This paper raises a slightly uncomfortable question: are some delusional subjects responsible for their delusions? This question is uncomfortable because we typically think that the answer is pretty clearly just ‘no’. However, we also accept that self-deception is paradigmatically intentional behavior for which the self-deceiver is prima facie blameworthy. Thus, if there is overlap between self-deception and delusion, this will put pressure on our initial answer. This paper argues that there is indeed such overlap by offering a novel (...) philosophical account of self-deception. The account offered is independently plausible and avoids the main problems that plague other views. It also yields the result that some delusional subjects are self-deceived. The conclusion is not, however, that those subjects are blameworthy. Rather, a distinction is made between blameworthiness and ‘attributability’. States or actions can be significantly attributable to a subject—in the sense that they are expressions of their wills—without it being the case that the subject is blameworthy, if the subject has an appropriate excuse. Understanding delusions within this framework of responsibility and excuses not only illuminates the ways in which the processes of delusional belief formation and maintenance are continuous with ‘ordinary’ processes of belief formation and maintenance, it also provides a way of understanding the innocence of the delusional subject that does not involve the denial of agency. (shrink)

People do, quite naturally and not uncommonly, speak of other people as deceiving themselves, as being their own dupes. A man's child is ill and growing constantly worse. The father keeps talking optimistically about the future, keeps explaining away the evidence, and keeps pointing to what he insists are signs of improvement. We can easily imagine ourselves deciding that he has deceived himself about his son's condition. Nor is it the case that talk of self-deception is appropriate only in (...) connection with other people. We can easily imagine the father admitting, say, after the son's death, that he has deceived himself about the child's condition. Thus the notion of self-deception obviously has application. Furthermore, ordinarily talk of self-deception is not thought to be puzzling. (shrink)

The doctor's use of deception in appropriate circumstances has commonly been considered a necessity of the medical art. Resistance to full and frank communication is typical of many traditionally Catholic countries, and particularly of Italy, a western country where Catholicism remains particularly influential. The Catholic teaching on truth and lies, and the problem of telling the truth to a severely ill patient is discussed. It is suggested that the contemporary Catholic model of gradually telling a terminal patient the truth, (...) which looks reasonable and feasible in theory, is rarely followed in practice, as in the majority of cases the truth is not told tout court. Problems stem from the way in which medicine is currently practiced in Italy; from the synergism between Catholicism and the medical tradition's grounded paternalism; and from the ambiguity of the term ?hope?. Catholic ethics in fact recommends that the truth must be told without destroying hope, but the Catholic meaning of ?hope? is very different from its meaning in current language. (shrink)

Abstract:Knock ou Le Triomphe de la Médicine [Knock, or the Triumph of Medicine] (1923) is a satirical play by Jules Romains parodying the hierarchical power relationship between patient and doctor and the supposed infallibility of science in the early twentieth century. Drawing on the phenomenological work of German physician Herbert Plügge (1970), I argue that the play exploits the physical interconnections between the healthy body and the sick body to present health as a deceptive state of hidden or imminent (...) class='Hi'>illness. By anticipating illness, the play shatters the illusion of health in ways that are ethically, psychosocially, and biomedically salient. (shrink)

Commentators raised 10 major questions with regard to self-deception: Are dual representations necessary? Does self-deception serve intrapersonal goals? What forces shape self-deception? Are there cultural differences in self-deception? What is the self? Does self-deception have costs? How well do people detect deception? Are self-deceivers lying? Do cognitive processes account for seemingly motivational ones? And how is mental illness tied up with self-deception? We address these questions and conclude that none of them compel (...) major modifications to our theory of self-deception, although many commentators provided helpful suggestions and observations. (shrink)

It is widely assumed that a literal understanding of someone’s self-deception that p yields the following contradiction. Qua self-deceiver, she does not believe that p, yet – qua self-deceived – she does believe that p. I argue that this assumption is ill-founded. Literalism about self-deception – the view that self-deceivers literally self-deceive – is not committed to this contradiction. On the contrary, properly understood, literalism excludes it.

Anosognosia for hemiplegia is the denial of neurologically-caused paralysis, and it often co-occurs with a number of distortions of belief and emotion such as somatoparaphrenia and an exaggeration of negative affect towards minor health complaints. The salience of these latter symptoms led early investigators to propose explanations of AHP which construed it as a process of motivated self-deception against the overwhelming anxiety and depression that knowledge of deficit would otherwise cause, and which was observed in hemiplegic patients without the (...) anosognosia. Since some influential critiques of this approach, however, theories of this kind have largely been rejected on the grounds that they are inappropriately “psychogenic.” What has replaced them are a class of theories which explain the lack of awareness in terms of neurocognitive deficit, with the deficit in question variously described by researchers as involving spatial awareness, motor control, and other capacities. In this paper I argue – contra claims in the literature – that the patterns of explanation which are characteristic of the psychodynamic theory are not incompatible in principle with the notion that the illness involves neurocognitive deficit. That means that these patterns of explanation can be preserved where they make good sense of the obscure attitudinal and emotional symptoms that occur in AHP – symptoms that are otherwise difficult to explain. I suggest some ways in which this fact could be accommodated by deficit theories of the illness which are based on motor deficit. (shrink)

Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors’ decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed (...) ought to make such decisions, and whether the relatives’ preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors’ decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious , because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death. (shrink)

The author revisits the question raised during the 1990s by Gayatri Spivak in her famous and difficult article « Can the Subaltern Speak ? », a question which fuelled endless debates in the field of postcolonial studies. He shows that the question is deceptive : the issue is less to decide whether, in the absolute, the subaltern can speak - they obviously can -, but to see whether they actually manage to do so, and to make themselves heard when it (...) really matters, i.e., within a specific political situation. (shrink)

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be (...) acceptable when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with (...) irrational beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this knowledge relates to the ‘world out (...) there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

