The main aim of this paper is to highlight the need to address the conceptual problem of “implicit knowledge” or “implicit cognition” —a notion especially important in the study of the nonverbal minds of animals and infants. We review some uses of the term ‘implicit’ in psychology and allied disciplines,and conclude that conceptual clarification of this notion is not only lacking, but largely avoided and reduced to a methodological problem. We propose that this elusive notion is central in the study (...) not only of animal and infant minds, but also the human adult mind. Some promising approaches in developmental and evolutionary psychology towards innovative conceptualisation of implicit knowledge remain conceptually underdeveloped and in need of reconsideration and re-elaboration. We conclude by suggesting that the challenge of implicit cognition and nonverbal minds will only be solved through a concerted interdisciplinary approach between psychology and other disciplines. (shrink)

As the cognitive revolution was slow to come to the study of animal behavior, the vast majority of what we know about primate cognition has been discovered in the last 30 years. Building on the recognition that the physical and social worlds of humans and their living primate relatives pose many of the same evolutionary challenges, programs of research have established that the most basic cognitive skills and mental representations that humans use to navigate those worlds are already possessed by (...) other primates. There may be differences between humans and other primates, however, in more complex cognitive skills, such as reasoning about relations, causality, time, and other minds. Of special importance, the human primate seems to possess a species-unique set of adaptations for “cultural intelligence,” which are broad reaching in their effects on human cognition. (shrink)

Cognitive abilities cannot be measured directly. What we can measure is individual variation in task performance. In this paper, we first make the case for why we should be interested in mapping individual differences in task performance on to particular cognitive abilities: we suggest that it is crucial for examining the causes and consequences of variation both within and between species. As a case study, we examine whether multiple measures of inhibitory control for non-human animals do indeed produce correlated task (...) performance; however, no clear pattern emerges that would support the notion of a common cognitive ability underpinning individual differences in performance. We advocate a psychometric approach involving a three-step programme to make theoretical and empirical progress: first, we need tasks that reveal signature limits in performance. Second, we need to assess the reliability of individual differences in task performance. Third, multi-trait multi-method test batteries will be instrumental in validating cognitive abilities. Together, these steps will help us to establish what varies between individuals that could impact their fitness and ultimately shape the course of the evolution of animal minds. Finally, we propose executive functions, including working memory, inhibitory control and attentional shifting, as a sensible starting point for this endeavour. (shrink)

The aim of this article is to analyse some of the representations of intersectional gender that materialise in activism against genetically modified organisms (GMOs). It uses the case of Hawai'i as a key node in global transgenic seed production and hotspot for food, land and farming controversies. Based on ethnographic work conducted since 2012, the article suggests some of the ways that gender is represented within movements against GMOs by analysing activist media representations. The article shows how gender, understood (...) intersectionally, informs possibilities for movement-identification, exploring how themes of motherhood, warrior masculinities and sexualised femininities are represented within these movements. The article suggests that some activist representations of gender invoke what could be considered as normative framings of gender similar to those seen in other environmental, food and anti-GMO movements. It is suggested that these gendered representations may influence and limit how different subjects engage with Hawai'i anti-GMO movements. At the same time, contextual, intersectional readings demonstrate the complex histories behind what appear to be gender normative activist representations. Taken together, this emphasis on relative norms of femininities and masculinities may provide anti-GMO organising with familiar social frames that counterbalance otherwise threatening campaigns against (agri)business in the settler state. Understood within these histories, the work that gender does within anti-GMO organising may offer generative examples for thinking through the relationships between gendered representations and situated, indigenous-centred, food and land-based resistances. (shrink)

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 post-menopausal women (...) newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

The study of spatial cognition has provided considerable insight into how animals (including humans) navigate on the horizontal plane. However, the real world is three-dimensional, having a complex topography including both horizontal and vertical features, which presents additional challenges for representation and navigation. The present article reviews the emerging behavioral and neurobiological literature on spatial cognition in non-horizontal environments. We suggest that three-dimensional spaces are represented in a quasi-planar fashion, with space in the plane of locomotion being computed separately and (...) represented differently from space in the orthogonal axis bicoded.” We argue that the mammalian spatial representation in surface-travelling animals comprises a mosaic of these locally planar fragments, rather than a fully integrated volumetric map. More generally, this may be true even for species that can move freely in all three dimensions, such as birds and fish. We outline the evidence supporting this view, together with the adaptive advantages of such a scheme. (shrink)

This book examines cultural recognition and the struggle for identity in America's schools. In particular, the contributing authors focus on the recognition and misrecognition as antagonistic cultural forces that work to shape, and at times distort identity.

