Neuropragmatism offers a non-dualistic conception of experience from which scientific inquiries can provide resources for sociocultural critique. This reconstructive effort addresses what Emma Dowling calls the care crisis without succumbing to what Mike W. Martin calls therapeutic tyranny. This tyranny relies on problematic dualisms, between mind/body, mind/world, and fact/value, that are also found in neuropsychoanalysis. While pragmatism and psychoanalysis more generally share an evolutionary perspective and can overlap in therapeutic approaches, neuropsychoanalysis diverges from this effort in its dual-aspect (...) monism and positivistic conception of science. Where neuropsychoanalysis seeks to reconcile the first-person subjectivity of lived experience with the third-person objectivity of science, neuropragmatism offers reconstruction. In taking the neuropragmatic turn, neuropsychoanalysts can better utilize Freudian therapies in conjunction with active inference principles, such as the free-energy principle and allostasis. Along with neuropragmatism’s conception of experience as organism-environment dynamic engagement, neuropsychoanalysis can benefit from allostatic approaches to experience and inquiry without reducing experience to brute mechanism or denying the utility of such mechanisms for prediction and intervention. Understanding the value-ladenness of experience, primary and secondary, in everyday waking life and in reflective inquiry, empowers people to better care for themselves without succumbing to merely coping with neoliberal oppression. (shrink)

Psychoanalytic Complexity is the application of a multidisciplinary, explanatory theory to clinical psychoanalysis and psychotherapy. It carries with it incisive and pivotal attitudes that aim to transform our understanding of therapeutic action and the change process. Here, William Coburn offers a revolutionary and far-reaching counterpoint to the remnants of Cartesianism and scientism, respecting and encouraging human anomaly rather than pathologizing or obliterating the uniqueness of the individual person. In Psychoanaltyic Complexity, William Coburn explores the value of complexity theory previously (...) understood as an explanatory framework with which clinicians can better understand, retrospectively, therapeutic action and the change process. He further extends this sensibility by examining the ways in which such a rich theoretical framework can inform what clinicians can do, prospectively, to effect positive change within the therapeutic relationship. He persuasively argues that the medium of bringing to light new ways of relating, emotional experiencing, and meaning making resides in the fundamental attitudes derived from a complexity theory sensibility as applied to psychoanalysis and psychotherapy. Using a variety of clinical illustrations throughout, Psychoanalytic Complexity is a radical corrective to reductionism and the more traditional presumption that the problem lies with the patient and the cure lies with the therapist. It offers a new language, vocabulary, way of thinking, and a new way of being with others that are pivotal in arriving at affirmative therapeutic change. This book is intended for psychoanalysts, clinical psychologists, therapists, mental health counsellors, academics and teachers who are interested in new trends in psychoanalysis and psychotherapy. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The few people familiar with the pseudo-Platonic dialogue Axiochus generally have a low opinion of it. It's easy to see why: the dialogue is a mish-mash of Platonic, Epicurean and Cynic arguments against the fear of death, seemingly tossed together with no regard whatsoever for their consistency. As Furley notes, the Axiochus appears to be horribly confused. Whereas in the Apology Socrates argues that death is either annihilation or a relocation of the soul, and is a blessing either way, "the (...) Socrates of the Axiochus wants to have it both ways": death is both annihilation and a release of the soul from the body into a better realm. This may be used to construct a valid argument for the conclusion that death is not evil, but at the expense of having a contradiction as one of its premises. But D. S. Hutchinson has recently proposed that these inconsistencies shouldn't surprise us if we view the Axiochus as "an unconventional version of a very conventional genre--the consolation letter." In this paper I expand on Hutchinson's brief suggestion and argue that the Axiochus can be rehabilitated by paying attention to its genre. Although the Axiochus does display many similarities to the consolation letter, the shift from letter to dialogue does--pace Hutchinson--significantly affect what's going on. Within the dialogue, Socrates behaves toward Axiochus in a way similar to the way the author of a consolation letter behaves towards the letter's reader: he is willing to use inconsistent arguments, borrowed from any source, in order to soothe the patient. However, in depicting this type of consolatory relationship between Socrates and Axiochus, the dialogue itself is not aiming at consoling its readers. Instead, it should be seen as displaying for the reader's consideration a certain type of consolatory argumentative practice. -/- Socrates notes that Axiochus is "very much in need of consolation" (365a), and he uses any means necessary to accomplish this task. Socrates exhibits many ways in which he is willing to sacrifice argumentative hygiene for the sake of therapeutic effectiveness. These include: -/- * Use of arguments with inconsistent premises, presented in propria persona. * Appeals to emotion * Tailoring arguments to the audience. * Presenting invalid arguments so as to induce unjustified but comforting beliefs. * Evasion. In these respects, I think that Socrates' argumentative practice is best compared to PH III 280-1, where Sextus Empiricus says that the skeptic will deliberately use logically weak arguments as long as they work. Dorothy Tarrant claims that what links the Socrates of the Axiochus to Socrates as he appears elsewhere in the Platonic corpus is his evident care for the welfare of his interlocutor's psyche. But this concern takes a quite different form in the Axiochus than it usually does. As with Sextus, psychic therapy in the Axiochus involves relief from pain. The primary difference between them is that Socrates, unlike Sextus, is not aiming at producing epochê in his patient. (shrink)