Critical realism provides an alternative to positivism and interpretivism. It foregrounds ontology and an evaluative approach to knowledge, while promoting eclectic reasoning, transdisciplinarity, and ethical research across the quantitative/qualitative, macro/micro and other divides. Health researchers have usefully employed critical realism, though it has also been dismissed as strange, a source of self-deception and hubris. Furthermore, it has been accused of dehumanizing many people. Responding to these charges, this article makes the case for carefully employing critical realism within and beyond (...) social studies of health. It first outlines some basic critical realist tenets before summarizing two exemplars within the sociology of health, illness and medical work. The discussion section, observing the principle of hermeticism, engages with some criticisms before offering a prolegomenon to research on the COVID-19 pandemic response. In conclusion, a ‘radical’ proposal is ventured for possible transformative action so that society is less hierarchical, more equal and salutogenic. (shrink)

Geoengineering – roughly “the intentional manipulation of the planetary systems at a global scale” (Keith 2000) – to combat climate change is often introduced as a “plan B”: an alternative solution in case “plan A”, reducing emissions, fails. This framing is typically deployed as part of an argument that research and development is necessary in case robust conventional mitigation is not forthcoming, or proves insufficient to prevent dangerous climate impacts. Since coming to prominence with the release of the Royal Society (...) report in 2009 (Shepherd et al. 2009, v), the Plan B framing has proved popular with scientists, in policy circles, and in the news media (see Nerlich and Jaspal 2012; Luokkanen, Huttunen, and Hilden 2014). Though sometimes used to refer to geoengineering as a whole, it is associated particularly strongly with stratospheric sulfate injection (SSI) techniques. Consequently, these will be our focus here. We argue that the plan B framing is particularly ill-suited to the integrative assessment of options within climate policy, because it oversimplifies a complex issue in a misleading and deceptive way. For instance, it highlights extreme positions, presents SSI as an alternative independent from mainstream policies, ignores the multiplicity of options available, and neglects threats of morally indecent SSI in a context of ongoing political inertia. We are particularly concerned about the way ‘Plan B’ risks conveying an implicit hyper-optimism about SSI, and so obscures the need for ethical standards. (shrink)

What is informed consent in medicine? For more than a generation, this deceptively simple question has vexed the law, discomfited medicine, and generated much inspired, provocative, and even contentious commentary.The question has also spawned several lawsuits. On one side stand patients who claim that, at the time of consent, they were ignorant of a particular risk; who state that, with more or different information, they would have chosen a different treatment; and who argue that, because of an adverse outcome, they (...) now deserve remuneration. On the other side, doctors uneasily watch the lengthening list of suits. Some, troubled by the law's expectations, have reacted by variously describing informed consent as a myth, a fiction, an unattainable goal, or a snare to entrap physicians. They point to the legal commentary condemning informed consent law as ill-defined, diffuse, and fraught with inconsistency, hazy at its best and virtually indecipherable to physicians at its worst: and lacking a fair standard to determine when a patient has sufficient knowledge to give effective consent. (shrink)

The question of whether any of us can truly be held responsible for what we do is an issue that occupied the ancient Greeks and continues to entertain our leading thinkers. Whether we can be held responsible for our health, or lack thereof, has additional layers of complexity because of the way in which what we do over time impacts our health. Those of us who have ever self-deceptively wondered about the apparent shrinking of our belt or at the fact (...) that the stairs seem to have multiplied are familiar with the idea that our health can change gradually over time as a result of successive choices that we have made. While there are one-off behaviours that can have an impact on health, for example, a single exposure to a very high level of radiation, in general, ill health develops over time, within an environment and complex set of interactions with other people. The implications of that complexity are central to this issue’s Feature Article by Brown and Savulescu.1 They note that there is debate over whether responsibility should play a role in the allocation of healthcare, and, rather than taking a view on that issue, make a number of suggestions about how the concept of responsibility used in healthcare can be enriched by attending to the complex relationship between behaviour and health. …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ConclusionNeil PickeringAs mentioned in my Introduction, and I am delighted to repeat now, the commentaries provided by Calvin Ho and Chua Hong Choon are both excellent. In reading them, some further thoughts were raised for me, and I briefly reflect on these now.In his legal commentary, Calvin Ho makes a plausible argument that Mr. T has the capacity (and hence the right) to make decisions in his current state (...) about his healthcare, and refers to two legal tests of decision-making competency laid down in the Singapore Mental Capacity Act (2008), which he believes Mr. T would pass. A question arises from each of the legal tests which Ho described.The first test involves the question of whether there is any “impairment of, or disturbance in the functioning of Mr. T’s mind or brain”. The claim made by Ho is that there is no impairment or dysfunction of Mr. T’s mind or brain. But, this raises a question: what are the functions of the mind? Christopher Boorse suggested that “We may surely assume … that the main function of perceptual and intellectual processes is to give us knowledge about the world” and against this standard “schizophrenia and all other psychoses with thought disorders look objectively unhealthy”.1 Further — and here is the specific point of discussion in relation to Mr. T — does his continuing denial that he is ill (his lack of insight) also constitute such a dysfunction? Is one function of our mind to tell us things about the functioning of our minds — to correct errors, spot illusions and self-deceptions, and respond to beliefs which are odd? If so, then perhaps Mr. T’s lack of insight indicates the presence of a dysfunction.The second test which (mainly for the sake of completeness) Calvin Ho refers to comprises a list of requirements for decision-making capacity. These are relevant if a dysfunction is identified by the first test. These are:(1). Understand information given to him;(2). Retain that information long enough to make the decision;(3). Use or weigh up that information as part of the process of decision-making; and(4). Communicate his decision.These requirements are familiar from other accounts of decision [End Page 222] making capacity, but at least some of these accounts have added a further requirement, “the ability to appreciate the nature of the situation and its likely consequences”.2 This is not merely the ability to understand what one is being told but also the ability “to apply the information abstractly understood to [one’s] own situation”. Potentially, Mr. T would fail this test. He frequently lacks insight into the fact that he is unwell, that is to say, he does not seem to appreciate that the information he is being given is true of him.I turn now to the clinical commentary by Dr. Chua. What chiefly struck me from this was the determination to engage with the patient as a person. Medication is not the first resort; rather, many other interpersonal approaches can and should be tried first. Medication is of course one aspect of treatment — and in some cases, any hope of any sort of engagement with a patient may rely upon some medical intervention succeeding. Perhaps Mr. T will turn out to be a patient of this kind, who can only be engaged in conversation about his experiences and the state of his mind if he has first taken a course of pills. But it has, over a number of years of speaking to psychiatrist colleagues, been borne in upon me that the psychiatrist himself or herself is a fundamental element of mental healthcare. The psychiatrist is not merely a route to help, the dispenser of prescriptions for pills, but someone with whom the patient can talk to and explore his or her experiences. In short, part of the therapeutic relationship which psychiatrists seek to establish is just a personal relationship. I am sure this is simply obvious to most clinicians and indeed to those who suffer from mental ill health and their caregivers. But sometimes, the obvious is worth pointing out.Indeed, the desire to engage with Mr. T as a person... (shrink)

