The World Psychiatric Association has emphasised the importance of idiographic understanding as a distinct component of comprehensive assessment but in introductions to the idea it is often assimilated to the notion of narrative judgement. This paper aims to distinguish between supposed idiographic and narrative judgement. Taking the former to mean a kind of individualised judgement, I argue that it has no place in psychiatry in part because it threatens psychiatric validity. Narrative judgement, by contrast, is a genuinely distinct complement (...) to criteriological diagnosis but it is, nevertheless, a special kind of general judgement and thus can possess validity. To argue this I first examine the origin of the distinction between idiographic and nomothetic in Windelband’s 1894 rectorial address. I argue that none of three ways of understanding that distinction is tenable. Windelband’s description of historical methods, as a practical example, does not articulate a genuine form of understanding. A metaphysical distinction between particulars and general kinds is guilty of subscribing to the Myth of the Given. A distinction based on an abstraction of essentially combined aspects of empirical judgement cannot underpin a distinct empirical method. Furthermore, idiographic elements understood as individualised judgements threaten the validity of psychiatric diagnosis. In the final part I briefly describe some aspects of the logic of narrative judgements and argue that in the call for comprehensive diagnosis, narrative rather than idiographic elements have an important role. Importantly, however, whilst directed towards individual subjects, narratives are framed in intrinsically general concepts and thus can aspire to validity. (shrink)

1. GENERAL The term "diagnostics" refers to the general theory of diagnosis, not to the study of specific diagnoses but to their general framework. It borrows from different sciences and from different philosophies. Traditionally, the general framework of diagnostics was not distinguished from the framework of medicine. It was not taught in special courses in any systematic way; it was not accorded special attention: students absorbed it intuitively. There is almost no comprehensive study of diagnostics. The instruction in (...) diagnosis provided in medical schools is exclusively specific. Clinical instruction includes (in addition to vital background information, such as anatomy and physiology) specific instruction in nosology, the theory and classification of diseases, and this includes information on diagnoses and prognoses of diverse diseases. What is the cause of the neglect of diagnostics, and of its integrated teaching? The main cause may be the prevalence of the view of diagnostics as part-and parcel of nosology. In this book nosology is taken as a given, autonomous field of study, which invites almost no comments; we shall freely borrow from it a few important general theses and a few examples. We attempt to integrate here three studies: ll of the way nosology is used in the diagnostic process; of the diagnostic process as a branch of applied ethics; ~ of the diagnostic process as a branch of social science and social technology. (shrink)

Metal roof enclosure system is an important part of steel structure construction. In recent years, it has been widely used in large-scale public or industrial buildings such as stadiums, airport terminals, and convention centers. Affected by bad weather, various types of accidents on metal roofs frequently occurred, causing huge property losses and adverse effects. Because of wide span, long service life and hidden fault of metal roof, the manual inspection of metal roof has low efficiency, poor real-time performance, and it (...) is difficult to find hidden faults. On the basis of summarizing the working principle of metal roof and cause of accidents, this paper classifies the fault types of metal roofs in detail and establishes a metal roof monitoring and fault diagnosis system using distributed multisource heterogeneous sensors and Zigbee wireless sensor networks. Monitoring data from strain gauge, laser ranging sensor, and ultrasonic ranging sensor is utilized comprehensively. By extracting time domain feature, the data trend characteristics and correlation characteristics are analyzed and fused to eliminate erroneous data and find superficial faults such as sensor drift and network interruption. Aiming to the hidden faults including plastic deformation and bolt looseness, an SVM fault diagnosis algorithm based on RBF kernel function is designed and applied to diagnose metal roof faults. The experimental results show that the RBF-SVM algorithm can achieve high classification accuracy. (shrink)