Psychotherapy helps one enact ideas about a good life, and therapists practice orientations rooted in their chosen approach. A 'good life' can therefore mean different things depending on the therapy. Building on the philosophy of Charles Taylor, Smith examines the link between therapy, ethics and the root of therapeutic views in comparison to modern, Western ideas about 'living well'. This is one of two complementary volumes. This volume builds on the last to explore what it means to engage the (...) different ethics of different therapies by offering a deeper explication of therapeutic ethics. Utilizing Taylor's work on practical reasoning, Smith explores topics like the nature of the ethical argument, the role of ethical intuitions and the value of framing ethical debate as ongoing dialogue. He applies this to therapeutics ethics to show how vital it is to consider the ethical proposals that are present in current theories and practices in order to understand the psychotherapies. A key text for upper level undergraduate, postgraduate students and professionals in the field of psychotherapy, psychoanalysis, theoretical psychology and philosophy of the mind. (shrink)

The integrated stress response (ISR) is a key determinant of tumorigenesis in response to oncogenic forms of stress like genotoxic, proteotoxic and metabolic stress. ISR relies on the phosphorylation of the translation initiation factor eIF2 to promote the translational and transcriptional reprogramming of gene expression in stressed cells. While ISR promotes tumor survival under stress, its hyperactivation above a level of tolerance can also cause tumor death. The tumorigenic function of ISR has been recently demonstrated for lung adenocarcinomas (LUAD) with (...) KRAS mutations. ISR mediates the translational repression of the dual‐specificity phosphatase DUSP6 to stimulate ERK activity and LUAD growth. The significance of this finding is highlighted by the strong anti‐tumor responses of ISR inhibitors in pre‐clinical LUAD models. Elucidation of the mechanisms of ISR action in LUAD progression via cell‐autonomous and immune regulatory mechanisms will provide a better understanding of its tumorigenic role to fully exploit its therapeutic potential in the treatment of a deadly form of cancer. (shrink)

Similar to parasites, cancer cells depend on their hosts for sustenance, proliferation and reproduction, exploiting the hosts for energy and resources, and thereby impairing their health and fitness. Because of this lifestyle similarity, it is predicted that cancer cells could, like numerous parasitic organisms, evolve the capacity to manipulate the phenotype of their hosts to increase their own fitness. We claim that the extent of this phenomenon and its therapeutic implications are, however, underappreciated. Here, we review and discuss what (...) can be regarded as cases of host manipulation in the context of cancer development and progression. We elaborate on how acknowledging the applicability of these principles can offer novel therapeutic and preventive strategies. The manipulation of host phenotype by cancer cells is one more reason to adopt a Darwinian approach in cancer research. -/- . (shrink)

The author presents a varied menu of ideas and experiences in many areas - in research, in diagnosis, and in psychotherapy, each using art media with patients of all ages. She integrates art, phenomenology and gestalt psychology, describing specific techniques and findings. Part I of the book lays out the theoretical foundations and the techniques; Part II addresses the formal components used in art therapy - line, shape and colour in their interrelated dynamics and discusses other aspects and modes of (...) symbolic expression found in clients' work. Part III looks at symbolic expression through the scribble, offering a system of classification, diagnostic possibilities and case studies of work with eating disorders. Part IV focuses on art expression for art therapy diagnostics, including a method for qualitative diagnostics, and a first full diagnostic battery for adolescents. Part V is devoted to Holocaust children's art expressions, highlighting the power of art expression in children under ultimate stress, the intensity of their inner experience, and its visualization in the structure of the pictures. The book is for art therapists and advanced students. It can be used as a textbook on phenomenological art therapy; for therapeutically-oriented art teachers, educators and social workers; and for practicing psychotherapists, to see that art is a source of expression demonstrating how a person is. (shrink)