In sub-Saharan Africa, a nurse gives iron pills as placebos to terminally ill patients. She tells them, acting in what she believes is in their best interests, “these will make you feel better”. The patients believe it will help their AIDS and their well-being improves. Do the motive and the patient’s positive outcome in well-being make the deceit justifiable when other issues such as consent, autonomy and potential consequences regarding the patient and the wider community are considered? Is there a (...) difference between lying and non-lying deception when the end result is the same? The patients feel better, but at what cost if the deceit was found out? It will be argued that although the actions of the nurse are understandable and to some extent defensible, they are unethical. It is not ethically acceptable to take away the patient’s autonomy and risk the health of the community even though the risk of deceit being discovered is a small one. (shrink)

This paper identifies and elucidates the underappreciated phenomenon of epistemic domination. Epistemic domination is the nonmutual capacity of one party to control the evidence available to another. Where this capacity is exercised, especially by parties that are ill-intentioned or ill-informed, the dominated party may have difficulty attaining epistemically valuable states. I begin with a discussion of epistemic domination and how it is possible. I then highlight three negative consequences that may result from epistemic domination.

Background Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening (...) diseases is provided to patients in Bangladesh. Methods This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets. Results This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family’s wishes and preferences. Conclusions While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient’s active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values. (shrink)