At present, most of the research in the field of medical-assisted diagnosis is carried out based on image or electronic medical records. Although there is some research foundation, they lack the comprehensive consideration of comprehensive image and text modes. Based on this situation, this article proposes a fusion classification auxiliary diagnosis model based on GoogleNet model and Bi-LSTM model, uses GoogleNet to process brain computed tomographic images of ischemic stroke patients and extract CT image features, uses (...) Bi-LSTM model to extract the electronic medical record text, integrates the two features using the full connection layer network and Softmax classifier, and obtains a method that can assist the diagnosis from two modes. Experiments show that the proposed scheme on average improves 3.05% in accuracy compared to individual image or text modes, and the best performing GoogleNet + Bi-LSTM model achieves 96.61% accuracy; although slightly less in recall, it performs better on F1 values, and has provided feasible new ideas and new methods for research in the field of multi-model medical-assisted diagnosis. (shrink)

In this resource for educators, Harold F. Burks offers a comprehensive guide to the evaluation techniques and intervention strategies that have worked with many school children experiencing problems. Thus, Diagnosis and Remediation Practices for Troubled School Children attempts to: clarify the understanding of observed, unwanted child behavior symptoms ; investigate with educators and parents—and sometimes children—the possible causal factors that antedate these behavior manifestations; create in cooperation with parents and school personnel, innovative intervention techniques to help children learn (...) accepted behavior patterns. (shrink)

Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories (...) has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions. (shrink)

An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role (...) it has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis. (shrink)

Chronic disorders of consciousness, particularly the vegetative and the minimally conscious states, pose serious diagnostic challenges to neurologists and clinical psychologists. A look at the concept of “diagnosis” in medicine reveals its social construction: While medical categorizations are intended to describe facts in the real world, they are nevertheless dependent on conventions and agreements between experts and practitioners. For chronic disorders of consciousness in particular, the terminology has proven problematic and controversial over the years. Novel research utilizing functional brain (...) imaging has demonstrated that a substantial number of patients retain their capabilities to communicate by brain activity even when they are incapable of classic verbal and nonverbal responses due to the dysfunction of their motor behavior. Moreover, thorough diagnostic assessments constitute the foundations for suitable rehabilitation measures. Thus, ethical arguments support the claim that the potential of emerging methods for communication via brain activity should be evaluated comprehensively in patients with chronic disorders of consciousness, once the technological methodology for this endeavor progresses to a reliable and affordable stage. (shrink)

Cognitive diagnosis models (CDMs) allow classifying respondents into a set of discrete attribute profiles. The internal structure of the test is determined in a Q-matrix, whose correct specification is necessary to achieve an accurate attribute profile classification. Several empirical Q-matrix estimation and validation methods have been proposed with the aim of providing well-specified Q-matrices. However, these methods require the number of attributes to be set in advance. No systematic studies about CDMs dimensionality assessment have been conducted, which contrasts with (...) the vast existing literature for the factor analysis framework. To address this gap, the present study evaluates the performance of several dimensionality assessment methods from the factor analysis literature in determining the number of attributes in the context of CDMs. The explored methods were parallel analysis, minimum average partial, very simple structure, DETECT, empirical Kaiser criterion, exploratory graph analysis, and a machine learning factor forest model. Additionally, a model comparison approach was considered, which consists in comparing the model-fit of empirically estimated Q-matrices. The performance of these methods was assessed by means of a comprehensive simulation study that included different generating number of attributes, item qualities, sample sizes, ratios of the number of items to attribute, correlations among the attributes, attributes thresholds, and generating CDM. Results showed that parallel analysis (with Pearson correlations and mean eigenvalue criterion), factor forest model, and model comparison (with AIC) are suitable alternatives to determine the number of attributes in CDM applications, with an overall percentage of correct estimates above 76% of the conditions. The accuracy increased to 97% when these three methods agreed on the number of attributes. In short, the present study supports the use of three methods in assessing the dimensionality of CDMs. This will allow to test the assumption of correct dimensionality present in the Q-matrix estimation and validation methods, as well as to gather evidence of validity to support the use of the scores obtained with these models. The findings of this study are illustrated using real data from an intelligence test to provide guidelines for assessing the dimensionality of CDM data in applied settings. (shrink)

