Background: although cognitive behavioural therapy is the gold standard treatments for bulimia nervosa (BN) and binge eating disorder (BED), evidence for its long-term efficacy is weak. Empirical research support the efficacy of brief strategic therapy (BST) in treating BN and BED symptoms, but its statistical significance still need to be investigated. Objective: to statistically test the long-term efficacy of the BST treatment protocols for BN and BED through one-year post-treatment. Methods: a two-group longitudinal study will be (...) conducted. Participants will be sequentially recruited for inclusion in a state-funded community psychotherapy clinic. Multilevel growth curve modeling will be used to estimate the average growth trajectories from baseline to one year after treatment termination for the severity of the BN and BED features as measured by the Eating Disorder Examination Questionnaire. Discussion: findings from this study will clarify the impact of BST in treating BN and BED symtoms. Conclusions: translating research into practice may inform how to ensure high-quality patient care. (shrink)

Recourse to a variety of well-constructed arguments is undoubtedly a significant strategic asset for cultivating more ethical eating habits and convincing others to follow suit. Nevertheless, common obstacles often prevent even the best arguments from getting traction in our lives. For one thing, many of us enter the discussion hampered by firmly-entrenched but largely uninvestigated assumptions about food that make it difficult to imagine how even well-supported arguments that challenge our familiar frames of culinary reference could actually apply to (...) us. When an argument contests our cherished food ways, we are inclined almost reflexively to dodge, downplay, or dismiss it, and all the more anxiously if we suspect it’s a good one. Moreover, even when we find such arguments convincing and resolve to change, we often discover to our chagrin that, when the buffet is open, we lack the will to act on our convictions. Whether the obstacle is a lack of imagination or a failure of will, the way to concrete moral progress is blocked. Our aim here is to consider how other modes of philosophical inquiry can help us to overcome these two obstacles that arise at the margins of philosophy’s argumentative contributions to food ethics. In part I, we diagnose these obstacles as common moral malaises—we call them the malaise of imagination and the malaise of will—that create existential unease for moral agents that can curtail their ability to eat in accordance with what they learn from philosophical arguments. We then propose that other modes of philosophical inquiry can serve as therapy for these malaises. In part II, we argue that philosophical hermeneutics (exemplified by Hans-Georg Gadamer) can treat the malaise of imagination by helping us to excavate and revise hidden prejudices that interfere with our ability authentically to engage arguments that challenge entrenched assumptions about food. In part III, we argue that philosophy as care of the self (exemplified by Pierre Hadot) can treat the malaise of will by helping us to identify habits of thought and action that hamper concrete progress toward new dietary ideals and to replace them, through repetitive exercises, with transformed habits. In a brief conclusion, we identify some benefits of this approach. (shrink)

In recent years, there has been a drive to develop briefer, more focal psychodynamic interventions, with the hope of satisfying the ever-increasing need for mental health support. This book outlines the principles and practice of Brief Psychoanalytic Therapy. An introductory chapter distils those aspects of psychoanalysis that provide a basis for the approach. This is followed by an overview of themes and variations in six forms of brief psychodynamic therapy. The remainder of the book is concerned (...) less with theory than with clinical practice. Treatment and Adherence Manuals detail the specifics of therapist orientation and technique, and a formal research study comparing the approach with Interpersonal Therapy is reported. Case histories of individual treatments unfolding over time are complemented by detailed examination of short sequences of patient-therapist dialogue from transcribed sessions. (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to be (...) fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:George Engel’s Legacy for the Philosophy of Medicine and PsychiatryBradley Lewis (bio)KeywordsBiopsychosocial model, George Engel, pragmatism, philosophy of medicine, philosophy of psychiatryEach of the respondents to this paper raises critical and important concerns. I am grateful for the quality of their insights. David Brendel’s response, along with his recent book, Healing Psychiatry: Bridging the Science/Humanism Divide, resembles my efforts in several ways. Like Brendel, I too believe that (...) the American pragmatic philosophy can be helpful in healing the splits and divisions within psychiatry. And, like Brendel, I believe that psychiatry would benefit from what he calls the “four ps” of pragmatism. Where we differ with regard to George Engel and his biopsychosocial model seems to be less about philosophy and more about strategy. Brendel argues that Engel was too scientistic in his manifest reasoning to be considered a pragmatist. I agree with this description of Engel. But, strategically, we can go beyond Engel’s manifest reasoning to draw out the implications of Engel’s writings in a pragmatic fashion. I am not saying that Engel did this himself; I am only saying that it is very possible to reinterpret Engel along these lines.Brendel also argues that the biopsychosocial model itself needs improvement. But, just as it is possible to update Engel’s theoretical scaffold, we can also update Engel’s biopsychosocial model. Along the lines of Brendel’s concerns, we can easily revise the model so that we remember that not all problems need complex analysis and interventions. Some problems are relatively simple and can have a simple solution. We can also revise the model so we include questions of consumer participation and the provisional nature of the clinical encounter. I see nothing in the biopsychosocial model that contradicts either of these concerns. Yes, the biopsychosocial model needs to be updated, refurbished, expanded, and reimagined. That is my point in the paper.The traction of Brendel’s concerns is not can we reinterpret Engel? or can we refresh the biopsychosocial model?—of course we can. The traction of his concern seems to be “should we?” To this strategic question, Brendel’s answer is no and my answer is yes. I argue that it is a good idea to refresh and refurbish Engel and his biopsychosocial model because it helps to create a connection with an important tradition within both medicine and psychiatry: the tradition of balanced, broadminded, nuanced, patient-centered and anti-reductionistic [End Page 327] care. This tradition is important because medicine and psychiatry seem perpetually vulnerable to the temptations of reductionist approaches and to what Engel, and Nassir Ghaemi more recently, call “dogmatism” (Engel 1977, 130; Ghaemi, 2003, 301). Whether reductionism and dogmatism take the form of biopsychiatry, or psychoanalysis, or antipsychiatry, or cognitive-behavioral therapy, the problems of dogmatism are the same.I am sure Brendel would agree with this, which is why he raises pluralism to such a prominent position in his own reasoning. The difference is that Brendel believes we can better get to this kind of balanced clinical care by letting go of the past figures like Engel and moving into the bright light of the twenty-first century. Maybe so. But my thinking when I wrote the paper goes the other way around. For me, if clinical medicine and psychiatry more carefully tended to its history and tradition, it would be less likely to fall sway to the next Johnny-come-lately reductionistic model.Jeffery Spike’s memories of George Engel during the years they worked together at the University of Rochester School of Medicine provide a good sense of why Engel is an important figure to remember and to pay homage. As Spike puts it, Engel was not only a “legendary figure” with an “almost mythical diagnostic ability,” Engel “probably had more influence on the philosophy of medicine in the United States than any other person, physician, or philosopher.” Both of these accomplishments help to explain why Engel is worth remembering.Those of us in medicine and psychiatry all know mythical clinicians and teachers—the ones who seem like Michael Jordan used to seem on the basketball court, able to somehow make even... (shrink)

This paper first elaborates ‘Art’ and the aesthetic as these concepts emerged in the eighteenth century, and uncovers the conflict between the resulting ideal of ‘art for art’s sake’ and the increasing use ‘art therapy’ for personal and social purposes. Taking this conflict to be a reason for the rejection of ‘Art’, it considers two accounts of ‘the end of Art’, one by Arthur Danto and the other by Nicholas Wolterstorff. The paper argues that both accounts fall short of (...) adequately recognizing the presence of the aesthetic in everyday life, and that once we do acknowledge the properly aesthetic character of ‘Design’, a way of thinking is opened up that can make better sense of art therapy. The paper concludes with a brief indication of where the next philosophical question about art therapy lies. (shrink)