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

This case study extends the findings of Pickering et al. 2009 to the domain of conversational humor. We find that, as was the case in humorous narratives, conversational humor is not marked by higher pitch or volume, increased speech rate, or significant pauses. Unlike narrative humor, conversational humor is not produced at a lower pitch and slower rate than non-humorous parts of the text. We find that smiling and laughter tend to occur with humor.

The purpose of public and community health is to improve the health of populations or groups rather than concentrating on individuals. This book examines the ethical issues associated with public and community health. The contributors analyse the major ethical issues in public health - prioritisation, public participation, health promotion and screening - all of which reflect current practice in the UK. They examine what health services should be available, who should have access to which health services, what are the best (...) strategies for preventing disease, how can professional and public views be reconciled and when can an individual's health needs override the choice of a community. The contributors apply up-to-date ethical theory to practical examples in public health practice to provide a comprehensive and accessible introduction to the key issues in public health ethics. (shrink)

This special issue of Cultural Studies Review brings together an interdisciplinary range of scholarship to investigate the ethical implications of troubled images.

PurposeAsian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students.Materials and methodsA survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association (...) enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping.ResultsA total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills.ConclusionProfessionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population. (shrink)

Apresenta uma análise preliminar das manifestações dos autores das Ciências Sociais e Humanas dentro do campo da Biblioteconomia e da Ciência da Informação (B & C.I.), por meio do método bibliométrico e análise de citação. Com o objetivo de descortinar quais teóricos são convocados para a construção do conhecimento na produção científica dos campos supracitados, realizou-se uma pesquisa exploratória com vistas ao levantamento dos autores das Ciências Sociais e Humanas e, posteriormente, a verificação da ocorrência deles na produção indexada pela (...) Base de Dados em Ciência da Informação (BRAPCI). Foram identificados 180 autores, dos quais 91 apareceram pelo menos uma vez nas buscas empreendidas pelos nomes e sobrenomes desses autores das Ciências Sociais e Humanas. O resultado desta pesquisa demonstrou os dois autores mais citados, Michel Foucault e Pierre Bourdieu, bem como a presença de diversos autores das Ciências Sociais e Humanas na construção do conhecimento da Biblioteconomia e da Ciência da Informação, o que contribui para o fortalecimento e a consolidação de ambas. (shrink)

The health crisis caused by COVID-19 has resulted in the physical and emotional deterioration of health personnel, especially nurses, whose emotional state is affected by the high risk of contagion, the high demands of health services, and the exhausting working hours. The objective of this research was to determine the relationship between fear, anxiety, and fatigue of nurses caring for patients with COVID-19 in a second level public hospital in Peru. This study presents a quantitative approach and correlational level, cross-sectional, (...) and non-experimental design. The sample consisted of 145 nurses who attended patients with COVID-19 in health care areas. The results show a significant relationship between fear of contagion and physical-cognitive fatigue and a significant relationship between generalized anxiety and physical-cognitive fatigue. It is concluded that in this context, both fear of contagion and generalized anxiety are related to physical-cognitive fatigue. (shrink)

ABSTRACTObjective: This study was designed to improve our understanding of prospective memory changes in ageing, and to identify the cognitive correlates of PM decline, using a virtual environment, to provide a more realistic assessment than traditional laboratory tasks.Design: Thirty-five young and 29 older individuals exposed to a virtual town were asked to recall three event-based intentions with a strong link between prospective and retrospective components, three event-based intentions with a weak link, and three time-based intentions. They also underwent retrospective episodic (...) memory, executive functions, binding in working memory, processing speed, and time estimation assessments.Results: Older individuals recalled fewer intentions than young adults. While age-related PM decline affected the recall of both prospective and retrospective components, the recall of the latter seemed more challenging for older individuals when the link was weak. This PM decline was linked to an age-related decline... (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty‐eight subjects met these inclusion criteria. Narratives from (...) 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: “mental health treatment,” “poor general health and chronic pain,” “substance use,” “worsening mental health after bereavement,” and “repeating a family member's suicide.” Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help‐seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life. (shrink)

Since the 1970s, anthropologists have moved into diverse workplaces, including private and public settings, that raise new issues for anthropology as a discipline as well as for the discourse on science more generally. In the context of increasing globalization, the articulation of new ethical dilemmas around such issues as technology, indigenous knowledge and rights, government regulation and bioethics among others, can and do inform and shape scientific public policy. The authors in this volume work in traditional research centres and universities, (...) as well as in private and public sectors, and across specialties from medical anthropology and social medicine to archaeology and cyberspace. They explore the dimensions of an ethical anthropology in today's world, and the unique contribution of anthropology to the sciences. (shrink)

