoretically. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)

Israel characteristically met the hurtful dimensions of existence head-on, of course viewing them as faith crises, times of wondering about God and his fidelity, but also as faith opportunities, times to articulate again their expectations and assumptions, times to reformulate their position vis-à-vis the world of hurt and the God of faithfulness.

This article examines the belief among the cultural elites that ‘people’ should be protected from dangerous knowledge, ‘dangerous’ in the sense that there are factual statements which may have negative moral and political consequences to society. Such a belief in the negative consequences of dangerous – that is, politically suspicious – knowledge represents an intellectual tradition that goes back to Plato and his famous state‐utopian work Republic. This article analyses moral interpretations of statements regarding matters of fact (so‐called moral reading), (...) and draws conclusions about the reasons why knowledge can be considered dangerous to ‘the people’ or to some specific groups in the population, such as children, mothers, students, the sick and dying and the working class. The so‐called sociobiology debate, a controversy that started with the publication of the zoologist E.O. Wilson’s Sociobiology in 1975, is discussed in this article as a ‘case study’ of dangerous knowledge. (shrink)

The Truth That Never Hurts brings together for the first time more than two decades of literary criticism & political thought about gender, race, sexuality, power & social change. As one of the first writers in the United States to claim Black feminism for Black women in the early seventies, this authors works has been ground breaking in defining a Black women's literary tradition; in examining the sexual politics of the lives of Black & other women of color; in representing (...) the lives of Black lesbians & gay men; & in making connections between race, class, sexuality, & gender. Her essay "Toward a Black Feminist Criticism," is often cited as a major catalyst in opening the field of Black women's literature. This essay also presented the first serious discussion of Black lesbian writing. Essays about racism in the women's movement, Black & Jewish relations, & homophobia in the Black community have ignited dialogue about topics that few other writers address. The collection also brings together topical political commentaries that examine the 1968 Chicago convention demonstrations; attacks on the NEA; the Anita Hill/Clarence Thomas Senate hearings; & police brutality against Rodney King & Abner Louima. It also includes a never before published personal essay on racial violence, the day-to-day life of Kitchen Table Press, & the bonds between Black women that make it possible to survive. This authors writing offers a rare combination of intellectual challenge & an accessible personal voice. her commitment to telling the truth about difficult, even volatile issues, makes a unique contribution to American literature & social thought. (shrink)

In this article, the author asserts that a group of poor white middle school young women in the postindustrial urban Northeast are living among high concentrations of domestic violence. Many of these females are constructing futures characterized by jobs and self-sufficiency. As their narrations indicate, such plans are fueled by the hope that by living independent lives as single career women, they will bypass the domestic violence that currently rips through their own and their mothers' lives. By not critically exploring (...) the issue of violence against women in classrooms, the author argues that schools become implicated in the silencing and “normalizing” of abuse. This analysis is one piece of a large-scale ethnographic study in which the production of identities among poor white urban girls and boys is explored. (shrink)

Pain and pleasure affect us all. Knowing this with empathy, and acting upon it, civilises us. Without such empathy, pain can become a means of domination and injustice. Moreover, pain is expressed and responded to in all social contexts, and the word “pain” has diverse meanings, depending on the associated activities. To observe various ways in which we say that it hurts, and the many meanings of pain, I follow ordinary-language philosophy, particularly Ludwig Wittgenstein and John L Austin, and I (...) consider a range of social and historical contexts, from the closest intimacy, everyday chatter, the clinic, and beyond, to the domain of public policy and human rights. This addresses our verbal expressions of pain, their lived contexts and effects, within relationships and among social groups, altering mutual obligations, eliciting actions and reactions, and thence creating moral, legal and political norms. My aim, then, is to consider the social and political implications of ordinary performative pain-talk, in particular regarding the relationship between pain and justice, public policy, human rights and law.Clinical Implications: Clinicians’ roles in disability assessment and pain management are often affected by extrinsic concerns such as financial incentives and the risks of substance abuse. This chapter addresses those complex issues, illustrating how they have arisen in particular historical circumstances, and with political and economic causes and consequences. While unable to provide ready-to-hand clinical solutions, a pragmatic ordinary-language approach to conversations and disagreements about pain helps to chart the grounds on which these matters are debated. (shrink)