In this clinically rich and deeply personal book, Chris Jaenicke demonstrates that the therapeutic process involves change in both the patient _and_ the analyst, and that therapy will not have a lasting effect until the inevitability and depth of the analyst's involvement in the intersubjective field is better understood. In other words, in order to change, we must allow ourselves to be changed. This can happen within the sessions themselves, as one grasps the influence of and decenters from (...) one's own subjectivity, with cumulative effects over the course of the treatment. Thus the process, limitations, and cure of psychotherapy are cocreated, without displacing the asymmetrical nature of roles and responsibility. Essentially, beyond the theories and techniques, it is the specificity of our subjectivity as it interacts with the patient's subjectivity which plays the central role in the therapeutic process. (shrink)

After years of failure, in November 2007 primate embryonic stem cells were derived by somatic cellular nuclear transfer, also known as therapeutic cloning. The first embryo transfer for human reproductive cloning purposes was also attempted in 2006, albeit with negative results. These two events force us to think carefully about the possibility of human cloning which is now much closer to becoming a reality. In this paper we tackle this issue from two sides, first summarising what scientists have achieved (...) so far, then discussing some of the ethical arguments in favour and against human cloning which are debated in the context of policy making and public consultation. Therapeutic cloning as a means to improve and save lives has uncontroversial moral value. As to human reproductive cloning, we consider and assess some common objections and failing to see them as conclusive. We do recognise, though, that there will be problems at the level of policy and regulation that might either impair the implementation of human reproductive cloning or make its accessibility restricted in a way that could become difficult to justify on moral grounds. We suggest using the time still available before human reproductive cloning is attempted successfully to create policies and institutions that can offer clear directives on its legitimate applications on the basis of solid arguments, coherent moral principles, and extensive public consultation. (shrink)

Since the realisation that the antigen‐binding regions of antibodies, the variable (V) regions, can be uncoupled from the rest of the molecule to create fragments that recognise and abrogate particular protein functions in cells, the use of antibody fragments inside cells has become an important tool in bioscience. Diverse libraries of antibody fragments plus in vivo screening can be used to isolate single chain variable fragments comprising VH and VL segments or single V‐region domains. Some of these are interfering antibody (...) fragments that compete with protein‐protein interactions, providing lead molecules for drug interactions that until now have been considered difficult or undruggable. It may be possible to deliver or express antibody fragments in target cells as macrodrugs per se. In future incarnations of intracellular antibodies, however, the structural information of the interaction interface of target and antibody fragment should facilitate development of binding site mimics as small drug‐like molecules. This is a new dawn for intracellular antibody fragments both as macrodrugs and as precursors of drugs to treat human diseases and should finally lead to the removal of the epithet of the ‘undruggable’ protein‐protein interactions. (shrink)

Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. (...) Thus, absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families. (shrink)

Summary This paper starts with a short review of recent developments in psychotherapy process research and analyzes that a medical, or better, technical approach in process research – using words such as ‘intervention’, ‘effect’ and ‘outcome’ – is gradually acknowledged as only one side of psychotherapy; the other, more human or ‘humanistic’ side, is ‘conversation’, described by prominent authors as ‘low technology’. Conversation analysis cannot study psychotherapy as a whole. Sessions are subdivided into ‘situations’. What are situations? I make (...) a proposal to answer this question by three components: open up, select and control options. Then, 11 transcribed extracts from psychoanalytical therapy sessions are used to describe three types of situations and the special kind of requirements they demand from a therapist. Obviously, such situations appear during a session, they can be handled if therapists are sensitized for certain difficulties to arise. Shift-of-situation and double meaning are new observations in this approach to define the situational gestalt and train ‘seeing’ it. (shrink)