In 1996, the 9th Circuit Court of Appeal of United States ruled that a Washington law banning physician-assisted suicide was unconstitutional. In the same year, the 2nd Circuit found a similar law in New York unconstitutional. One year later, the U.S. Supreme Court reversed both rulings, saying that there was no constitutional right to assisted suicide. However, the Court also made plain that they did not reject such a right in principle and that “citizens are free to press for permissive (...) reforms… through legislation or referendums” (Dworkin 1997: 6). (The unanimity of the vote was therefore, as Dworkin notes (1997:1), deceptive.) Oregon chose to do so and legalized physician-assisted suicide in 1997. Oregon’s “Death with Dignity Act” is one of the latest expressions of a medical and legal consensus that has gradually emerged in U.S. and some European countries over the past two decades, that is, the consensus that recognizes the right of terminally ill and competent patients to receive assistance with suicide. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.4 (2005) 301-305 [Access article in PDF] The Beauty of Psychotherapy R. D. Hinshelwood Keywords awe, psychotherapy, representation, self-esteem The Enlightenment was devoted to clear uncontaminated reason; its success has given us the terrific achievements of science and technology. However, it has bequeathed problems too. Untrammeled reason has led to the devaluing and exclusion of emotions. Emotions are irrational—self-deception, akrasia, and so on. They (...) were a problem for the eighteenth-century philosopher Kant and right through to the modern therapist Aaron Beck. Callender rightly looks around the edges of rationalist thought to see what can be said about the emotional and subjective side of mankind. He argues that there is more to the human mind than cognition. Something has been left out. What can be found to fill the gap?Callender has searched for the missing link that might complete our view of human nature. And he came back with aesthetics. Meaning The Enlightenment failing is writ large for therapists who are confronted with people who feel things. So we need to ask what place the emotions have in understanding the nature of man? It is not a hypothetical question, but a very practical one for a therapist. Emotions, Callender says, and most people would agree with him, are what gives meaning to life, a sense of purpose in living, even an ill-defined or delusional purpose.He presents Kant's description of aesthetics. Aesthetic judgements have a number of features, the most enigmatic and perhaps profound is a "purposiveness without purpose." A work of art, say a portrait, may have a purpose insofar as it represents a person for his aggrandizement or for his descendents through many generations, but the aesthetic quality does not come from that purpose. The aesthetic purpose involves a different set of judgements. They are about the painting as a piece of art in itself. If it is possible to compare this kind of aesthetic judgement with a judgement of a person's life, then I find myself reminded of Wollheim's definition of a person: The simplest way of putting the matter, which is not to be taken as a metaphysical claim, is this: There are persons, they exist; persons lead lives; and as a result, in consequence—in consequence that is, of the way they do it—there are lives, of which those who lead them may, for instance, be proud, or feel ashamed. So there is a thing, and there is a process, and there is a product. (Wollheim 1984, 2) Although many things do not lead lives, we do. And our lives have a process and a product. Like an aesthetic product, our lives have a sense of emotional meaning, without it having a clear purpose.Aesthetic judgements are therefore of a particular and somewhat peculiar kind. They judges talent for producing "that for which no determinate [End Page 301] rules can be given," as the paper quotes Kant. Other kinds of judgements do have determinate rules. First are empirical judgements for getting practical things done; and moral judgements for assessing ethical good from bad. Aesthetic beauty does not have clear rules, although many systems of rules have been proposed starting with the rules of perspective as they were laid out by renaissance painters, through to systems of color, such as that proposed by Paul Klee, once color was correlated with electromagnetic wavelengths. However, artists have always kept one jump ahead and evaded imprisonment in codified rules. So too it is with leading a life, perhaps. The really creative life is not lead according to rules. The art of life is to live meaningfully without simply running along tramlines. Although moral conduct and the practicalities of life remain significant, perhaps leading a life implies simply a "flare for living." Representation Of these three kinds of judgements that a mind makes, two do have sets of rules. Only one based on rationality, empirical evidence, and reason. Reason judges what can be done and achieved in the real physical world. It is about pragmatics and the usefulness of action. Moral judgements, about what... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 239-242 [Access article in PDF] The Uses of Borrowed Knowledge: Chaos Theory and Antidepressants Stephen H. Kellert Keywords chaos, metaphor, rhetoric, values Ever since the popularization of chaos the-ory in the 1980s, there has been an explo-sion of interest in work in nonlinear dynamics generally and the study of strange attractors in particular. From law to economics to theology, researchers in the social (...) sciences and the humanities have sought to make use of the concepts, methods, and results of chaos theory. Previous generations have seen similar attempts to explore the consequences of relativity theory or quantum mechanics for their own areas of inquiry. In examining the implications of chaos for the treatment of mental illness, Douglas Heinrichs provides an example of this phenomenon, which I call "borrowed knowledge." Lacking expertise in the areas of psychotherapy or psychopharmacology, I view his suggestions as a case study in the ways that knowledge gets used across disciplinary boundaries. In these remarks, I examine some of the different functions that borrowed knowledge can serve in order to argue that although cross-disciplinary borrowing can be a fruitful source of new insights, it is not without its dangers. I look at the persuasive function that borrowed knowledge can serve in making one's ideas plausible candidates for further exploration, as well as in motivating methodological change. I look at the conceptual work performed by metaphors, paying special attention to the question of how we can judge whether or not a nonliteral use of knowledge from the natural sciences is fruitful. And finally, I look at the ways in which borrowed knowledge can be used to address evaluative questions—in this case, questions about autonomy and appropriate therapeutic practice. I do not mean for these various functions to be thought of as exclusive categories. Instead, they overlap, interact, and combine in various ways. Rhetorical Functions, Disciplinary Prestige, and Methodologic Change In examining the persuasive uses of chaos theory, I should make it clear that by "persuasive" I do not mean illegitimate or deceptive. When Heinrichs points out that what he calls the traditional model of brain function is used to [End Page 239] present and explain the use of antidepressants (ADs) to clinicians and the general public, it becomes clear that he believes an alternative model can be useful for explicating and justifying the use of ADs for clinicians and patients. This descriptive function of the metaphorical appeal to a chaotic "attractor landscape" shows up where Heinrichs discusses the use of the chaotic model for patient education and the "rationale for pharmacotherapy," giving patients "appropriate expectations."But the rhetorical functions of chaos theory also come into play with audiences other than patients; they apply to the audience for the scholarly article itself, perhaps attracting attention because of the novelty or promise of a new field of research, but also harnessing the considerable disciplinary prestige that the natural sciences wield in our culture. All of these functions are useful in directing attention to the author's suggestions for further research, especially where he suggests that it would provide the clinician with guidance in working with an individual patient. Here I take it that Heinrichs has made fruitful use of the work of Thelen and others on the variability of individual developmental trajectories. This proposal for methodological change suggests that focusing on the dynamics of system and its evolution through time may be important in addition to focusing on equilibrium states. The disciplinary prestige of the natural sciences can provide a valuable and legitimate resource for the persuasive task of encouraging one's colleagues to explore a new methodological approach.A further rhetorical use is found in the appeal to the unpredictability of chaotic systems to account for the variability of results in the application of ADs. We see this where Heinrichs says, "a meaningful science of persons is possible even in the face of their ultimate unpredictability" (2005, 221). The disciplinary prestige of the natural sciences, which in studying chaotic systems are able to achieve genuinely "scientific" status without being able... (shrink)