Visual content captures attention, is easy to understand, and is more likely to be remembered. However, it is not limited to conveying informative content; it can also be used to propagate hate. While existing research has predominantly focused on textual hate speech, this study aims to address a research gap by analyzing the characteristics of visual hate, including its channels, intensity, sources, and targets, through a standardized manual content analysis. The hate images were collected through the citizen science approach of (...) data donation. Findings highlight that transgender individuals and migrants are the primary targets of visual hate. It reveals a presence of hate images not only on communication platforms but also in various intermediaries and journalistic media. Half of these images use factual or humorous methods to discriminate against individuals or groups, while an equal number adopt a highly aggressive tone. The study suggests governance measures to combat this issue effectively. (shrink)

This chapter contains sections titled: Moral Argument Science and Health Argument Social Policy Argument.

This article suggests reading Theodor Adorno not as a notoriously pessimistic sociologist but as a committed public educator. Partly drawing on still unpublished transcripts of lectures, public talks and radio broadcasts from the 1950s and ’60s, the article offers an account of Adorno’s concept and practice of a ‘democratic pedagogy’. The key question is how we should understand the difference between Adorno the social philosopher, on the one hand, and Adorno the educator, on the other. It is argued that Adorno’s (...) pedagogical interventions are not a footnote to his social theory, but a key to understanding his entire oeuvre. (shrink)

Abusive supervision, defined as subordinates’ perception of the extent to which supervisors engage in the sustained display of hostile verbal and non-verbal behaviors, excluding physical contact, is associated with various negative outcomes. This has made it easy for researchers to overlook the possibility that some supervisors regret their bad behavior and express remorse for their actions. Hence, we know little about how subordinates react to the perception that their supervisor is remorseful and how this perception affects the outcomes of supervisors’ (...) undesired behavior. Specifically, drawing on the social exchange theory and displace revenge literature, this study explains how abusive supervision leads to victims’ service sabotage behavior. In addition, this study also investigates how perceived supervisors’ remorse mitigates the adverse effects of abusive supervision. Based on time-lagged, dyadic data from Chinese individuals, this study found support for all the proposed relationships, i.e., abusive supervision leads to service sabotage through the mediating effect of revenge desire. The findings also conclude that PSR lessens the detrimental effects of abusive supervision on victims’ behavior with their customers. Finally, this research contributes to service sabotage literature by highlighting the possibility where abusive supervisors cause service sabotage behavior among victims. This study also shows the importance of PSR’s role in decreasing service sabotage behavior exhibited by victims of abusive supervisors in the service sector. (shrink)

Pain asymbolia is a rare condition caused by brain damage, usually in adulthood. Asymbolics feel pain but appear indifferent to it, and indifferent also to visual and verbal threats. How should we make sense of this? Nikola Grahek thinks asymbolics’ pains are abnormal, lacking a component that make normal pains unpleasant and motivating. Colin Klein thinks that what is abnormal is not asymbolics’ pains, but asymbolics: they have a psychological deficit making them unresponsive to unpleasant pain. I argue that an (...) illuminating account requires elements of both views. Asymbolic pains are indeed abnormal, but they are abnormal because asymbolics are. I agree with Klein that asymbolics are incapable of caring about their bodily integrity; but I argue against him that, if this is to explain not only their indifference to visual and verbal threat, but also their indifference to pain, we must do the following: (i) take asymbolics’ lack of bodily care not as an alternative to, but as an explanation of their pains’ missing a component, and (ii) claim that the missing component consists in evaluative content. Asymbolia, I conclude, reveals not only that unpleasant pain is composite, but that its ‘hedomotive component’ is evaluative. (shrink)

Mitchell defends the Epicurean account of friendship. I argue that since Epicureans are hedonists who hold that all pleasures are good and all pains are bad, Epicureans would desert their friends in circumstances in which standing by their friends causes them pain.