This article describes the spiritual formation training program for counseling students at Richmont Graduate University, an evangelical institution providing Master’s-level instruction for counselors and ministers. This model of spiritual formation has a dual foundation which includes the centrality of love to the Christian life and the importance of attachment to the development of persons. The training is intentionally designed to invite students to pursue a more secure attachment to God, healthier relationships with others, and a more grace-based self-awareness. Integrative and (...) clinical instruction, and experiences that foster establishment of secure attachment are described. Co-curricular efforts in research and student advisement focus on grace and wellness, as well as opportunities for service, and these serve to further contribute to a supportive environment for spiritual formation. (shrink)

A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno‐specific nursing homes create the ideal social condition for residents to express their (...) care needs and preferences in a language of choice. In nonethno‐specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences. (shrink)

ObjectiveHopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients.MethodsNeuro-oncological patients were examined perioperatively with the Distress Thermometer and the (...) Herth Hope Index. In addition, psychological comorbidities and an assessment of general psycho-oncological distress were recorded.ResultsSixty-six brain tumor patients were included. No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression and more negative expectations regarding therapeutic success. The extent of depression correlated negatively with hope.ConclusionUnexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression. (shrink)

In this paper we argue that predictive processing (PP) theory cannot account for the phenomenon of affect-biased attention prioritized attention to stimuli that are affectively salient because of their associations with reward or punishment. Specifically, the PP hypothesis that selective attention can be analyzed in terms of the optimization of precision expectations cannot accommodate affect-biased attention; affectively salient stimuli can capture our attention even when precision expectations are low. We review the prospects of three recent attempts to accommodate affect with (...) tools internal to PP theory: Miller and Clark’s (2018) embodied inference; Seth’s (2013) interoceptive inference; and Joffily and Coricelli’s (2013) rate of change of free energy. In each case we argue that the account does not resolve the challenge from affect-biased attention. For this reason, we conclude that prediction error minimization is not sufficient to explain all mental phenomena, contrary to the claim that the PP framework provides a unified theory of all mental phenomena or the brain ‘s cognitive functioning. Nevertheless, we suggest that empirical investigation of the interaction between affective salience and precision expectations should prove helpful in understanding the limits of PP theory, and may provide new directions for the application of a Bayesian perspective to perception. (shrink)

The acquaintance debate in aesthetics has been traditionally divided between pessimists, who argue that testimony does not provide others with aesthetic knowledge of artworks, and optimists, who hold that acquaintance with an artwork is not a necessary precondition for acquiring aesthetic knowledge. In this paper I propose a reconciliationist solution to the acquaintance debate: while aesthetic knowledge can be had via testimony, aesthetic judgment requires acquaintance with the artwork. I develop this solution by situating it within a virtue aesthetics framework (...) based on Ernest Sosa's virtue epistemology. I go on to apply the solution to the debates on moral testimony and expert testimony. An interesting variant on Gettier cases emerges: cases in which subjects have knowledge, but it has been formed by the wrong competence. (shrink)

Current uses of robots in classrooms are reviewed and used to characterise four scenarios: Robot as Classroom Teacher; Robot as Companion and Peer; Robot as Care-eliciting Companion; and Telepresence Robot Teacher. The main ethical concerns associated with robot teachers are identified as: privacy; attachment, deception, and loss of human contact; and control and accountability. These are discussed in terms of the four identified scenarios. It is argued that classroom robots are likely to impact children’s’ privacy, especially when they masquerade as (...) their friends and companions, when sensors are used to measure children’s responses, and when records are kept. Social robots designed to appear as if they understand and care for humans necessarily involve some deception, and could increase the risk of reduced human contact. Children could form attachments to robot companions, or robot teachers and this could have a deleterious effect on their social development. There are also concerns about the ability, and use of robots to control or make decisions about children’s behaviour in the classroom. It is concluded that there are good reasons not to welcome fully fledged robot teachers, and that robot companions should be given a cautious welcome at best. The limited circumstances in which robots could be used in the classroom to improve the human condition by offering otherwise unavailable educational experiences are discussed. (shrink)