In spite of the advances in our knowledge of cancer biology, most cancers remain not curable with present therapies. Current treatments consider cancer as resulting from uncontrolled proliferation and are non‐specific. Although they can reduce tumour burden, relapse occurs in most cases. This was long attributed to incomplete tumour elimination, but recent developments indicate that different types of cells contribute to the tumour structure, and that the tumour's cellular organization would be analogous to that of a normal tissue, with a (...) main mass of differentiating cells sensitive to anti proliferative agents, together with a small percentage of quiescent, resistant stem cells responsible for replenishing the tumour: the Cancer Stem Cells (CSCs). Anti‐CSCs targeted therapeutic agents would prevent tumour regeneration. New mouse models tailored to exploit this novel concept will be critical to develop CSC‐based anti‐cancer therapies. Here we review the biological basis and the therapeutic implications of the stem‐cell model of cancer. BioEssays 29:1269–1280, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Use of the imagination is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken, and learn to trust their creative inner life, while therapists use their imaginations to mentalise the suffering other and to trace the unconscious stirrings evoked by the intimacy of the consulting room. Working from this premise, in _The Therapeutic Imagination_ _Jeremy Holmes_ argues unashamedly that literate therapists make better therapists. Drawing on psychoanalytic and literary traditions both classical and (...) contemporary, Part I shows how poetry and novels help foster therapists’ understanding of their own imagination-in-action, anatomised into five phases: attachment, reverie, logos, action and reflection. Part II uses the contrast between secure and insecure narrative styles in attachment theory and relates these to literary storytelling and the transformational aspects of therapy. Part III uses literary accounts to illuminate the psychiatric conditions of narcissism, anxiety, splitting and bereavement. Based on Forster’s motto, ‘Only Connect’, Part IV argues, with the help of poetic examples, that a psychiatry shorn of psychodynamic creativity is impoverished and fails to serve its patients. Clearly and elegantly written, and drawing on the author’s deep knowledge of psychoanalysis and attachment theory and a lifetime of clinical experience, _Holmes _convincingly links the literary and psychoanalytic canon. _The Therapeutic Imagination _is a compelling and insightful work that will strike chords for therapists, counsellors, psychoanalysts, psychiatrists and psychologists. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, (...) 94 articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

There is ongoing debate about whether it is ethically acceptable to allow the creation of cloned embryos in order to produce human stem cells. A cloned embryo is created through a process called somatic-cell nuclear transfer, often known as ‘therapeutic’ cloning. The value of stem cells lies in their capacity to become any sort of cell in the human body. This capacity is particularly useful for treating medical conditions where stem cells can be used to repair or replace damaged (...) tissue. The value of a cloned embryo is that the DNA from a person who needs stem cell treatment can be used to create the clone and thereby minimise the likelihood that any inserted stem cells will be rejected. Research on the use of cloned stem cells is in its earliest stage. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The (...) evolution of the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

The aim of regenerative medicine is to reconstruct tissue that has been lost or pathologically altered. Therapeutic cloning seems to offer a method of achieving this aim; however, the ethical debate surrounding human therapeutic cloning is highly controversial. Artificial parthenogenesis—obtaining embryos from unfertilised eggs—seems to offer a way to sidestep these ethical pitfalls. Jacques Loeb , the founding father of artificial parthogenesis, faced negative public opinion when he published his research in 1899. His research, the public’s (...) response to his findings, and his ethical foundations serve as an historical argument both for the communication of science and compromise in biological research. (shrink)

The ‘right to the truth’ involves disclosing all the pertinent facts to a patient so that an informed decision can be made. However, this concept of a ‘right to the truth’ entails certain ambiguities, especially since it is difficult to apply the concept in medical practice based mainly on current evidence-based data that are probabilistic in nature. Furthermore, in some situations, the doctor is confronted with a moral dilemma, caught between the necessity to inform the patient (principle of autonomy) and (...) the desire to ensure the patient's well-being by minimising suffering (principle of beneficence). To comply with the principle of beneficence as well as the principle of non-maleficence ‘to do no harm’, the doctor may then feel obliged to turn to ‘therapeutic privilege’, using lies or deception to preserve the patient's hope, and psychological and moral integrity, as well as his self-image and dignity. There is no easy answer to such a moral dilemma. This article will propose a process that can fit into reflective practice, allowing the doctor to decide if the use of therapeutic privilege is justified when he is faced with these kinds of conflicting circumstances. We will present the conflict arising in practice in the context of the various theoretical orientations in ethics, and then we will suggest an approach for a ‘practice of truth’. Last, we will situate this reflective method in the broader clinical context of medical practice viewed as a dialogic process. (shrink)

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic (...) responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology. (shrink)

From a theoretical standpoint, the problem of human suffering can be understood as one formulation of the classical problem of evil, which calls into question the compatibility of the existence of a perfect God with the extent to which human beings suffer. Philosophical responses to this problem have traditionally been posed in the form of theodicies, or justifications of the divine. In this article, I argue that the theodical approach in analytic philosophy of religion exhibits both morally and epistemically harmful (...) tendencies and that philosophers would do better to shift their perspective from the hypothetical “God’s-eye view” to the standpoint of those who actually suffer. By focusing less on defending the epistemic rationality of religious belief and more on the therapeutic effectiveness of particular imaginings of God with respect to suffering, we can recover, (re)construct, and/or (re)appropriate more virtuous approaches to the individual and collective struggle with the life of faith in the face of suffering. (shrink)