_Sandplay Therapy in Vulnerable Communities_ offers a new method of therapeutic care for people in acute crisis situations such as natural disasters and war, as well as the long-term care of children and adults in areas of social adversity including slums, refugee camps and high-density urban areas. This book provides detailed case studies of work carried out in South Africa, China and Colombia and combines practical discussions of expressive sandwork projects with brief overviews of their sociohistoric background. Further (...) topics covered include: the social aspect of psychoanalysis the importance of play pictographic writing and the psyche. Providing the reader with clear, practical instructions for carrying out their own sandwork project, this book will be essential reading not only for psychotherapists involved with sandplay therapy but also for those with an interest in cross cultural psychotherapy, as well as all professionals working with those in situations of social adversity. (shrink)

IntroductionDignity therapy is brief psychotherapy targeting psychological and existential suffering among patients with a life-limiting illness. Studies have been conducted on the use of DT by healthcare professionals. In Italy, the current legislation defines that any form of psychotherapy may be performed exclusively by psychotherapists. Consequently, this intervention is unlikely to be used by other healthcare professionals. Herein, we will describe a training on DT not as a psychotherapy intervention but as a narrative intervention for non-psychotherapists health care (...) professionals. Finally, we will explore the potential enablers/barriers as experienced by palliative care physicians and nurses.MethodsThe study was conducted in the Psycho-Oncology Unit within the Cancer Research Hospital of Reggio Emilia. It consisted of an exploratory qualitative case study. Data were collected employing observations and interview data and thematically analyzed.ResultsThe training was attended by six physicians and ten nurses and took place during two-afternoon sessions for 10 h. Two participants put their training into practice and administered DT under the supervision of a psychotherapist. Data analysis highlighted five overarching themes relating to the training experience and direct use of DT, namely, time required, psychological skills, patient’s disease awareness, patient’s life history, and distinguishing DT from Advance Care Planning.ConclusionPalliative care professionals found DT to be a valuable non-pharmacological hospital-based intervention to address the person beyond the patient and his clinical conditions. In our experience, considering that in Italy, psychotherapy is an intervention that psychotherapists can only perform, it can help organize different training on DT for psychotherapists and other healthcare professionals. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional (...) challenges. `Wise Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at timlebon@aol.com A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

Sports physicians are continuously confronted with new biotechnological innovations. This applies not only to doping in sports, but to all kinds of so-called enhancement methods. One fundamental problem regarding the sports physician's self-image consists in a blurred distinction between therapeutic treatment and non-therapeutic performance enhancement. After a brief inventory of the sports physician's work environment I reject as insufficient the attempts to resolve the conflict of the sports physician by making it a classificatory problem. Followed by a critical assessment (...) of some ideas from the US President's Council on Bioethics, the formulation of ethical codes and attempts regarding a moral topography, it is argued that the sports physician's conflict cannot be resolved by the distinction between therapy and enhancement. Instead, we also have to consider the possibility that the therapy-based paradigm of medicine cannot do justice to the challenges of the continuously increasing technical manipulability of the human body and even our cognitive functions as well. At the same time we should not adhere to transhumanist ideas, because non-therapeutic interventions require clear criteria. Based on assistive technologies an alternative framework can be sketched that allows for the integration of therapeutic and non-therapeutic purposes. After a thorough definition of standards and criteria, the role of the sports physician might be defined as that of an assistant for enhancement. Yet the process of defining such an alternative framework is a societal and political task that cannot be accomplished by the sports physicians themselves. Until these questions are answered sports physicians continue to find themselves in a structural dilemma that they partially can come to terms with through personal integrity. (shrink)

This year marks the tenth anniversary of the world's first transplantation of tissue generated from induced pluripotent stem cells (iPSCs). There is now a growing number of clinical trials worldwide examining the efficacy and safety of autologous and allogeneic iPSC‐derived products for treating various pathologic conditions. As we patiently wait for the results from these and future clinical trials, it is imperative to strategize for the next generation of iPSC‐based therapies. This review examines the lessons learned from the development of (...) another advanced cell therapy, chimeric antigen receptor (CAR) T cells, and the possibility of incorporating various new bioengineering technologies in development, from RNA engineering to tissue fabrication, to apply iPSCs not only as a means to achieve personalized medicine but also as designer medical applications. (shrink)