As the population in the United States gets older, more people suffer from dementia, which often causes neuropsychiatric symptoms such as agitation and paranoia. This can lead patients to refuse medications, prompting consideration of covert administration (that is, concealing medication in food or drink). While many condemn this practice as paternalistic, deceptive, and potentially harmful, the end result of assuming the “moral high ground” can be increased suffering for patients and families. This article addresses common criticisms of covert medication and (...) presents a detailed algorithm by which to determine whether the practice is ethically permissible in specific cases. It also explores why so little attention has been paid in the U.S. to this presumably common practice, and reviews professional statements from Europe that endorse the practice. Finally, it presents a compelling argument for the role of Ulysses clauses in advance care planning, not only for patients with psychiatric illness but also for those who may suffer from dementia, which is far more common. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Working with Patience:An Insight into Dealing with Difficult EmotionsDavid VilanovaAs the most trusted professionals in the nation, nurses are expected to care for their patients with empathy and freedom from bias. The reality is that nurses are human, and some form of implicit bias is inevitable. In my own experience, this issue has reared its head on several occasions. My nursing background is prominently in cardiac and intensive care. (...) Seeing patients at their most vulnerable has become a regular part of my practice. Among some of the most challenging cases for me have been when I assume care of a patient withdrawing from alcohol. As an adult child with close alcoholic family members, many instances of abuse and pain stick with me today and these are brought to the surface when I care for patients with alcohol use disorder. In most cases, I easily find a healthy balance between remaining an understanding-and-empathetic provider and protecting my emotional and mental health as I navigate ethical and moral issues. However, with this patient population, walking that fine line is especially challenging. How do I navigate and manage intensely personal emotions and biases while providing the high-quality care I vowed to deliver regardless of my patient's life choices, addictions, and illnesses? How do I maintain an appropriate level of neutrality and clarity as this patient's behavior and attitude spark emotional triggers? In other words, how do I take care of someone I don't like?Mrs. H was a middle-aged Hispanic woman, barely coherent, but speaking clearly enough that I could understand her slurred speech. Immediate dread washed over me as I realized my assignment included a patient withdrawing from alcohol. The patient's affect, incoherence, and aggression were all too reminiscent of a traumatic past I still work to heal from. My coworkers couldn't understand her insults and obscenities and were therefore unphased except for noting her unruly and erratic behavior. On the other hand, I could understand much of what she was yelling at me and any other staff who bravely walked into her room. My immediate thoughts were that this woman clearly did not want our help. My every attempt to enter her room, speak with her, and provide care were met with an all too familiar rejection and denial that she even had a problem. Yet here she was in a hospital room, and I was her nurse. She verbalized denial of drinking too much when told that she was being treated for alcohol withdrawal. She stated this denial more to herself than to the health care providers in the room, and it was reminiscent of the denial I have seen in my loved ones. This was ironic, I always thought, as the need for such self-deception in and of itself points to the fact that something may be wrong and worth addressing.But denial or not, today, this patient—Mrs. H, was entrusted into my care. She refused treatments and medications, and this put me in a complex ethical predicament—treating a patient that I do not like for the personal issues she reminds me of, and the treatment of a patient against their refusal, as she was deemed incapable of making her own decisions. The latter of these two issues was easiest to put aside. Legally, this patient needed to be treated through her alcohol withdrawal. Once her mental status cleared up, she could sign out against medical advice or choose to remain until a safe discharge plan was in place. There was a protocol and legal guidelines for this situation. However, no guidelines [End Page 10] truly exist when it comes to the management of a patient that you simply do not like. The result can be a near-instantaneous dread each time you must answer that patient's bed alarm, call light, or most basic needs. A negative bias takes over, and it would be an understatement to say that this affects the quality of care. Patients in situations like this—with providers who judge them as I have been guilty of—can easily become subject to derogatory remarks, health inequities, and biased labeling... (shrink)

Scientific interest in hysteria began in Mexico at the end of the 19th-century, as the medical profession expanded. The Mexican doctors studied madness, drawing on what was confidently regarded as a firm basis of epistemological knowledge. Using modern physiology they entered a discussion that had begun some time before in Europe. Encountering hysteria, an illness presumed to be caused by ‘over-civilization’, they searched for a universal definition. The doctors tried to impose a unifying concept onto the diverse symptoms of (...) hysteria, and, although imitating European ideas, the discourse became distinctive in its attempts to relate hysteria to science and modernity so that all three would make sense. My interest in this article is the feminine; not a reconstruction of the relationship that medicine established between hysteria and the feminine, but a search for a space within the discourse that deconstructs identity and stereotypes. The feminine appears when the coherence of medical discourse is ruptured and when, to explain the illness, the doctors stop attempting to define it. This eventually occurs when the medical discourse considers the subject as unidentifiable and deceptive. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sophocles’ Trachiniae: Some ObservationsD. J. ConacherIn several ways Trachiniae seems almost a textbook of Sophoclean tragedy, so many elements of plot, theme, and even formal structure does it have in common with one or another (sometimes with several other) of the playwright’s works. The deceptive quality of oracles and prophecies, 1 the equally illusory nature of human happiness, the alternation between the familiar, even the domestic (insofar as Greek (...) tragedy can ever be “domestic”) and “the wild country”—the lonely, unknown, and sometimes feral areas of experience “out there”—, 2 even the curious, “diptych” structure of the play, involving the disappearance of a major tragic figure from the action: 3 all these features, so prominent in Trachiniae, are to be found in various other Sophoclean tragedies. Yet in all cases Sophocles uses what appear to be common features in different combinations and contexts to produce strikingly different tragic effects. It [End Page 21] should not surprise us, then, that Trachiniae, despite all these typically “Sophoclean” elements, 4 should turn out to be, if not the most baffling, at least among the most mysterious of his extant works.The key to the full appreciation and understanding of this tragedy lies, I think, in recognizing precisely how the poet interweaves these different elements of plot and theme to achieve, ultimately, a single tragic effect. Ironically, it is the constant alternation of human fortunes, apparent good fortune arising from ill and vice versa, which supplies the cohesive, “sequential” element to the plot. 5 Two essential thematic elements lie behind this alternation. One is the repeated misunderstanding of oracles and other prophetic utterances; the other is the repeated interaction between the protected, domestic sphere and the mysterious, natural (and sometimes magical) world, which threatens its existence. In the deployment of both these elements, the characterization of Deianira, the central figure though not the ultimate focus of this tragedy, is essential. It is through the gentle Deianira that Heracles is twice brought in contact with the savage “outside world” which leads ultimately to his undoing. Thus (as is usual in Sophocles) are the play’s prophecies fulfilled in unexpected and tragic ways. Thus, too, do the gods fulfill the destinies which they have planned through the unwitting cooperation of their pawns.Deianira sounds, as it were, the keynote of the play with her opening words in the Prologue:There is an ancient saying that one may not know the fate of any man, whether it be good or bad, until that man has died. But I, for my part, know, before I come to Hades’ house, that my lot is both grievous and unfortunate.(1–5) 6 [End Page 22]Deianira’s fear of life has begun (as she tells us in her Prologue account) in her maidenhood, with the courtship of the river-god Achelous. Here the three forms in which her monstrous suitor appears—first as a bull, then as a snake with shimmering coils, finally as a man with brow of ox and beard dripping with river’s springs—provide our introduction to the horrors of the untamed world. Heracles, a properly heroic suitor, appears to rescue her. It is significant, however, that the gentle heroine cannot bring herself to watch the struggle between the hero and Achelous, as she sits wrapped in terror lest her beauty should prove to be her bane (24–25). Thus, though threatened, Deianira remains untouched by—and ignorant of—the dangerous world outside.Deianira’s joy (18) at her rescue by Heracles is short-lived. As Heracles’ wife, and mother of his children, she is in constant fear for her absent husband (“each night dispelling last night’s terror with terror of its own,” 30–31) and these very fears are themselves fresh encounters, at one remove, with the savage world of Heracles’ labours. Her wandering husband, too (“like a tiller of a distant field, who sees it only when he sows and when he reaps,” 32–33), must himself seem like a visitor from a distant clime.The opening choral ode confirms the contrast between the world of the wandering Heracles and that of the waiting Deianira. Only the sun can tell... (shrink)