Sin-talk, though politically incorrect, is indispensable. Placing human life under the ‘hermeneutic of sin’ means acknowledging that one ought to aim flawlessly at God, and that one can fail in this endeavor. None of this can be appreciated within the contemporary post-Christian, mindset, which has attempted to reduce religion to morality and culture. In such a secular context, the guilt-feelings connected with the recognition of sin are considered to be harmful; the eternal benefit of a repentance is disregarded. Nevertheless, spirituality (...) appears to have therapeutic benefits. Therefore attempts are made to re-locate within healthcare a religion shorn of its transcendent claims, so as then to harvest the benefits of a spirituality ‘saved from sin’. This reduction of religiosity to its therapeutic function is nourished by a post-modern constructivist construal of religion. This article critically examines the dis-ingenuity marring such recasting, as well as the incoherence of related attempts to reduce transcendence to solidarity, and to re-shape the significance of religious rituals. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, (...) and clinicians. It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

Psychodrama is an effective psychotherapeutic model but interventions with adolescents require age-tailored techniques that maximize engagement and facilitate communication processes. This study describes a novel adaptation of a therapeutic mask technique to psychodrama with adolescents. Over the course of eight group sessions of psychodrama, five adolescents created their own mask and explored its therapeutic use. Their experiences were captured at the end of each session with the Helpful Aspects of Therapy form, and at the end of the study (...) with the Clinical Change Interview. Awareness/insight/self-understanding, empowerment and relief were the most significant aspects experienced by the adolescents, along with perceived increase of calmness and world connection, satisfaction in interpersonal communication and better emotional expression and regulation. The mask technique was experienced as a playful and engaging task that facilitated insight and interpersonal communication. Findings provide preliminary evidence on the clinical utility of mask-based psychodrama with adolescents. (shrink)

Children and pregnant women are often excluded from clinical research. This has resulted in a paucity of evidence on how medicines work for fetuses, neonates, infants, and adolescents. It also raises bioethics, scientific, and public health concerns. For over half a century, doctors have prescribed medicines to children largely on the basis of how they work in adults, despite children’s varied physiologies and differences in how their bodies absorb and metabolize drugs. Regulations and legislation have led to an increase in (...) the number of pediatric studies and to better drug labeling. However, children at all stages of their lives often remain “therapeutic orphans” owing to insufficient evidence about how medicines work for them. (shrink)

This article addresses the way in which therapeutic practice in an English prison creates conditions whereby both prisoners and prison officers are caught up in networks and relationships of power that contribute to the constitution of particular subjects. The development of therapeutic practice, in relation to prisons and probation, is described and contextualised. Subsequently, the practices of group therapy in operation at Grendon prison - a rather unique institution built on principles of therapeutic community – are analysed (...) with a focus on five ”practices of moulding,” namely, naming, confession, assessment and surveillance, tolerance and participation. The argument that psychotherapy, under conditions of imprisonment, is a form of repression or social control is discussed and dismissed as too simple a model to account for the relations of power and constitutive practices that effect all participants, not only prisoners. Members of staff, as well as prisoners, are shown to be caught up in the disciplinary web. Discipline, as opposed to control, is advocated as a more appropriate concept for understanding therapeutic practices in prison. The work of Thomas Mathiesen, on the concept of synoptic power, is introduced to help illustrate these dynamics. The article represents a shift in my own thinking, from scepticism to a pragmatic idealist position, that creates space for institutions like Grendon to be imagined as potential least worst options for people convicted of offences and obliged to serve “time”. It is my hope, argued for in the article, that Grendon can be conceived of as a “visionary space” with emancipatory potential. (shrink)

The question of whether or not children may be used as subjects in non-therapeutic research projects has generated a great deal of debate and received answers varying from 'no, never' to 'yes, if societal interests are served'. It has been claimed that a Kantian, deontological ethics would necessarily rule out such research, since valid consent would be impossible. The present paper gives a deontological argument for allowing children to be subjects in certain types of research.

This special issue of the Journal of Medicine and Philosophy focuses on unintended intrauterine death (UID) and preterm delivery (both phenomena that are commonly—and unhelpfully—referred to as “miscarriage,” “spontaneous abortion,” and “early pregnancy loss”). In this essay, I do two things. First, I outline contributors’ arguments. Most contributors directly respond to “inconsistency arguments,” which purport to show that abortion opponents are unjustified in their comparative treatment of abortion and UID. Contributors to this issue show that such arguments often rely on (...) a grossly oversimplified picture of abortion opponents’ views. Furthermore, contributions in this issue weigh in on issues regarding UID with theoretical import and therapeutic implication beyond the inconsistency argument debate. These papers can be mined for principles that better inform us about anembryonic pregnancies (i.e., nonviable pregnancies in which a gestational sac exists but no embryonic pole can be seen via transvaginal ultrasound), UID-prevention research, the law concerning UID (especially post-Dobbs), policies for handling embryonic remains, and moral psychology as it relates to UID, emotion, and empathy. In each case, conceptual philosophical analysis might bring about therapeutic benefits for those affected by UID. Philosophers, therefore, are in position not only to provide clarity—careful analysis and discussion of UID and related phenomena—but are also in position to genuinely help people affected by UID. (shrink)