Long ago, I set out to solve a problem, but something happened along the way: I was diverted by an unexpected observation. Thereafter, the direction of my research was guided at each stage by increasing familiarity with the experimental material and what could be done with it. The result was the birth of therapy with cultured keratinocytes. Subsequent developments soon led to the formation of the company Biosurface Technology (later taken over by the Genzyme Corporation), which provided autologous cultures (...) for burn victims in many parts of the world. Further progress by others led to new therapeutic applications of cultured keratinocytes, such as treatment of an ocular disease and gene therapy. Unfortunately, there have developed serious regulatory problems that are a danger to future progress. As described in this brief history, the initial stages of development of cell therapy for the treatment of human disease were possible only because there was no restraint by committees or governmental regulations. BioEssays 30:897–903, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Strategic Emergence of Cartesianism:Descartes, Public Controversy, and the Quarrel of UtrechtTyler J. ThomasBetween the years 1645 and 2005, the writings of René Descartes and the teaching of Cartesian philosophy were officially banned at Utrecht University. Although the ban had not been enforced in recent centuries, and was only questionably enforced in its immediate aftermath, this episode at a prominent university in the French philosopher's adopted country (...) rightly qualifies as one of the seventeenth century's most scandalous affairs. Despite the centrality of Cartesianism to "the quarrel," existing scholarship has not captured its full significance to the emergence of Cartesian philosophy. Even Jonathan Israel and Theo Verbeek, the two scholars who have contributed the most to our historical knowledge of the quarrel, tend to characterize its drama as an external annoyance brought upon Descartes because of peculiar features of the Dutch academic-religious landscape rather than an incident deliberately shaped by his own actions.1 [End Page 749]While it is undeniable that Descartes felt persecuted by his Dutch antagonists, this article argues that Descartes's involvement in, and ultimate responsibility for, the quarrel requires reassessment. Specifically, I argue that the quarrel incited certain political dangers associated with publication that Descartes had well anticipated at the outset of his public career. Descartes traced the root of these dangers to the institutional predominance of Scholasticism, which he viewed not only as an erroneous philosophical system but also as a set of principles and methods with pernicious sociopolitical effects. More explicitly than in his philosophical works, Descartes would reveal in the polemical documents of the quarrel his understanding of how the Aristotelian principles at the heart of Scholasticism sustained a class of intellectuals whose social status required the perpetual irresolution of philosophical controversy, which Descartes especially identified with the formal method of disputation practiced in the universities of Europe.Recognizing that he was in a public battle for the legitimacy of his philosophy and, after a certain point, for his own safety, Descartes would admit to employing an evolving publication strategy intended to prepare the intellectual grounds for the acceptance of his principles among the learned public. Ranging from Jesuit priests to Protestant ministers to university officials, Descartes's critics were almost uniformly alarmed by the apparent threat Cartesianism represented to the union of Aristotelianism and orthodox theology. Descartes himself believed that the social status of these officials determined their opposition to his philosophy, and the quarrel prompted him to reveal that the order of his publications and their forms were governed primarily by the need to subvert such hostilities. Moreover, in a letter exchange deserving more attention than it has yet received, Descartes would advocate the wider usage of certain writing techniques to neuter the objections of institutional gatekeepers.2 Even at this well-developed stage of Descartes studies, the extent to which the very appearance of the Cartesian writings was determined by such strategic considerations remains underappreciated. [End Page 750]Careful comparison of the developments of the quarrel with Descartes's own statements helps reveal the intimate relation he perceived between sociopolitical authority in seventeenth-century Europe and the philosophical practices of Scholasticism. His formative role in the quarrel thus merits reexamination not only as a pivotal moment in the emergence of Cartesian philosophy but also as an occasion for further questions regarding the status of the Cartesian writings as strategic documents, including their influence upon later public controversies.3 For these reasons, Descartes's account of his actions during the quarrel deserves a large audience among philosophers, political theorists, and intellectual historians interested in the conflicts that would eventually characterize the Enlightenment.4THE QUARREL UNFOLDS: JUDGMENT OF MARCH 1642In late 1641, almost immediately following publication of the Meditations, a dispute over Cartesian philosophy emerged among the theologians at Utrecht University. In March 1642, Gisbertus Voetius, a prominent Dutch Calvinist theologian and rector of the university, convinced the academic senate to issue a formal condemnation of Cartesian philosophy on three counts. The senate decreed:I. It is opposed to the traditional philosophy which universities throughout the world have hitherto taught on the best advice, and it undermines its foundations.II. Second, it turns away... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep TherapyDiskin ClayThe Therapy of Desire: Theory and Practice in Hellenistic Ethics, by Martha Nussbaum; xiv & 558 pp. Princeton: Princeton University Press, 1994; $29.95For three decades now interest in Hellenistic philosophy has been gaining among philosophers both in England—and its philosophical colony the United States—and in Europe. The principal documents of the Hellenistic schools have now been made available in both scrupulously edited Greek and Latin (...) texts and fine English translations by A. A. Long and David Sedley in their The Hellenistic Philosophers (1987). Conditions are right for the latest assimilation of this philosophical culture, whose conventional dates are those of the Hellenistic age—from the death of Alexander of Macedon in 323 B.C. to the suicide of the last of his successors, Cleopatra VII of Egypt in 31 B.C., but which in fact extends through the second century A.D. In the fracturing of the autonomous Greek city state and the new empires and cosmopolitanism that grew up in its place, in the turning inward of ethical thought and the simultaneous turning outward of science, the Hellenistic age holds up a mirror to our own. Especially congenial to philosophers in this country and in England is the radical skepticism that reaches from Socrates in the fifth century to Sextus Empiricus in the second century A.D.Martha Nussbaum’s The Therapy of Desire is very much a book for this age. Her topic is the “compassionate medical philosophy” of three of [End Page 501] the Hellenistic schools, the Epicurean, the Skeptic, and the Stoic. In focusing sharply on therapy, she leaves to the side—and on the outside—the connections that made Epicurean and Stoic philosophy systematic. But her awareness of the psychiatric possibilities of modern philosophy and what Michel Foucault called a technique de soi provide the contemporary context for the project of this book, at a stage when Freudian psychology is preparing to make its exit at the end of its century. Medicine is the only science that enters this book’s field of vision. Its thirteen studies (some already familiar) concentrate on the practical and therapeutic aims of Hellenistic philosophy and what the author terms the therapy of the passions, particularly the passions of erotic love, anger, and aggression, and fear of the gods. In The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy (1986), Nussbaum took the side of Aristotle against Plato. Here she takes the part of the Epicurean, Skeptic, and Stoic against the ethical theory of Aristotle, who is impressed to illustrate the practical turn in ethics which Nussbaum explores in Therapy. Plato is glimpsed on the horizon of this book “standing on the rim of the heavens” (p. 23). What links the intellectual program of both Fragility and Therapy is Nussbaum’s keen and sympathetic attention to poetry as a vehicle for philosophy or as a provocation to philosophical engagement. Four of the chapters of this study are devoted to poetry: three to Lucretius’ De Rerum Natura; one to Seneca’s Medea.The ethical project illustrated throughout these studies is formulated by Democritus, who first enunciated the claim: “medicine heals the sickness of bodies; but wisdom rids the soul of its sufferings” (DK 68B31). Each of the Hellenistic schools Nussbaum studies repeated this claim. Unexplored is the medical end of the analogy and the degree to which this much invoked analogy (whose terms are fused in our word psychiatry) conforms to actual medical practice, with its pathology, consultation, diagnosis, and treatment (therapeia). Nor is not clear from the Greek record that desires as opposed to the individual who harbors these desires are regarded as the object of therapy. The Hellenistic philosophers were clearly concerned with “extirpating” desires and disruptive passions, but the object of therapy was usually not desire but the individual who is disturbed by desire (as Philodemus, On Plain Speaking 84.11 Olivieri makes plain). But occasionally by extension the passions are described as the objects of therapy (as they are in Diogenes of Oenoanda, fr. 4.II.3 Smith).No one who has read Fragility will be taken aback by Nussbaum’s [End Page 502] invention of a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Advocacy, Therapy, and PedagogyJohn E. MacKinnonBeyond Political Correctness: Toward the Inclusive University, edited by Stephen Richer and Lorna Weir; 272 pp. Toronto: University of Toronto Press, 1995, $55.00 cloth, $19.95 paper.Anyone who would doubt the relevance of philosophy to public affairs ought to attend to the unhappy evolution of the Canadian university. On campuses across the country in recent years, speech codes have been introduced, the “re-education” (...) of professors urged, visiting speakers on controversial subjects silenced, and classes monitored by administrators eager to do the bidding of various special interest groups. As universities have come more and more to see their role as that of some sort of multipurpose social project, education itself has become less pressing a priority. Thus, while money is found to hire sexual harassment officers, employment equity advisors and “wellness” mavens, academic posts disappear. Those that remain are frequently filled in accordance with crass gender and race-based quotas, and when that fails to guarantee positions for members of bureaucratically favored groups, contrived “schools” and pseudodisciplines proliferate. Many of these developments, however, are simply the manifestation of trickle-down deconstruction, trickle-down Rortyism, trickle-down “politics of difference,” of the sort that Charles Taylor is prone to rhapsodize. Notions of value, nature and merit, of equality, universality and objectivity are dismissed as mere inventions, “imperial” notions designed to favor the powerful and oppress the disenfranchised. The art [End Page 492] of spoken and written argument, with their ideals of detachment and discipline, are taken as evidence of a smug “androcentrism,” while rationality itself is derided as a “regime” that works “to maintain patriarchal control of knowledge and knowledge production.” Even the notion of evaluating students by means of essays and exams is ridiculed as scandalously “non-feminist.” While past attacks on academic independence have tended to come from outside the university, Canadian academics over the past decade have slavishly accepted their own domestication. More disconcerting still has been the role of pliant university presidents, most of whom have proved eager to unburden themselves of the inconvenience of scholarship and to indulge the cosmological musings of the radical left.Beyond Political Correctness: Toward the Inclusive University bristles both with resentment that such criticisms should even be aired and paranoia about their motivation. According to its contributors, the challenge to political correctness—the very use of the term as an epithet—is the result of a “neo-conservative” attack that has been orchestrated in and “imported” wholesale from the United States (to morally smug Canadians, there can be no more dastardly provenance) and insinuated into public debate by a servile media. The first two articles in the collection, by Dorothy Smith and Lorna Weir respectively, pursue this very theme. Each betrays that dreary habit, particularly prevalent among social scientists, of rendering imposingly technical the most bracingly trite. For instance, Smith writes: “The textuality of public text-mediated discourse is essential to its peculiar temporal and spatial properties of ubiquity and constancy of replication across multiple and various actual situations of watching, reading, or hearing” (p. 25). Translation? The more one sees, reads or hears a view expressed, the more one tends to believe it’s true. Her concern here, of course, is to establish that whoever controls the means of public debate controls its terms as well, that those means happen to be controlled by neo-conservative interests bent on retarding social progress, and that growing public disquiet about educational reform simply confirms the success of that neo-conservative strategy. But the failure of Smith’s account goes far beyond the thoroughly rebarbative nature of her expression.According to Smith, the very term, “political correctness,” is shorthand for an “ideological code” that has been expressly designed by “neo-conservatives” to caricature the good works of the visionary left. An ideological code, she says, operates as a “free-floating form of control,” which, once established, is “self-reproducing” (p. 27). Now, [End Page 493] the trouble with this picture is that it can account only for ascendant ideological codes, those that are successfully transmitted and progressively consolidated. And yet, in recent years, the ideological code of the left has to a considerable extent... (shrink)