Wish-fulfilment as a singular means of satisfying ineluctable desire is a pivotal concept in classical psychoanalysis. Freud argued that it was the thread that united dreams, daydreams, phantasy, omnipotent thinking, neurotic and some psychotic symptoms such as hallucinations and delusions, art, myth, and religious illusions. The concept's theoretical exploration has been largely neglected within psychoanalysis since, but contemporary philosophers have recognised it as providing an explanatory model for much of the kind of irrational behaviour so problematic for psychiatry, social psychology (...) and the philosophy of mind. Although critically neglected in contemporary psychological and psychoanalytic thought, the concept remains clinically fundamental, under different labels: it encompasses the processes of omnipotent phantasy, symbolic or substitutive satisfaction, actualisation in transference and acting out, symptom formation and defenses such as projective identification. Wish-fulfilment can be shown to be a specifically psychoanalytic compartment of a common-sense psychological theory of action that illuminates not just clinical material but also the paradoxes of irrationality – such as weakness of will and self-deception – that preoccupy philosophers. The first half of this book develops a comprehensive and novel theory of wish-fulfilment, explores its radical implications for the structure of mind, and locates it against the backdrop of both contemporary psychoanalytic and philosophical thought. In the second half, the book applies the theory to illuminate important features of self-deception and delusion, religion, insanity defences, creative writing and the exclusion of mind and intention in the biological drift of modern psychiatry. The book will be essential to philosophers of mind, psychoanalysts, psychiatrists, psychologists, social theorists, and students in these disciplines; as well as readers interested in understanding how the mind works in mental illness, self-deception, religion, and creative writing. (shrink)

Jørgen Bukdhal’s study is a quietly moving and deceptively simple corrective to Kierkegaard’s reception. First published in Danish in 1961, it dispels the image of a lonely, angst-ridden individual, hopelessly mired in interiority and oblivious to concrete social ills. By deftly and eruditely elucidating the problematics of his time and by following the full expanse of his philosophical career, Bukdahl’s Kierkegaard comes closer to someone like Levinas. For “what matters is to exist for the sake of every person, unconditionally everyone”.

In a world where meat is often a token of comfort, health, hospitality, and abundance, one can be forgiven for raising an eyebrow at the conjunction “meat and evil.” Why pull meat into the orbit of harm, pestilence, ill-will, and privation? From another perspective, the answer is obvious: meat—the flesh of slaughtered animals taken for food—is the remnant of a feeling creature who was recently alive and whose death was premature, violent, and often gratuitous. The truth is that meat has (...) a checkered history in the West. From its origin-story in Abrahamic religion to its industrial production in today’s world, meat is well-marbled with evil and its minions: sin, violence, injustice, destruction, suffering, and death. Beyond keeping company with these obtrusive forms of evil, meat’s success at remaining, nevertheless, in our collective good graces illuminates some of evil’s subtler shades too. We might learn something of insidiousness, self-deception, rationalization, and bad faith by exploring why the ever-strengthening consensus that habitual meat-eating is unhealthful, morally dubious, and environmentally damaging is often still no match for a philosopher’s savor of cheeseburgers. My aim is to consider meat’s fitness for a place in the Western history of evil by reflecting briefly on its outsized roles at the bookends of this narrative: meat’s primeval history in Genesis, and its contribution today to ethical and environmental problems of arguably apocalyptic proportions. (shrink)

This essay argues that film deserves a place within the medical humanities curriculum and demonstrates effective strategies for employing it within medical ethics and humanities classrooms. Part One of the article emphasizes how and why medical ethics teachers can utilize documentary and fictional films, such as “Thomas Szasz and the Myth of Mental Illness,” “The Deadly Deception,”Whose Life Is It Anyway? and “Voices From the Front” in their courses. Such films encourage students to move beyond abstract debates and (...) confront the human pain inherent in all ethical dilemmas. Part Two focuses on documentary and fiction film in the medical humanities classroom. In this section, the author details how to incorporates films, such asThe Doctor, The Waterdance andHospital, into the humanities classroom, juxtaposing them with various literary works, such asOther Women's Children, Borrowed Time, andCeremony. Part Three of the essay presents a detailed discussion ofThe Elephant Man andFrankenstein, illustrating how visual and literary texts compliment each other within the humanities classroom. Overall, the author demonstrates how films function as engaging and complex visual texts providing unique insights in the particularities of American health care and, as such, can become valuable components within medical ethics and humanities classrooms. (shrink)