In recent years, there have been debates in aesthetics and philosophy of art on the question of whether we can acquire knowledge about the world from works of art. However, little has been written on the effects that art has on cultivating self-knowledge and self-development. While, for most of us, it seems obvious that art has these effects, little is known about how and why these effects occur. Addressing this issue is the main aim of this paper. The gist of (...) the argument is that narrative art provides a unique opportunity to adopt a dual (first- and third-personal) perspective on the self, which is argued recently by psychologists and philosophers of mind to be necessary for obtaining the kind of self-knowledge that leads to self-development and self-change, that is, therapeutic self-knowledge. (shrink)

Discovering Spinoza's early modern psychology some 35 years into his own clinical practice, Ian Miller now gives shape to this connection through a close reading of Spinoza's key philosophical ideas. With a rigorous and expansive analysis of Spinoza's Ethics in particular, Miller explores how Spinozan thought simultaneously empowered the original conceptual direction of psychoanalytic thinking, and anticipated the field's contemporary theoretical dimensions. Miller offers a detailed overview of the philosopher's psychoanalytic reception from the early work of German-language psychoanalytic thinkers, such (...) as Freud and Andreas Lou-Salome, forward into its Anglophone reception, influencing both mid-century humanistic American psychoanalysis as well as anticipating thinkers such as Bion and Winnicott. Covering key concepts in psychoanalytic theory and clinical practice, this book demonstrates how knowledge of Spinoza's philosophical work can help to both illuminate and improve modern psychoanalytic therapies. (shrink)

Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)

Nursing on paper: therapeutic letters in nursing practice This paper offers a selected piece of interpretive research extracted from the context of a larger research study. The hermeneutic research inquiry described in this paper involved the examination of the nursing and family therapy intervention of therapeutic letters. It incorporated the textual interpretation of 11 therapeutic letters, clinical sessions with three families, clinical team discussions, and research interviews with four family members and three nurse clinicians who participated in (...) the writing of the letters. This particular paper extracts segments of the research related to the letters received by two participants, as well as some general findings, with a focus on the possibilities and influences of therapeutic letters in nursing practice. The findings of this research offer suggestions, not as a template, but as an inspiration and evocation to write therapeutic letters that address the obligation of meeting people experiencing illness at the point of their suffering, with words and questions that invite relationship, reflection, and are large enough to sustain a meeting. (shrink)

This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and advance directives for dementia research are discussed. Then attention is paid to the philosophical issue of dementia and personal identity, and the implications for the moral authority of research advance directives. Thirdly, a number of (...) practical shortcomings of advance directives for non-therapeutic dementia research are explored and attention is paid to the role of proxies. It is concluded that upon a closer look the initial attractiveness of advance directives for dementia research is lessened, and that it is doubtful whether these instruments can compensate for the lack of subject consent in case of non-therapeutic dementia research involving more than minimal risks and/or burdens for the incompetent demented subject. (shrink)

Pediatric participation in non-therapeutic research that poses greater than minimal risk has been the subject of considerable thought-provoking debate in the research ethics literature. While the need for more pediatric research has been called morally imperative, and concerted efforts have been made to increase pediatric medical research, the importance of protecting children from undue research risks remains paramount.United States research regulations are derived largely from the deliberations and report of the National Commission for the Protection of Human Subjects of (...) Biomedical and Behavioral Research. The authors of this report specifically designated children as a vulnerable population and suggested additional protections, most of which became U.S. law. One of the more contested sets of regulations surrounds non-therapeutic research, e.g., research that does not offer the potential for direct benefit to participants. Federal regulations allow local Institutional Review Boards to approve non-therapeutic research posing a minor increase above minimal risk when it involves children who have the disease or medical condition that the research addresses. (shrink)