This paper challenges the field to move beyond strategic philanthropy to a more encompassing concept of sustainable philanthropy. A brief history of philanthropic practices is presented, as well as a discussion of contemporary approaches to corporate philanthropy. The model of sustainable philanthropy developed here advocates integrating a triple bottom line approach with the strategic practice of corporate giving. It shifts the traditional model of powerful donor and a powerless recipient, to one where both donor and recipient must (...) work harder to identify a partner that shares their intrinsic values and objectives. The aim of sustainable philanthropy is to establish a working partnership with broadly shared goals and openly acknowledged benefits. (shrink)

BackgroundEmotional regulation is important for adolescents’ adaptive development. Preventive interventions for anxiety and depression are necessary for reducing the development of disorders later in life, and emotional regulation is a potentially relevant factor.ObjectiveWe investigated the effects of a mindfulness-based psychological education and prevention program [the Mindfulness and Awareness Program ] on the mental health of junior high school students in Japan.MethodsOur MAP primarily focused on mindfulness meditation to improve emotional regulation, thereby reducing depression and anxiety. The MAP comprised eight sessions (...) administered by a school counselor in a school setting. All participants were 12–13-year-old adolescents from nine classes in two Japanese schools. The program was provided to the intervention group, wherein students were educated on emotional expression, emotional cognition, and emotional regulation. The control group received regular school counseling services.ResultsCompared with the control group, the intervention group showed significant improvement in emotional regulation and a decrease in depression and generalized anxiety. The effect was greater at the follow-up assessment than at the immediate post-intervention assessment, and greater in female students.ConclusionOur mental health prevention program exhibited efficacy in reducing depression and anxiety and enhancing emotional regulation in early adolescence. Further, it appeared to be more effective for female adolescents. (shrink)

Persuasive definitions – those that convey an attitude in the act of naming – are frequently employed in discourse and are a form of strategic maneuvering. The dynamics of persuasive definition are explored through brief case studies and an extended analysis of the use of the “war” metaphor in responding to terrorism after September 11, 2001. Examining persuasive definitions enables us to notice similarities and differences between strategic maneuvering in dialectical and in rhetorical argument, as well as (...) differences between the role of strategic maneuvering in normatively ideal argument and in actually existing argument. This will avoid the double standard of comparing ideal dialectic with actual rhetoric, or vice versa. The results of the analysis suggest possibilities for a rapprochement between dialectical and rhetorical approaches to argumentation. (shrink)

Pt. I. Philosophy and cognitive-behavioral therapy (CBT) -- Ch. 1. The "philosophical origins" of CBT -- Ch. 2. The beginning of modern cognitive therapy -- Ch. 3. A brief history of philosophical therapy -- Ch. 4. Stoic philosophy and psychology -- Ch. 5. Rational emotion in stoicism and CBT -- Ch. 6 Stoicism and Ellis's rational therapy (REBT) -- Pt. II. The stoic armamentarium -- Ch. 7. Contemplation of the ideal stage -- Ch. 8. Stoic (...) mindfulness of the "here and now" -- Ch. 9. Self-analysis and disputation -- Ch. 10. Autosuggestion, premeditation, and retrospection -- Ch. 11. Preditatio malorum and mental rehearsal -- Ch. 12. Stoic fatalism, determination, and acceptance -- Ch. 13. The view from above and stoic metaphysics. (shrink)

CRISPR is currently viewed as the central tool for future gene therapy. Yet, many prominent scientists and bioethicists have expressed ethical concerns around CRISPR gene therapy. This paper provides a critical review of concerns about CRISPR gene therapy as expressed in the mainstream academic literature, paired with replies also generally found in that literature. The expressed concerns can be categorised into three types depending on whether they stress risk/benefit ratio, autonomy and informed consent, or concerns related to (...) various aspects of justice. In the reviewed literature, we found no intrinsic objections to CRISPR gene therapy, even though many such objections were present in discussions of gene editing in the 1990s. The paper then proposes a brief outline for a practically applicable moral framework for public decision-making about CRISPR gene therapy and suggests how such a framework might be supported. We also suggest that this framework should govern public engagement about CRISPR gene therapy in order to reduce the risk that we make decisions about CRISPR gene therapy based on misperceptions, inflated views of risk, or unreasonable moral or religious views. (shrink)

As command economies transition toward economic liberalisation, the underdevelopment of market-supporting institutions often creates institutional voids at the microscale. Drawing on Fligstein and McAdam’s (2011) theory of strategic action fields, this paper examines the emergence of ‘Institutional Fiefdoms’: socially constructed spaces of collective action where incumbents, typically the state, rely on politically aware social actors to develop policy and provide governorship within these voids. The governance units within an institutional fiefdom are drawn from the challenger base of the (...) class='Hi'>strategic action field, moving into the middle position to influence and shape how the field evolves. Leveraging their social and political capital, they can design policy and processes that contradict state-held ideologies by positioning it appropriately within the legal-institutional context, and ensuring economic and political objectives are met. By developing support mechanisms that reinforce the structure and stability of the field, governance units can enforce desired behaviours among challengers, whilst maintaining their own central position and autonomy. Importantly, governance units can establish new institutional norms, influencing the wider state infrastructure, for example, through the creation of new laws. This paper is focused in two contexts, which have undergone economic liberalisation; rapidly, in the case of the Republic of Poland’s Shock Therapy, and gradually, in the case of the Socialist Republic of Viet Nam’s Doi Moi. The paper focuses specifically on the changes that impacted the nonprofit sector, in particular, social enterprises. The findings contribute to our theoretical understanding of field governance mechanisms, as well as how governance units themselves emerge, operate, and express their agency. We position institutional fiefdoms as being defined by rule complexity, new or novel institutional norms being established, and the embedding of the field’s social order. (shrink)

This article opens with a brief analysis of key features of the Mexican semi-authoritarian regime. It then moves to a discussion of the critical realist positions and features that inform the strategic-relational approach. Attention is paid to social interactions and causal relations that enable the SRA to trace patterns of punctuated evolution and to highlight the processes of transformation. Since ideal types serve to highlight key characteristics in specifc phenomena, processes and actors, some features of ideal types of (...) the state and of the transition from one type to another are also discussed. In particular, attention is paid to the Keynesian welfare national state and to the Schumpeterian workfare post-national regime ideal types elaborated by Jessop. For it is contended that the specific features of these ideal types could be of great help in broadening the debate on economic restructuring and political reforms in countries such as Mexico. Moreover, the SRA approach provides an insight into the endogenous features of social change and stresses the importance of networking for a strategic agenda as well. For the never-static dynamics of the processes of change the role of situated agents in context is fundamental, as it injects intentionality and acknowledges the contingency of the conditions that surround them. (shrink)