Avi Mintz (2008) has recently argued that Anglo-American educators have a tendency to alleviate student suffering in the classroom. According to Mintz, this tendency can be detrimental because certain kinds of suffering actually enhance student learning. While Mintz compellingly describes the effects of educator’s desires to alleviate suffering in students, he does not examine one of the roots of the desire: the feeling of compassion or pity (used as synonyms here). Compassion leads many teachers to unreflectively alleviate student struggles. While (...) there are certainly times when compassion is necessary to help students learn, there are other times when it must be overcome. Compassion in the classroom is a two-edged sword that must be carefully employed; and yet it is often assumed that it is an unequivocal good that ought to trump all other impulses. In this article I hope to raise awareness concerning the promises and pitfalls of compassion in education by examining the theories of two historical figures who famously emphasised compassion in their philosophical writings: Jean-Jacques Rousseau and Friedrich Nietzsche. Rousseau and Nietzsche argue that compassion is a powerful educational force but that it must be properly employed. For Rousseau and Nietzsche, compassion is necessary to develop self-mastery in human beings—the ultimate goal of education—but it is a compassion that must hurt in order to help. My hope is that Rousseau’s and Nietzsche’s ideas on compassion will encourage thoughtful reflection on the uses and abuses of compassion in education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 23-24 [Access article in PDF] Did You Hurt Yourself? Katherine Morris PEOPLE WITH BORDERLINE PERSONALITY DISORDER (BPD) frequently deliberately injure themselves, to the extent that "the diagnosis [BPD] rightly comes to mind whenever recurrent self-destructive behaviors are encountered" (Gunderson, 2001, 54) quoted by (Potter, 2003, 1). How are we to understand this puzzling and disturbing behavior?Situating her approach to this question within a (...) general framework that sees the body as a "text" that requires "interpretation," Potter deliberately avoids answering this question in the way we might expect. It is doubtful, she argues, that every act of self-injury has a meaning, and a fortiori doubtful that every such act has the same meaning. Her discussion includes a section, informed by medical anthropology, in which she attempts to distinguish pathological self-injury of the sort that occurs with BPD from such culturally acceptable (or at least culturally understood or tolerated) body modifications, such as tattooing, scarification, and body piercing. It also includes a section in which it is suggested that the meaning of some self-injurious behavior may indicate cultural rather than individual pathologies (e.g., the "commodification" and "objectification" of women's bodies in Western culture). The principal issue for her, however, is how a clinician is to work out the meaning of a particular individual's self-injuring behavior when it does indeed have an individual meaning, and the prerequisite for doing so, she argues, is the cultivation of a virtue she terms giving uptake.The general tenor of her argument seems to me to be admirable: the issues are dealt with subtly and with ethical, anthropological, and philosophical sensitivity. There are nonetheless a number of questions I want to raise. The Framework It is of course fashionable in certain quarters these days to speak of the body as a text. One might, however, wonder to what extent this metaphor is illuminating. After all, texts, one might think, are by definition linguistic; yet part of the point here is precisely to move away from the narrow "speech-act" focus of "traditional philosophical analyses of communication" (Potter 2003, 1-16).The point of the metaphor according to Potter is to "suggest that the body, like other mediums of communication, must be interpreted and that its meanings are not given or inevitable" (Potter 2003, 2). Again, however, this invokes a number of fashionable but questionable ideas: an easy reliance on the difficult idea that "how we experience the world is shaped by our conceptual scheme" (Potter 2003, 3), a structuralist account of signification (Potter 2003, 3), and the concomitant notion that all communication involves interpretation, indeed that the listener (or observer) "relies on linguistic and other conventions [End Page 23] to infer meaning" (Potter 2003, 4). As a general account of communication this seems to me to be wildly off the mark: we very seldom interpret others' words, we very seldom "infer their meaning." The supposition that we always do is the direct consequence of the externalizing of the relation between "signifier" and "signified" that constitutes the heart of structuralist linguistics. 1Now, it may well be that the sort of self-injuring behavior that is the focus of Potter's essay precisely does require interpretation. Insofar as it is expressive behavior (and again Potter is right to question whether it is necessarily always such), it seems to be importantly different, in just these respects, from many other forms of expressive behavior. In the first place, it is different (in just these respects) from the culturally tolerated forms of body modifications discussed in section 2; for members of the culture in which body piercing or tattooing is acceptable or tolerated, such behavior is understood without the need for interpretation. In the second place, it is different in just these respects from natural expressions (e.g., moaning as an expression of pain). And in the third, it is different in just these respects from the expression of thoughts in (at least nonmetaphorical) language (which, one might add, is all the more reason not to think of the body as a... (shrink)