Female genital cutting (FGC) is generally understood as a gendered harm, abusive cultural practice and human rights violation. By contrast, male genital cutting (MGC) is held to be minimally invasive, an expression of religious identity and a legitimate parental choice. Yet scholars increasingly problematize this dichotomy, arguing that male and female genital cutting can occasion comparable levels of harm. In 2015 this academic critique received judicial endorsement, with Sir James Munby's acknowledgement that all genital cutting can cause ‘significant harm’. This (...) article investigates the harm occasioned by MGC. It is informed by a Freedom of Information (FoI) study which provides some empirical evidence of the nature and frequency of physical harm caused by MGC in U.K. hospitals. While acknowledging the challenges and limitations of FoI research, we outline important lessons that this preliminary study contains for medical ethics, law and policy. It provides some empirical evidence to support claims regarding the risks which accompany the procedure and the obligation of health professionals to disclose them, and reveals the paucity of measures in place to ensure that harms are recorded, disclosed and monitored. (shrink)

The aim of this article was to interpret Habermas's concept of language in terms of its therapeutic potential which can be effectively realized in nursing practice. Drawing on Habermas's definition, we analyse the components of rational communication which are necessary for the patient and the therapist to achieve understanding. In doing this, we examine not only lifeworld, system and validity claims, which are well‐known notions within Habermas's theory of communicative action, but also less frequently studied elements of this theory, (...) such as everyday world, to which the patient refers in the process of self‐understanding and identity construction. We also address culture and language as a pre‐rational factor which can disturb, or even preclude, communication and understanding. In such circumstances, we propose supplementing the Habermasian therapeutic project with a psychoanalytical interpretations of the utterances of the patients who have difficulty defining the situation within which therapy is possible. (shrink)

The rapid sequencing of entire genomes based in large measure on a DNA cloning procedure, the polymerase chain reaction (PCR), has opened new frontiers in the discovery process for novel therapeutic agents. DNA cloning is a basic tool in genomics and it has been used for over a decade. Drug discovery is currently focused on the identification of gene databases, gene arrays and protein arrays aimed at therapeutic modulation of disease-related genes—which require procedures that may involve cloning techniques. (...) Currently, cloning for pharmacologic products is most applicable in the preclinical area of drug discovery. For example, the identification of specific receptor subtypes occurred via cloning whereas traditional pharmacologic approaches that use agonists and antagonists may have failed to separate binding affinities. Successful therapeutic agents where cloning played vital role resulted in the development of synthetic insulin, growth hormone, erythropoiten and other tissue factors in blood products, Vaccines may be another successful application derived from cloning. Another area where cloning can make a significant impact upon human therapeutics is that this technique may provide a new source of cells for tissue engineering and transplantation. Stem cells, and in particular, embryonic stem cells can differentiate into other cell types such as hepatocytes and neurons to provide normal products for hepatic and neurological diseases. However, the use of cloning embryonic stem cells introduces important ethical, medical and legal issues which require that leaders in government, academic, and religious groups be fully educated in these applications. A close working relationship among these diverse groups is needed to respond wisely to the introduction of new therapeutic opportunities while at the same time providing protection for the individual and the public at large from unethical practises. (shrink)

A rational justification for therapeutic decisions can be developed using probability and decision theory. The set of treatments and their outcomes or consequences, which are states of health, have to be defined; and estimates made of the probabilities of outcomes, their utilities, and the costs of treatments. Most difficult is the estimation of utilities of states of health but this may be possible using a wagering technique. Until it is possible to establish some equivalence between utility and money, costs (...) may be introduced by measuring the efficiency of treatment by comparing expected utilities per unit cost. The whole method is examined practically in a plausible clinical setting. Emphasis is laid on the value of testing the completed model using a computer to get an intimate feel of the problem using different assumptions and different values for all the parameters. (shrink)

In recent times, we have seen a resurgence of interest in the application of philosophy as a therapeutic for the purpose of alleviating the existential ills of human life. Within this paper, it is argued that not only can philosophy be applied as a therapeutic, but that the very act of doing philosophy is therapeutic. The paper begins with a discussion of human nature as bound to finitude and the suffering of existence. The necessity to labor along (...) with the need for relief from labor in the form of recreation and play is then discussed. Play is thereafter distinguished from leisure, and the concept of philosophical contemplation, following Aristotle, is introduced. It is argued that the activity of contemplation results in relief from the suffering of existence, and that its exercise may in consequence be considered a kind of therapeutic. (shrink)

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals. Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs’ perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs (...) from different positions and experience, including doctors and nurses in four different departments, were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient’s timing and sharing the patient’s wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs’ emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation. (shrink)