This chapter examines two premises of cognitive-behavioral therapy (CBT) - that emotions are caused by beliefs and that those beliefs are represented in the mind as words or images. Being a philosophical examination, the chapter also seeks to demonstrate that these two premises essentially are philosophical premises. The chapter begins with a brief methodological suggestion of how to properly evaluate the theory of CBT. From there it works it way from examining the therapeutic practice of capturing the mental (...) representations that supposedly elicit emotional reactions to examining the assumption that emotions are caused by beliefs. The chapter ends by briefly pointing to some consequences of what has been said to the practice of CBT. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.1 (2003) 196-210 [Access article in PDF] On Philosophy as Therapy:Wittgenstein, Cavell, and Autobiographical Writing Garry Hagberg IN HIS LATER PHILOSOPHICAL WRITINGS Wittgenstein was exquisitely sensitive to the misleading implications housed within the formulations of philosophical questions. The question with which he opened the Blue Book, "What is the meaning of a word?," the question "What is thinking?," and the question "What constitutes understanding?," (...) each put into place presumptions concerning how an answer is going to proceed: in the first, that the meaning will be an entity of some kind—likely of an ontological kind different from the acoustical or calligraphic sensory property of the word (to which we will then think the meaning attached); in the second, that thinking will be in essence a determinate mental process or event—likely one of an ontological kind different from that of speaking (to which we will then picture thinking as prior); in the third, an inner process culminating in a state that is metaphysically hidden from all things outer and that is the inner condition that lies unreachable behind what we will then call the behavior that is contingently correlated with it. It is by now no secret that each of these questions has been subjected to thorough scrutiny throughout the writings in The Blue and Brown Books, Philosophical Investigations, Remarks on the Philosophy of Psychology, Last Writings on the Philosophy of Psychology, Zettel, and even more extensively in the typescripts and manuscripts from which these are taken. 1 But it is still perhaps less widely realized than it might be that the very phrase "Wittgenstein's method" can easily prove as misleading as each of the above questions, and there is an aspect of irony waiting to dawn on those who reflect that the modern philosopher most concerned to maintain a philosophically relevant mindfulness about front-loaded [End Page 196] implications is perhaps too often not afforded precisely the mindfulness about his own later philosophical writings that he was most concerned to teach.The phrase "Wittgenstein's method" might well lead us to expect, in the first place, a unitary way of contending with philosophical difficulties that is employed across the board; in the second place, it might lead us to expect an acceptance of a set of perennial problems as framed by philosophers through the ages that are treated with that unitary method; and in the third place, it might lead us to expect a set of solutions to those time-honored questions providing answers formulated in a way parallel to, if different from, those worked out by Frege, Russell, Quine, or many others before and since. Indeed, such an expectation has often outlived the recognition that Wittgenstein's own writings are presented in a piecemeal way that seems not to offer any such overarching method or any such problem-accepting concisely formulated answers; some have simply assumed that, while Wittgenstein himself did not or could not provide such results, the raw material is there, and the task of interpretation, in his case, just comes to the task of argument-and-position formulation. To load a spatial metaphor into epistemology, nothing could be further from the truth. What Wittgenstein's later writings offer us is—to put the matter in a different way misleadingly briefly—a way of seeing philosophical problems that constitutes a radical departure from the approaches of Frege, Russell, Quine, and so many others. And in enacting this departure throughout his writings from the Blue Book and the Cambridge lectures of those years through to his final remarks in On Certainty, he himself, wary of too simply or too conventionally characterizing his own ways of working, appeals to the notion of therapy. This is a fitting concept for a moment in philosophy's history of radical departure and an ensuing process of radical change.It is true that in the Tractatus Wittgenstein wrote "Most of the propositions and questions of philosophers arise from our failure to understand the logic of our language" (4.003), and it would not be wrong to call... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bernard Mandeville and the Therapy of “The Clever Politician”Harold J. CookAs the institutional authority of the learned physicians of Augustan London waned, new threats to the classical foundations of medical practice appeared. 1 Patients had more freedom to chose from a variety of practitioners and practices, giving both consumer demand and the advertising skills of suppliers an even more powerful hand in medical affairs. While the burgeoning (...) medical marketplace developed mostly because of the profound socio-economic and political changes of the late Stuart period, intellectual transformations were at play, too. The new science appeared to encourage empiricism and the development of new remedies based on experimentation, devaluing university education in medical classics, but conversely the new science could strengthen physicians’ claims to superiority over mere patients and practitioners. Medical materialists, for instance, could turn the classical advisor/client relationship into that of an expert contolling a passive recipient (patient) for his or her own good.One contemporary debate that shows the implications of materialism for medical relationships is the theory of the passions. The passions linked mind and body. According to most classical accounts, one could (or should) control the passions by applying reason, resulting in both a virtuous and a healthy life. But according to a strong version of materialism, the mind could not hope to control the passions. A doctor therefore could no longer appeal to patients’ reason; rather, he had to manipulate the patient’s passions for his or her own good. Hence for a materialist, the doctor was not an adviser to the patient but an expert therapist, not a teacher of health and virtue but a “clever politician” who ordered bodily passions. Some versions of the new science, then, favored [End Page 101] the expertise of physicians while undermining older views about learned authority. Such an outlook is clear in the work of Dr. Bernard Mandeville, whose famous Fable of the Bees shows how the “clever politician” played on passions to make the body politic run smoothly. Mandeville held coherent views on politics, economics, moral philosophy, and medicine. Like many doctors of his time, he fought to establish his expertise in the new science. His views are expressed most clearly in the theory of the passions. By examining his discussion of the passions in both his social commentary and his medical dialogues, we can note similarities among his various writings and glimpse one of his fundamental positions on medicine and humanity.The Fable and its CriticsTo many English minds of the early eighteenth century, no one exemplified materialism’s threat better than Dr. Bernard Mandeville. Mandeville’s famous slogan, the subtitle of his Fable of the Bees—“private vices, public benefits”—seemed to epitomize materialism’s inherent immorality. The book seemed to argue that what most people recognized as human vices were the main engines of the collective good. Mandeville’s famous book pictured human nature as animalistic, in which the passions held sway over reason. In Mandeville’s world, it appeared, reason became little more than the ability to rationalize, the instrument of hypocrisy, merely letting people cover their true motives (grounded as they were in the passions) with empty words pretending to more exalted ends.His Fable had begun as a little, anonymous, satirical poem in 1705, titled “The Grumbling Hive: or, Knaves Turn’d Honest.” It began by speaking of “A Spacious Hive well stockt with Bees, / That liv’d in Luxury and Ease.” Many of the bees were knaves, with no calling free of deceit, but while “every Part was full of Vice, / Yet [was] the whole Mass a Paradise; /... Such were the Blessings of that State; / Their Crimes conspir’d to make them Great.” Avarice, prodigality, luxury, pride, envy, vanity, folly, fickleness, and inconstancy employed millions, encouraging ingenuity and industry and creating pleasures and comforts “To such a Height, the very Poor / Liv’d better than the Rich before.” But many of the thriving bees complained, shouting for honesty and virtue. When Jove “rid / The bawling Hive of Fraud,” economic collapse followed, with the consequent end of arts and sciences as well; population declined; the hive’s territory decreased; and the remaining bees toiled long and... (shrink)

In the past decade, the Norwegian government has emphasized user participation as an important goal in the care of mentally ill patients, through governmental strategic plans. At the same time, the governmental documents request normalization of psychiatric patients, including the re‐socialization of psychiatric patients back into society outside the psychiatric hospital. Milieu therapy is a therapeutic tool to ensure user participation and re‐socialization. Based on an ethnographic study in a long‐term psychiatric ward in a psychiatric hospital, we identified (...) how staff tried to implement user participation in their milieu‐oriented therapy work. We have identified three major tensions and challenges in implementing user participation in milieu‐therapeutic work. First, it is difficult to implement individual‐based user participation and at the same time take collective house rules and codes of conduct into consideration. Second, user participation proved a difficulty when patients’ viewpoints challenged staff judgements on proper conduct and goals for which patients might aim. Third, user participation becomes a challenge when trying to establish relationships based on equality when using milieu therapy in a biomedical hierarchical hospital structure. These tensions and challenges are seen in light of paradoxical political frames and demands on one side, and milieu therapy as a complex tradition anchored in different ideologies on the other. (shrink)