Perceptual learning is an enduring change in the perceptual system – and our resulting perceptions – due to practice or repeated exposure to a perceptual stimulus. It is involved in the acquisition of perceptual expertise: the ability to make rapid and reliable high-level categorizations of objects unavailable to novices. Attentional weighting is one process by which perceptual learning occurs. Advancing our understanding of this process is of particular importance for understanding what is learned in perceptual learning. Attentional weighting seems to (...) favour the hypothesis that what experts learn is simply to better direct their attention to elements of the stimulus relevant to making post-perceptual categorizations. Here I argue against this hypothesis. Attentional weighting is an integral component of the process that allows experts to come to represent high-level properties in perceptual experience. (shrink)

How do the ways we argue represent a practical philosophy or a way of life? Are concepts of character and ethos pertinent to our understanding of academic debate? In this book, Amanda Anderson analyzes arguments in literary, cultural, and political theory, with special attention to the ways in which theorists understand ideals of critical distance, forms of subjective experience, and the determinants of belief and practice. Drawing on the resources of the liberal and rationalist tradition, Anderson interrogates the limits (...) of identity politics and poststructuralism while holding to the importance of theory as a form of life. Considering high-profile trends as well as less noted patterns of argument, The Way We Argue Now addresses work in feminism, new historicism, queer theory, postcolonialism, cosmopolitanism, pragmatism, and proceduralism. The essays brought together here--lucid, precise, rigorously argued--combine pointed critique with an appreciative assessment of the productive internal contests and creative developments across these influential bodies of thought. Ultimately, The Way We Argue Now promotes a revitalized culture of argument through a richer understanding of the ways critical reason is practiced at the individual, collective, and institutional levels. Bringing to the fore the complexities of academic debate while shifting the terms by which we assess the continued influence of theory, it will appeal to readers interested in political theory, literary studies, cultural studies, gender studies, and the place of academic culture in society and politics. (shrink)

This article addresses dilemmas of agency for feminism through reflections on social psychological research on the role of representations in the construction of identity by Muslim women. Engaging first with Saba Mahmood’s account of religious subjectivities in Politics of Piety, the author argues that feminist research requires a social conception of agency that addresses dialogical dynamics of representation and identity. Drawing on research concerning veiling and identity among Muslim women in the UK and Denmark, the author shows how a social (...) conception of agency may be elaborated through the analysis of how competing representations of gender are negotiated in the self–other encounter. The author argues that a dialogical approach to researching identity in context defies blunt political judgement while shedding light on the intersecting socio-cultural forces and relations of power that engage processes of resistance and re-presentation. (shrink)

This paper surveys the current philosophical discussion of the ethics of risk imposition, placing it in the context of relevant work in psychology, economics and social theory. The central philosophical problem starts from the observation that it is not practically possible to assign people individual rights not to be exposed to risk, as virtually all activity imposes some risk on others. This is the ‘problem of paralysis’. However, the obvious alternative theory that exposure to risk is justified when its total (...) benefits exceed its total costs faces the standard distributional challenges of consequentialism. Forms of contractualism have been proposed as a solution, but how exactly such theories can be formulated remains problematic, especially when confronted with the difficult cases of mass, novel, risk such as climate change. (shrink)

In this paper Amanda Fulford addresses the issue of student writing in the university, and explores how the increasing dominance of outcome-driven modes of learning and assessment is changing the understanding of what it is to write, what is expected of students in their writing, and how academic writing should best be supported. The starting point is the increasing use of what are termed “technologies” of writing — “handbooks” for students that address issues of academic writing — that systematize, (...) and smooth the work of writing in, Fulford argues, an unhelpful way. This leads to a reconsideration of what it means to write in the university, and what it is to be a student who writes. Fulford explores etymologically the concept of “writing” and suggests that it might be seen metaphorically as physical labor. Writing as physical labor is explored further through the agricultural metaphors in Henry David Thoreau's Walden and through Stanley Cavell's reading of that text. In making a distinction between writing-as-plowing and writing-as-hoeing, Fulford argues that some technologies of writing deny voice rather than facilitate it, and she concludes by offering a number of suggestions for the teaching and learning of writing in the university that emphasize the value of being lost and finding one's own way out. These “lessons” are illustrated with reference to Thoreau's text Walden and to American literature and film. (shrink)

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes. Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others brings them closer to the research but also brings the research closer (...) to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and ‘thorny’ work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, “How could it be otherwise?” ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of ‘keeping open’ the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to ‘open up’ engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: engagement and knowledge exchange; analysis of mindmap contributions; development of a conceptual schema ; and feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it. (shrink)