The surprising story of how Greek classics are being pressed into use in contemporary China to support the regime’s political agenda As improbable as it may sound, an illuminating way to understand today’s China and how it views the West is to look at the astonishing ways Chinese intellectuals are interpreting—or is it misinterpreting?—the Greek classics. In Plato Goes to China, Shadi Bartsch offers a provocative look at Chinese politics and ideology by exploring Chinese readings of Plato, Aristotle, Thucydides, and (...) other ancient writers. She shows how Chinese thinkers have dramatically recast the Greek classics to support China’s political agenda, diagnose the ills of the West, and assert the superiority of China’s own Confucian classical tradition. In a lively account that ranges from the Jesuits to Xi Jinping, Bartsch traces how the fortunes of the Greek classics have changed in China since the seventeenth century. Before the Tiananmen Square crackdown, the Chinese typically read Greek philosophy and political theory in order to promote democratic reform or discover the secrets of the success of Western democracy and science. No longer. Today, many Chinese intellectuals use these texts to critique concepts such as democracy, citizenship, and rationality. Plato’s “Noble Lie,” in which citizens are kept in their castes through deception, is lauded; Aristotle’s Politics is seen as civic brainwashing; and Thucydides’s criticism of Athenian democracy is applied to modern America. What do antiquity’s “dead white men” have left to teach? By uncovering the unusual ways Chinese thinkers are answering that question, Plato Goes to China opens a surprising new window on China today. (shrink)

In “The Phenomenology of Spirit” and “Philosophy of Right”, Hegel gives a detailed specification of the theses about the war that were claimed in earlier papers and manuscripts, but his position is not fundamentally changed. In the “The Phenomenology of Spirit” Hegel advocates governments’ need and right to initiate a war from time to time in order to prevent both the isolation and atomization, and let individuals feel the death. As in the past, the war, as Hegel says, has a (...) moment of ethical life. In the “Philosophy of Right” Hegel introduces final deliberations about war that rely on ideas of his earlier paper about natural law even more than in the “The Phenomenology of Spirit”. Hegel emphasizes the ethical role of sacrifice in the war and expresses opinions critical of not an abstract perpetual peace but a concrete philosophical project of Kant. Due to Hegel, Kant’s perpetual peace does not resemble a perpetual deception, since the required union of states is elusive and none except the world spirit in the world history can be a praetor. In line with Heraclitus, Hegel maintains that wars underlie the nature of things. I contribute to the discussions of Hegel scholars if Hegel’s philosophy glorifies a war or not as follows: I substitute the term “glorification” with the term “bellicisme” that suits better to measured, not snobbish and deprived of certain historical implications Hegel’s theses about reasonableness, necessity, the ethicality of war and ethicality of perpetual peace illness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Life Worthy of the Gods: The Materialist Psychology of EpicurusKelly E. ArensonDavid Konstan. A Life Worthy of the Gods: The Materialist Psychology of Epicurus. Las Vegas-Zurich-Athens: Parmenides Publishing, 2008. Pp. xx + 176. Paper, $34.00.In this modestly expanded edition of his 1973 book, Some Aspects of Epicurean Psychology (Brill), David Konstan attempts to flesh out the Epicurean explanation of the causes of unhappiness: “empty beliefs” (kenodoxia)—most importantly, (...) the groundless fear of death—and the irrational desires that fuel and are fueled by them. Konstan’s central argument, preserved from the earlier edition, is deceptively simple: empty beliefs, according to Epicureans, are in large part the product of a symbolic association—a “linguistic confusion”—of the afterlife with certain real-life human ills, such as poverty and obscurity.In the first chapter, which is new to this edition, Konstan calls on psychology to flesh out the Epicurean understanding of empty fears and irrational desires—ancient psychology, that is: a science of the soul. Konstan’s reading of the relation between sensation (aisthēseis), the passions (pathē) of pleasure and pain, and belief (doxa) in Epicurean doctrine is unorthodox but thorough. Rather than mapping pathē onto either the soul as a whole or the body, Konstan assigns pathē to the non-rational part of the soul, the seat of sensation. He locates the emotions, which “do not seem to have a special name in Epicurean theory,” in the rational part (11). Crucial to this schema is Konstan’s claim, based on Lucretius’s De Rerum Natura and Diogenes Laertius’s doxography of Epicurus, that Epicureans did not consider emotions such as fear and joy to be pathē at all, since emotions depend on memory and reasoning, whereas pathē do not. The upshot is that fear, as a rational emotion, involves belief and evaluation, and is therefore susceptible to error; whence the psychological roots of pernicious “empty beliefs.”In chapter two, Konstan addresses the Epicurean conundrum of why humans are plagued by fears and anxieties when their needs are so basic. Konstan takes as an explanation of this phenomenon Lucretius’s analysis of irrational desires and their parasitic relationship [End Page 95] with baseless fears. Out of their fear of death—the fear to beat all fears, according to Epicureans—people irrationally desire goods such as wealth, power, and glory that they mistakenly believe will delay their descent into the underworld. Konstan contends that there was a “symbolic association between poverty and death’s antechamber” that was not merely metaphorical (45); to escape poverty is not to cheat something like death, but to cheat death itself, just as to pursue wealth is literally to pursue life. In their vain quest to waylay death, people resort to greediness, crime, deceit—in short, any behavior that could result in material gain. Unfortunately, these unsavory activities serve only to augment rather than assuage fears, since wrongdoers fear being punished for their illicit deeds. The fear of punishment in turn spurs more irrational desires, forming a vicious cycle of mutually reinforcing behavior and states of mind that are incompatible with tranquility.In the final two chapters, Konstan combs Epicurean social theory for the roots of irrational fears and desires and shows how Epicurean epistemology enables the sage to avoid them. Konstan argues that harmful fears and desires emerged when words came to refer not only to visible sensory phenomena, but also to abstract notions whose referents might be phantoms—misleading accounts of the gods and the limits of desire that do not correspond with reality. In addition, laws served to foment fears of divine retribution and death as lawmakers attempted to regulate behavior by disseminating myths about the wrath of the gods and the afterlife. In the final chapter, Konstan is on well-trodden ground when he claims that the Epicurean sage is able to control fears and desires by understanding the nature of reality, pleasure, and human needs.This book will primarily be of interest to scholars of Epicureanism; the sheer number of footnotes and the technical language make it rather inaccessible to the non-specialist. And the specialist may find that Konstan’s treatment of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XX, Number 1, April 1994, pp. 73-84 Beattie's Lost Letter to the London Review JAMES FIESER The most well known written attack on Hume's philosophy during his life was James Beattie's Essay on the nature and immutability of truth (1770). Beattie's target was Hume's Treatise and its skeptical discussions of personal identity, the origin of ideas, causality, and virtue. His Essay was highly praised and resulted (...) in a yearly pension from King George III. Hume is reported to have reacted with anger to the publication of the Essay,1 and Hume's advocates retaliated by charging Beattie with unjustly abusing Hume. One such advocate was the London Review. The last issue of the London Review contains an editorial response to a letter they received from James Beattie. The context of the London Review response indicates that Beattie's letter was to have been printed in that journal. Strangely, however, the letter never appeared. Enough detail is provided in the London Review's response to reconstruct the thrust of Beattie's letter: Beattie contends that, contrary to the London Review's accusations, he did not abuse Hume in the Essay, and that Hume's criticisms of Beattie's poetic writings were based on prejudice. The letter is important since it represents Beattie's only attempt at a public defense of his treatment of Hume, and an explanation of Hume's unfavorable reaction to his poetical writings. After presenting the London Review's "Answer," I will discuss the nature of the conflict between Beattie and the London Review, and reconstruct the key James Fieser is at the Department of Philosophy, University of Tennessee at Martin, Martin, TN 38238 USA. e-mail: [email protected] 74 James Fieser points in Beattie's letter. It will be helpful to begin with background on the London Review itself. The London review of English and foreign literature was founded in January 1775 by William Kenrick as a monthly book review journal styled after, and in competition with, the Monthly Review and Critical Review. The review lasted for twelve Volumes with its final issue in December 1780. Kenrick, born in 1725, reviewed for the Monthly Review for seven years and was himself the author of books and articles on a range of subjects. As early as 1759 Kenrick voices his praise for Hume in an article for the Monthly Review, referring to him as a "masterly writer."2 Kenrick had a reputation for maliciously and deceptively provoking disputes with other writers, including Johnson, Garrick, and Goldsmith. Unlike the Monthly Review and Critical Review, which zealously preserved the anonymity of their reviewers,3 the London Review hinted at the authorship of their reviews by providing a single initial at the close of each article. The initial "W" refers to Kenrick himself. Kenrick's son, William Shakespeare Kenrick, assumed editorship of the journal when Kenrick was taken ill in the Spring of 1779 and after his death in June 1779. The Response to Beattie's Letter The reply to Beattie's letter appeared as the final item in the July 1780 issue of the London Review under the heading "Correspondences," and under the subheading "Answer to an Extract from a Letter from Dr. Beattie." The complete reply is as follows: Having, we apprehend, done Dr. Beattie ample justice by publishing his defence, let us now be equally just to the memory of a man who can no longer defend himself. Dr. Beattie's defence charges Mr. Hume with the meanness of contradicting himself in a fit of disgust, and of being swayed by passion in pronouncing sentence upon his poetical works. Till he produces his evidence, this attack upon the established character of Mr. Hume will have but little weight with the public, who have been long apprised of his exemplary probity, and strict honour. Why should Dr. Beattie suppose that we should be misinformed by a disinterested person, and desire us to disbelieve his testimony, when he would have us believe himself, who is not disinterested? Does he wish to prove that "we believe in all unbelief?" The Dr. says, "I never had any personal pique at Mr. Hume... (shrink)