Homosexual aversion therapy enjoyed two brief but intense periods of clinical experimentation: between 1950 and 1962 in Czechoslovakia, and between 1962 and 1975 in the British Commonwealth. The specific context of its emergence was the geopolitical polarization of the Cold War and a parallel polarization within psychological medicine between Pavlovian and Freudian paradigms. In 1949, the Pavlovian paradigm became the guiding doctrine in the Communist bloc, characterized by a psychophysiological or materialist understanding of mental illness. It was taken (...) up by therapists in Western countries who were critical of psychoanalysis and sought more ‘scientific’ diagnostic and therapeutic methods that focused on empirical evidence and treating actual symptoms. However, their attitude towards homosexuality often played a decisive role in how they used aversion therapy. Whereas Czechoslovakian researchers cautioned readers about low success rates and agitated for homosexual law reform in 1961, most of their anglophone counterparts selectively ignored or misrepresented the results of ‘the Prague experiment’, instead celebrating single-case ‘success’ stories in their effort to correct ‘abnormal’ sexual orientation. In histories of queer sexuality and its pathologization, the behaviourist paradigm remains almost entirely unmapped. This article provides the most detailed study to date of aversion therapy literature from both sides of the East/West border. In doing so, it contributes to the project not only of ‘decentring Western sexualities’, but of decentring Western sexological knowledge. Given its Pavlovian origins, the history of homosexual aversion therapy can be fully understood only in the context of Cold War transnational sexological knowledge exchange. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Gene TherapyMary Carrington Coutts (bio)On September 14, 1990, researchers at the U.S. National Institutes of Health (NIH) performed the first approved gene therapy procedure on a four-year-old girl named Ashanti DeSilva. Born with a rare genetic disease, severe combined immune deficiency (SCID), Ashanti lacked a healthy immune system and was extremely vulnerable to infection. Children with SCID usually develop overwhelming infections and rarely survive to adulthood; (...) even a common childhood illness like chicken pox is life-threatening. Ashanti led a cloistered existence, avoiding contact with people outside her family, remaining in the sterile environment of her home, and battling frequent illnesses with massive amounts of antibiotics.In Ashanti's gene therapy procedure, her own white blood cells were genetically modified and then infused back into her bloodstream. Laboratory tests show that the therapy has strengthened Ashanti's immune system. She no longer has recurrent colds, has been allowed to attend school, and has been immunized against whooping cough. This gene therapy procedure is not a cure, however. The genetically-treated white blood cells only survive for a few months and must then be replaced, but Ashanti's future is much brighter because of the new therapy (VI, Thompson [The First] 1993).Although this simplified description of Ashanti's gene therapy procedure sounds like a happy ending, it is little more than an optimistic chapter in a long story. The road to the first approved gene therapy procedure was rocky and fraught with controversy. The biology of human gene therapy is very complex, and there are still many techniques that need to be developed and diseases that need to be understood more fully before gene therapy is well established. The public policy debate surrounding the possible use of genetically engineered material in human subjects is equally complex. Major participants in the debate come from the fields of biology, government, law, medicine, philosophy, politics, and religion, each bringing different views to the discussion.In studying the ethics of gene therapy, one should draw a distinction between [End Page 63] therapy on somatic (non-reproductive) cells and germ (reproductive) cells. Only the germ cells carry the genes that will be passed on to the next generation. Reactions to gene therapy have varied widely. Some commentators on gene therapy object to any form of genetic manipulation, no matter how well-intentioned (VI, Rifkin 1983). Another reaction is to allow the use of somatic-cell therapy, but not to approve the use of germ-line therapy, which could have unforeseeable effects on future generations. A different stance is that, with proper regulation and safeguards, germ-line gene therapy is a logical extension of the progress made to date and that it is an ethically acceptable procedure.TechniquesTo date, 43 research protocols have been approved for somatic-cell gene therapy in the United States. The techniques employed in each protocol vary, but in general a virus is used as a "vector" to insert the desired gene into the DNA of the patient's cells, in order to compensate for a defective gene. For Ashanti's gene therapy, this technique involved obtaining white blood cells and introducing properly functioning genes into as many of the cells as possible. The normal genes were delivered through the use of a specially-engineered virus.Although similar techniques are used in germ-line gene therapy, the procedure is more difficult. There are two basic ways to perform germ-line gene therapy: (1) to treat a preimplantation embryo that carries a serious genetic defect before its implantation in the mother, which necessitates the use of in vitro fertilization techniques; or (2) to treat the germ cells (sperm or egg cells) of afflicted adults so that the genetic defects would not be passed on to their offspring, which requires the technical expertise to delete the defective gene and insert a properly functioning replacement. Because of the complexity of the procedures involved and the attendant ethical controversy, germ-line therapy is not currently performed.Candidate Diseases for Gene TherapyAt present, gene therapy is likely to be most successful in treating diseases that are caused by single-gene defects and has been approved for treating diseases such... (shrink)

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view from this position, although not without challenge and internal discipline (...) dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Thomas Aquinas and Cognitive TherapyChristopher Megone (bio)Keywordsemotions, rationality, cognitivism, Aristotelian psychology, powersGiuseppe butera has written a stimulating and persuasive defence of the view that Aquinas’s philosophical psychology (APP) can provide “a profound and cogent philosophical framework for cognitive therapy (CT).” In this short commentary, I respond to Butera’s claims from the perspective of one possible reading of the moral psychology of Aristotle, one of Aquinas’s major philosophical (...) influences. Given the general debt that Aquinas owes to Aristotle, as noted by Butera, this may provide a helpful slant on Butera’s interpretation of Aquinas.Indeed although Butera offers Aquinas as an alternative source for a philosophical underpinning of CT, rather than the Stoics cited by Beck, one might think that Socrates, Plato, and Aristotle could in any case be put forward as equally fruitful areas for inquiry in this context. Thus, one might think that Socrates’ moral psychology, which led him to the cognitivist claim that virtue is knowledge, provides a commitment to a CT-related perspective that both predated and itself influenced the Stoics. And one might then expect to learn things of relevance to CT from the ways in which Plato and Aristotle responded to that Socratic cognitivist outlook.From such an Aristotelian perspective, then, Butera’s approach is very welcome. He makes a strong case for considering Aquinas’s broadly Aristotelian conception of the human person as a desirable alternative to any account that depends on Cartesian substance dualism (of mind and body). On the Aristotelian account, by contrast, the human person is itself a single substance comprised of form (the soul) and matter (the body), the ensouled body constituting a substantial unity. The soul is a set of essential powers, the powers each human has which makes him/her a human being. These powers are necessarily linked in such a way as to comprise that unity and enmattered in a body, each enmattered set of powers constituting an individual member of the species.As Butera also notes, Aquinas follows Aristotle in supposing there to be five basic kinds of human essential powers—vegetative or nutritive, locomotive, sensitive or perceptual, appetitive or desiderative, and rational. Taken together, these distinguish humans from other species. And broadly speaking Aquinas thinks of the distinctively human motivational features as having three parts, non-rational appetites or desires, appetites or desires open to reason, and the purely rational intellect.Within this broad framework, Butera offers an account of APP and in particular of the emotions whose treatment is so important with CT. Given that this account is broadly congenial from an Aristotelian perspective, I offer three main comments. First, Butera makes interesting methodological claims, which I briefly explore. Second, and most [End Page 373] substantially, I examine Butera’s claims about emotions in APP in terms of some Aristotelian points about the acquisition of emotions. Third, I suggest that these latter points bring out a slight tension between the way in which Butera endorses CT at the outset of his paper and his slightly more qualified remarks at the end of it.MethodIn footnote 1, Butera talks of “the differences and complementarity of the methods employed by philosophers and scientists.” However, although he fairly notes that the ambitions of his paper far exceed its scope, so he cannot be expected to have elaborated this theme, his methodological comments do raise some questions as to how exactly we might understand the relation between the two modes of inquiry. He suggests, as noted, that APP can provide the philosophical underpinnings for CT. He goes on to indicate that APP can provide a deeply rooted and highly articulated philosophical explanation for the effectiveness of CT (347). This consists in showing that the principles and methods of CT can be philosophically grounded by APP (348), which he exemplifies by identifying seven points of contact between CT and APP.Butera contrasts this approach with that of Beck, who is content for CT to be “an empirically grounded system of psychological principles and therapeutic methods” (347). So what does the philosophical material add? According to Butera, “employing the rational, dialectical method of the philosophers, [Aquinas] is able to sound depths inaccessible... (shrink)