Some worry that offering too much money to participate in medical research can seduce people into participating against their better judgment. These overly attractive offers that impair judgment are often referred to as ‘undue inducements’. The current approach to prevent undue inducement is to limit the size of such offers. The hope is that smaller offers will not be attractive enough to impair judgment. Even if this is true, I argue that we should reject this solution. In Section 1, (...) I go over the problem of undue inducement, and our current approach to preventing it, in more detail. In Section 2, I argue that, like money, therapeutic benefits of medical research may also unduly induce. In Section 3, I argue that the current approach to preventing undue inducement is absurd in the case of therapeutic inducements. In Section 4, I argue that our current approach is analogously problematic in the case of monetary inducements. (shrink)

In a previous article, I attempted to assess the likely impact of the most prominent versions of the therapeutic misconception (TM) on research subjects’ informed consent. I concluded that the TM is not nearly as significant a concern as is commonly thought, and that focusing on it is more likely to undermine than promote research subjects’ informed consent.A recent commentary rejects these conclusions, as least as they pertain to the “consensus” definition of the TM. The authors of the commentary (...) argue that work on the TM remains central to ensuring the appropriateness of research subjects’ consent and, by implication, the ethical acceptability of clinical research.The present work evaluates the arguments offered in support of these claims. This analysis reveals that the authors offer few substantive responses to my arguments, and the responses they do offer fail to undermine my prior conclusions. Furthermore, consideration of an additional issue—the emergence of learning healthcare systems—suggests that the TM is likely to be even less significant in the future, hence, focusing on it may be even more problematic than I argued previously. (shrink)

BET proteins such as Brd3 and Brd4 are chromatin‐associated factors, which control gene expression programs that promote inflammation and cancer. The Nrf2 transcription factor is a master regulator of genes that protect the organism against xenobiotic attack and oxidative stress. Nrf2 has demonstrated anti‐inflammatory activity and can support cancer cell malignancy. This review describes the discovery, mechanism and biomedical implications of the regulatory interplay between Nrf2 and BET proteins. Both Nrf2 and BET proteins are established drug targets. Small molecules that (...) either activate or suppress these proteins are currently tested in clinical trials. The crosstalk between Nrf2 and BET proteins may have important, and until now overlooked, implications for the therapeutic effects of these drugs. Based on the information covered in this review, it should be possible to design combinatorial treatment strategies for cancer and inflammatory diseases, which may improve the efficacy of targeting a Nrf2 or BET proteins individually. (shrink)

The contemporary emergence of the concept ‘debility’, which pertains to a broad swathe of humanity whose ordinary lives simply persist without ever getting better, shares a time span with an acute critique of neo-liberal biopolitics. Where capital has historically relied on a population that through its labour necessarily becomes debilitated, the newer model of understanding references the intrinsic profitability of debility itself. The two dimensions overlap and co-exist, but what I shall pursue here are the implications of recognising that, (...) at the most fundamental level, it is in the interests of neo-liberalism to produce and sustain bodies as debilitated and therefore susceptible to a range of market commodities that hold out the promise of therapeutic interventions into the relative failures of physical, cognitive and affective embodiment. In previous work, I have argued strongly for the inherent vulnerability of all bodies, but in considering here a more overtly politicised context, it becomes possible to readdress the questions posed by Jasbir Puar: ‘which bodies are made to pay for “progress”? Which debilitated bodies can be reinvigorated for neoliberalism, and which cannot?’ And at the present moment, writing at a time of imposed austerity, I would add, what, if anything, is lost in the deployment of the term debility instead of disability? (shrink)

In this paper I argue that some human reproductive genome editing interventions can be therapeutic in nature, and thus that it is false that all such interventions just create healthy individuals. I do this by showing that the conditions established by a therapy definition are met by certain reproductive genome editing interventions. I then defend this position against two objections: (a) reproductive genome editing interventions do not attain one of the two conditions for something to be a therapy, and (...) (b) some reproductive genome editing interventions are therapeutic but in a nonstandard way. In the Conclusion I call for a more nuanced discussion of the nature of reproductive genome editing interventions. (shrink)

The ‘Precautionary Principle’ provides a somewhat ill-defined guide, often of uncertain normative status, for those exercising administrative decision-making power in circumstances where that may create potential risks to human health or the environment. This paper seeks to explore to what extent the precautionary principle should have been and was in fact utilised by the Australian Therapeutic Goods Administration (TGA) in its decision to approve the marketing of sunscreens containing titanium dioxide (TiO2) and zinc oxide (ZnO) in nanoparticulate form. In (...) particular, this article assesses to what extent better application of that principle might have altered the TGA’s decision that TiO2 and ZnO ENPs in sunscreens do not require new safety testing, because they are considered to be functionally equivalent to their bulk counterparts. (shrink)

The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience—an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response. The putative mechanism of action of psychedelics as meaning enhancers (...) raises normative ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick’s Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick’s standards. (shrink)