The concepts of omniscience and omnipotence are defined in 2 ? 2 ordinal games, and implications for the optimal play of these games, when one player is omniscient or omnipotent and the other player is aware of his omniscience or omnipotence, are derived. Intuitively, omniscience allows a player to predict the strategy choice of an opponent in advance of play, and omnipotence allows a player, after initial strategy choices are made, to continue to move after the other player is forced (...) to stop. Omniscience and its awareness by an opponent may hurt both players, but this problem can always be rectified if the other player is omniscient. This pathology can also be rectified if at least one of the two players is omnipotent, which can override the effects of omniscience. In some games, one player's omnipotence ? versus the other's ? helps him, whereas in other games the outcome induced does not depend on which player is omnipotent. Deducing whether a player is superior (omniscient or omnipotent) from the nature of his game playing alone raises several problems, however, suggesting the difficulty of devising tests for detecting superior ability in games. (shrink)

Hypothesizing after the results are known, or HARKing, occurs when researchers check their research results and then add or remove hypotheses on the basis of those results without acknowledging this process in their research report (Kerr, 1998). In the present article, I discuss three forms of HARKing: (1) using current results to construct post hoc hypotheses that are then reported as if they were a priori hypotheses; (2) retrieving hypotheses from a post hoc literature search and reporting them as a (...) priori hypotheses; and (3) failing to report a priori hypotheses that are unsupported by the current results. These three types of HARKing are often characterized as being bad for science and a potential cause of the current replication crisis. In the present article, I use insights from the philosophy of science to present a more nuanced view. Specifically, I identify the conditions under which each of these three types of HARKing is most and least likely to be bad for science. I conclude with a brief discussion about the ethics of each type of HARKing. (shrink)

Economic exchange constitutes the basis of many, but not all, aspects of human cooperation. The incentives overlap with, but remain distinct in important ways, from other fundamental aspects of cooperation, including the organization of collective violence for combat. The specific alignment of sometimes-conflicting goals helps inform the construction of political ideology.

Participation in sports such as football puts youth athletes at high risk of injury. helmets cannot protect players from the possibility of traumatic brain injury, and repeated concussive injuries can lead to chronic traumatic encephalopathy later in life. in light of such facts, the morally appropriate role of physicians who treat patient-athletes comes into question. i argue that pediatricians ought to be committed to a high level of shared decision making, whereby their goal, rather than being to provide the medically (...) best advice (which, let’s be honest, would be to not play football at all), would be to provide the medically best advice in light of patients’ honestly professed plans and goals. if patient-athletes see their doctor as an ally, who wants them on the field as much as they want to be there, they will be more likely to trust their pediatrician to help in the realization of those goals, even if they report an injury. while this approach could feel like a medical betrayal, in that the physician could feel complicit in helping a patient to continue engaging in high-risk behavior, i argue that medical outcomes will be better than if patientathletes see physicians as an obstruction to their athletic goals. (shrink)