This paper is the Introduction to the Special Issue comprising a selection of papers submitted to the 19th IESE International Symposium on Ethics, Business and Society. The main topic of the Symposium was “Ethical Challenges in Strategic Management.” The paper presents the rationale and context of the Symposium. We begin with a brief historical overview of the evolution of the relationship between ethics and strategy. We propose four pillars that are at the core of a definition of strategy (...) and elaborate on how ethics can contribute to strategy. We present the six papers that make up this selection within the framework of the four aspects introduced in the previous section. We conclude with some proposals for further research that consider the content of the papers. (shrink)

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the (...) basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field. (shrink)

In recent years there has been an outpouring of work at the intersection of social movement studies and organizational theory. While we are generally in sympathy with this work, we think it implies a far more radical rethinking of structure and agency in modern society than has been realized to date. In this article, we offer a brief sketch of a general theory of strategic action fields (SAFs). We begin with a discussion of the main elements of the (...) theory, describe the broader environment in which any SAF is embedded, consider the dynamics of stability and change in SAFs, and end with a respectful critique of other contemporary perspectives on social structure and agency. (shrink)

During an illness requiring brief use of life-sustaining therapy, patients and surrogates sometimes feel that LST must be withdrawn before it becomes unnecessary to avoid later being stuck living in a debilitated condition that the patient considers worse than death. This fear depends on the belief that the patient can legitimately refuse only artificial LST, so that if such therapies are no longer required, he or she will have missed the ‘opportunity to die.’ This fear of being stuck (...) with life can lead to premature decisions to terminate LST and is unfounded because adequate ethical and moral justification exists for refusal of not just artificial LST, but also for refusal of natural LST, including oral hydration and nutrition. (shrink)

The ArgumentOne disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra–Orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that (...) focus on the patient's mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post–traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self–reconstruction. (shrink)

In this essay I argue that a comprehensive understanding of addiction and its treatment should include an existential perspective. I provide a brief overview of an existential perspective of addiction and recovery, which will contextualize the remainder of the essay. I then present a case study of how the six-step philosophical practice method of Logic-Based Therapy can assist with issues that often arise in addiction treatment framed through an existential perspective.

Extensively updated to include clinical findings over the last two decades, this third edition of A Practitioner's Guide to Rational-Emotive Behavior Therapy reviews the philosophy, theory, and clinical practice of Rational Emotive Behavior Therapy. This model is based on the work of Albert Ellis, who had an enormous influence on the field of psychotherapy over his 50 years of practice and scholarly writing. Designed for both therapists-in-training and seasoned professionals, this practical treatment manual and guide introduces the basic (...) principles of rational-emotive behavior therapy, explains general therapeutic strategies, and offers many illustrative dialogues between therapist and patient. The volume breaks down each stage of therapy to present the exact procedures and skills therapists need, and numerous case studies illustrate how to use these skills. The authors describe both technical and specific strategic interventions, and they stress taking an integrative approach. The importance of building a therapeutic alliance and the use of cognitive, emotive, evocative, imaginal, and behavioral interventions serves as the unifying theme of the approach. Intervention models are presented for the treatment of anxiety, depression, trauma, anger, personality disorders, and addictions. Psychologists, clinical social workers, mental health counselors, psychotherapists, and students and trainees in these areas will find this book useful in learning to apply rational-emotive behavior therapy in practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Breathing:Proustian Therapy1Christopher Prendergast (bio)I begin with a question I would never have imagined myself asking. Is Proust good for you? Might there even be, albeit in carefully controlled doses, a place for him in modern 'health care'? He certainly belongs in the select, if occasionally scary, company of writers whose name, or that of one of their fictional characters, has lent itself to the designation of a psycho-physical (...) condition often with medical characteristics. A short list includes: Stendhal ('Stendhal syndrome,' the condition of obsessional attachment to works of art); Musset (the 'Musset Sign,' manifested as an uncontrollable tremor of the head); Gogol's Plyushkin in Dead Souls ('compulsive hoarding syndrome'); Dickens's Miss Havisham in Great Expectations ('senile squalor syndrome'); Wilde's Lady Windermere ('Lady Windermere syndrome,' associated with pulmonary illness and breathing difficulties).There is no evidence that Proust was directly acquainted with Wilde's play, but there can be little doubt that what came to be called 'Lady Windermere Syndrome' would have spoken to him loud and clear. In an early story called L'Indifférent, Proust penned an encomium to the air we breathe: "A child who from birth has always breathed without paying any attention has no idea how much the air, which swells so sweetly his chest that he doesn't even notice it, is essential to life." A memory of this is doubtless somewhere in the background of the passing mention in Le Côté de Guermantes of "the alpine resort" that teaches him "that the act of breathing, to which we habitually pay no attention, can be a constant source of pleasure." It was almost certainly also in Proust's thoughts when, in the final volume, he penned the famous definition of Paradise Lost as the place and time of "an air we have breathed before, this purer air which the poets have tried in vain to make reign in paradise and which could not provide this profound feeling of renewal if it has not already been breathed, for the only true paradise is a paradise that we have lost."But the early story, like the novel itself, is also haunted by a subtext in which what is precious to life can also be the enemy of life, as, in an access of fever and sudden convulsion, the child feels himself to be suffocating. The story clearly has its origins in Proust's own life, the moment of his first asthma attack as a young boy on a family outing to the Bois de Boulogne. It struck out of the blue with a frightening intensity, and was to pursue [End Page 49] him throughout his life like a fury, proliferating further symptoms such as emphysema and cardiac seizures. As late as 1919, he writes in a letter of an attack that leaves him "gasping like someone half-drowned who is pulled out of water." And it was there again at the moment of Proust's exit from the world, carried off by a bout of pneumonia exacerbated by a pulmonary abscess.There were treatments and consultations galore, the former on a spectrum from inhalations to cauterizing of the nasal tubes, and the latter including a meeting with his father's colleague, Dr. Buissand, who inclined to the view– and increasingly fashionable in medical circles–that the prime cause was neurasthenic. Proust himself hesitated: in a letter he described it as "a bodily illness," but in the Recherche, "asthma crises" are linked to a "mystery" of the "unconscious" and strike out of the blue. The 'mystery' is often, and plausibly, associated with fear of separation from the protective mother. This will be one of the major themes of the novel, and the source of the "sobs that never cease" of which the narrator speaks in the opening volume. But whether physical or psychosomatic, a guaranteed trigger was proximity to tree blossoms (apple especially virulent) and certain flowers–that is, the very things that, for Proust, often something approaching quasi-sacred status, thus illustrating the law that it is what you most love that can kill you.In the novel, however, much of this is distilled into comedy, all terrifying... (shrink)

Mentalization-based family therapy and family rehabilitation represent a rich variety of approaches for assisting families with difficult interaction patterns. On the other hand, adventure therapy methods have been successfully used with families to offer them empowering experiences of succeeding together against difficult odds and to improve communication between family members. Further, the health promoting qualities of spending time outdoors are now well established and recognized. The Nordic approach to mentalization-based family rehabilitation combines adventure, outdoor, and systemic therapy. (...) We provide three examples of nature-based family rehabilitation practices that are delivered as brief, multi-family psychological interventions taking place in nearby nature and aiming to support sustainable, systemic change. The current contribution is a description of clinical practice, not a systematic review or a formal evaluation. We propose that recontextualizing mentalization-based family rehabilitation to the outdoors can not only provide added health benefits, but also strengthen intra-familial attuned interaction and emotional connectedness. The outdoor adventure provides the families with embodied, multisensory experiences of verbal and, especially, non-verbal interaction that can be usefully examined through the lens of theory of mentalization. The concreteness of adventure experiences is particularly beneficial for families that have difficulties in verbal communication and/or utilizing executive functions, perhaps due to neuropsychiatric traits, intellectual disabilities, or learning difficulties. Furthermore, outdoor adventure can support the participants’ connectedness to nature. (shrink)