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of (...) carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point - even a backbone - for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. (shrink)

In October 2022, I had the privilege of joining Hank Greely on the opening panel of the annual International Neuroethics Society (INS) meeting in Montréal, Tiohtiá:ke, situated on the traditional t...

In Phillip Kerr’s 1994 spellbinding novel A Philosophical Investigation, the medical test to which the protagonist refers is a functional brain scan based on positron emission tomography. It is used to run large studies of male and female brains and, following a lead suggested by animal studies, has been used to identify rare cases of human male subjects who lack the ventral medial nucleus. This nucleus, in the experiment, is hypothesized to inhibit the activity of the sexually dimorphic nucleus, a (...) preoptic area of the male brain believed to be a repository of male aggressive response. Prior research, we learn from the plot, shows that 3 in 100,000 human males are VMN-negative. Thirty percent of those affected are believed to be in prison or to have a criminal record; 70% are believed to stabilize levels of aggression by producing increased levels of estrogen. Identities of subjects participating in the brain scan studies are protected through the conversion of real names to those of famous figures of the past — Bertrand Russell, Charles Dickens. Those for whom results are unfavorable are recontacted, and they are offered counseling. (shrink)

In proportion to other serious illnesses, diseases of the brain and mind represent the greatest—and still increasing—public health burden that Western societies are facing. Consequently, scientists, governments, advocacy groups, and public health authorities are committed to research to tackle the causes and consequences of neurological and psychiatric diseases and to find cures for them. As neuroscience research progresses, ethicists and neuroscientists face numerous ethical challenges to the integration of frontier application of research—neurotechnology—with the delivery of high-quality healthcare. In this special (...) neuroethics issue, we have invited distinguished scholars with diverse disciplinary backgrounds to present their reflections and research on the ethical dimensions of this crucial integration. (shrink)

This paper was inspired by William Holman Hunt’s Pre-Raphaelite painting, The Light of the World.https://www.keble.ox.ac.uk/about/chaptel/Light%20of%20the%20world%202.JPG/view. It is a well-known Victorian oil painting with rich symbolism. In this essay I outline the context, describe the painting and reflect on the role of spirituality and contemplation in one’s work and personal life. I offer autoethnographic illustrations and argue that spirituality and contemplation make a positive contribution to wellbeing and can support one’s search for meaning, purpose and connectedness in the world.