What does it mean to ‘drop out’ of therapy? Many definitions of ‘dropout’ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client’s experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether (...) this refined categorisation of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioural Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11-17 years. 32 were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. 67 cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analysed using ideal type analysis. Three types of dropout were constructed: ‘dissatisfied’ dropout, ‘got-what-they-needed’ dropout, and ‘troubled’ dropout. ‘Dissatisfied’ dropouts reported stopping therapy because they did not find it helpful. ‘Got-what-they-needed’ dropouts reported stopping therapy because they felt they had benefitted from therapy. ‘Troubled’ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of 'dropout' cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment. (shrink)

During an illness requiring brief use of life-sustaining therapy, patients and surrogates sometimes feel that LST must be withdrawn before it becomes unnecessary to avoid later being stuck living in a debilitated condition that the patient considers worse than death. This fear depends on the belief that the patient can legitimately refuse only artificial LST, so that if such therapies are no longer required, he or she will have missed the ‘opportunity to die.’ This fear of being stuck (...) with life can lead to premature decisions to terminate LST and is unfounded because adequate ethical and moral justification exists for refusal of not just artificial LST, but also for refusal of natural LST, including oral hydration and nutrition. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. (...) This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

This paper reports on the meeting of the Sounding Board of the EU Reprogenetics Project that was held in Budapest, Hungary, 6–9 November 2005. The Reprogenetics Project runs from 2004 until 2007 and has a brief to study the ethical aspects of human reproductive cloning and germline gene therapy. Discussions during The Budapest Meeting are reported in depth in this paper as well as the initiatives to involve the participating groups and others in ongoing collaborations with the goal (...) of forming an integrated network of European resources in the fields of ethics of science. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Experience, and TherapyDominic Murphy (bio)The contemporary philosophical idea of autonomy has a psychological implication, to wit, that there exists a comprehensive set of ideal competences, realized in our mind/brain, that enable a person to be self-governing. Autonomy is normally accorded individuals who enjoy a certain kind of psychological functioning and, perhaps, a certain sort of psychological history (Christman 1991). We think that autonomous individuals critically evaluate their (...) life and actions, endorse them as self-determined rather than imposed from without, and guide their own lives in accordance with the plans and values they have worked out for themselves. Such self-government has to depend on some psychological structures, but philosophers have tended to theorize about what these structures might be at a considerable distance from what the behavioral sciences can tell us. Anderson and Lux's paper is a welcome contribution to the growing literature that tries to connect issues in ethics with empirical considerations. This sort of methodological, as opposed to merely metaphysical, naturalism, is only just coming into vogue in ethics, even in moral psychology.1 Anderson and Lux are, as far as I am aware, the first people to reflect seriously on what we can learn about autonomy from clinical experience. Theirs is a very suggestive and fruitful paper that looks at real-life cases of loss of autonomy and tries to reach conclusions about what the deficits in performance tell us about the psychological preconditions of autonomy. Their paper also opens the way for an investigation into the precise neurologic and computational underpinnings of these capacities, which is essential if we are to get a serious moral psychology underway.I find little to quarrel with in the story that Anderson and Lux tell, but I will try to modify it slightly to bring out what I think is the important psychological point they make and explore some ramifications. I begin by claiming that they have scored a decisive point in favor of an external conception of autonomy. Second, I suggest that what Anderson and Lux have really put their finger on is less a requirement of accurate self-assessment than a requirement of sensitivity to feedback from the environment. I conclude by raising some of these issues about the relations between autonomy and assessments of psychological function when the deficit responsible is less amenable to clear cut neurologic identification.The External Perspective on AutonomyOne way of taking the paper (although this goes beyond anything that Anderson and Lux suggest) is that there is a smooth naturalistic picture of the cognitive basis of autonomy. When people have a normally functioning neurocomputational setup in their heads, we should assume that they are autonomous, and vice versa. However, autonomy cannot simply be identifiable with a mind that is working as some scientific theory says it should, because a mind that is [End Page 303] in that sense working correctly could, nonetheless, be directed by forces other than the agent. Servile or deluded individuals might endorse their lives even if those lives are the product of indoctrination, self-deception, or internalized oppression (Mackinnon 1997; Mele 1995). Normal mechanisms of belief fixation, for example, may not foster one's autonomy if the only context in which they are exercised is one in which many possible ways of life are simply unavailable for consideration, having been excluded from consideration by the dominant forces around one. We might, then, think of full autonomy as depending on relational rather than intrinsic properties. Perhaps autonomy requires a subject to have both normal psychological capacities and the right sort of environment in which to exercise them. I do not follow-up on this suggestion, but I mention it because it introduces two dimensions, within the subject and around the subject, where the externalist perspective on autonomy can get a grip. I discuss the former, but I do not mean to suggest that the latter is not important. A full account must deal with both. But even the psychological structures that foster autonomy cannot be identified with a mind working according to some scientific theory, as we shall see.Many writers on autonomy argue that we must recognize appropriate, objective constraints... (shrink)

Within the Australian university context, research has uncovered increasing levels of psychological distress, in the form of stress, anxiety and depression. Higher rates of psychological distress have been reported in undergraduate students specifically enrolled in creative arts programs. Despite these increasing levels of psychological distress, university students are reluctant to engage with mental health and wellbeing supports. To explore ways to meet the mental health and wellbeing needs of creative arts university students, the Creative Arts and Music Therapy Research (...) Unit at The University of Melbourne commenced a project exploring the benefits and pitfalls of a brief creative arts therapies approach for students attending a campus based wellbeing clinic. This exploratory research study formed the art therapy component of this much broader research endeavor. Creative arts students in this research study were invited to participate in a single session art therapy encounter that involved the visual exploration of the miracle question, asking students to visually depict “what the problem looks like and how it will look when the problem is resolved or you feel like you can cope with it better?” The descriptive findings of this exploratory research study revealed how the combination of art therapy used within a single session framework was able to afford students a novel means to externalize problems, leading students to forming a less internalized view of the self. (shrink)

Respecting patient autonomy through the process of soliciting informed consent is a cornerstone of clinical ethics. In pediatrics, until a child becomes an adult or legally emancipated, that ethical tenet takes the form of respect for parental decision-making authority. In instances of respecting religious beliefs, doing so is not always apparent and sometimes the challenge lies not only in the healthcare provider’s familiarity of religious restrictions but also their knowledge of medical interventions themselves which might conflict with those restrictions. We (...) examine a case of a newborn receiving animal-derived surfactant, a common scenario in neonatology, and present considerations for providers to weigh when confronting when such an intervention might conflict with parent’s religious beliefs. We end with strategizing ways to address this issue as a medical community. (shrink)

The ancient puzzle of the Liar was shown by Tarski to be a genuine paradox or antinomy. I show, analogously, that certain puzzles of contemporary game theory are genuinely paradoxical, i.e., certain very plausible principles of rationality, which are in fact presupposed by game theorists, are inconsistent as naively formulated. ;I use Godel theory to construct three versions of this new paradox, in which the role of 'true' in the Liar paradox is played, respectively, by 'provable', 'self-evident', and 'justifiable'. I (...) also construct in modal operator logic a paradox involving reflexive empirical reasoning. Unlike the paradox of the Liar, the paradox of reflexive reasoning does not depend on self-reference. ;I consider various solutions to the Liar paradox and evaluate how well these solutions cope with the paradox of reflexive reasoning. I then formalize the solution to the paradoxes which I favor: the indexical-hierarchical approach, first sketched out by Charles Parsons and Tyler Burge. In this solution, occurrences of the predicate 'true' in sentence-tokens are contextually relativized to levels of a hierarchy. Drawing also on some brief remarks of Bertrand Russell and Charles Parsons, I develop an account of the kind of schematic generality needed for this theory to be statable. ;Finally, I demonstrate that the principles shown to be paradoxical are in fact presupposed by contemporary game theorists in their reliance on the notion of common knowledge or, more precisely, mutual belief. I create novel analyses of and corresponding solutions to several recalcitrant puzzles within game theory, including the "chain-store paradox". (shrink)