Although diagnosis is integral to the theory and practice of psychiatry, social scientists have not developed a comprehensive approach to diagnosis. This paper presents a preliminary outline of the issues which a sociology of diagnosis should integrate. These include bias and social control in psychiatric diagnosis, diagnosis as part of a new extension of the biopsychiatric medical model, and flaws in contemporary diagnostic categorization. These issues are then viewed in terms of professional practice styles, (...) diagnostic biases, psychiatry's professional dominance over the mental health field, and psychiatric hegemony over the clinical interaction with patients. (shrink)

While often dubbed “the bible of contemporary psychiatry” and widely hailed as providing “a benchmark” for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance (...) of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM’s diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework. (shrink)

BackgroundAttention Deficit Hyperactivity Disorder is one of the most prevalent psychiatric disorders among school-age children and is characterized by varying degrees of inattention, hyperactivity, and impulsivity. Diagnosis, which currently relies on the DSM-V criteria, is complex. This research proposes an integrated procedure for ADHD diagnosis in children, improving the diagnostic process and scientific research on etiopathology.Materials and methodsWe conducted a clinical report on ADHD diagnosis in children between the ages of 8 and 13, based on the results (...) of the application of different scales to parents of school-age children in Chile. The children were divided into two groups, those with an ADHD diagnosis and those without.ResultsThe results revealed statistically significant differences between groups for scales EDAH y SDQ-Cas, Conners Comprehensive Behavior Scale, Conners Parent Scale and the criteria according to the DSM-V and its dimensions, with the exception of inattention.ConclusionThe findings indicate the importance of appropriate criteria and procedures to establish a diagnosis and implement effective interventions in ADHD. (shrink)

Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used to (...) synthesise data from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

The two significant zoonotic bacterial infections that have remained a concern due to the complex dynamics involved in transmission and global prevalence are anthrax and brucellosis. The present paper attempts to address some of the most important zoonotic pathogens, highlighting their epidemiology, clinical manifestations, diagnosis, treatment, and prevention strategies. Anthrax is largely transmitted through direct contact with the infected animals or their products resulting in cutaneous, inhalational, and gastrointestinal forms, all with specific clinical outcomes and approaches for treatment. Similarly, (...) the genus Brucella primarily transmits brucellosis to humans by occupational exposure and consumption of contaminated animal products. Its presentation may be acute, chronic, or in relapse. Diagnosis is made by a combination of serological, molecular, and culture-based techniques, while the treatment focuses on antimicrobial regimens specific to the pathogen. However, this increases the problem of antimicrobial resistance, which makes their effective management challenging, necessitating an integrated approach. Mitigating risks through biosecurity measures, vaccination, public health education, and a One Health approach that includes human, animal, and environmental health, all facilitate prevention and control of an outbreak. Advanced surveillance and diagnostic technologies further support the prompt interventions to contain outbreaks. It then goes on to highlight the importance of interdisciplinarity for decreasing the global burden of zoonotic bacterial diseases. (shrink)

This chapter contrasts the recent emphasis on operationalism as the route to reliability in psychiatry with arguments for an ineliminable role for tacit knowledge. Although Michael Polanyi popularized the idea of tacit dimension, the chapter argues that two clues he offers as to its nature-that we know more than we can tell and that knowledge is an active comprehension of things known-are better interpreted through regress arguments set out by Ryle and Wittgenstein. Those arguments, however, suggest that tacit knowledge is (...) not inexpressible but merely inexpressible in context-free terms. The chapter suggests instead that tacit knowledge is best understood to be context-dependent practical knowledge. So understood, the regress arguments suggest that the operational approach to psychiatric diagnosis can never free itself from a tacit dimension. Given that claim, then Parnas' opposing view of diagnosis can be seen as a way to embrace, rather than deny, the importance of tacit knowledge and skilled clinical judgment for psychiatry. (shrink)

This paper provides a comprehensive exploration of the transformative role of generative AI models, specifically Generative Adversarial Networks (GANs) and Variational Autoencoders (VAEs), in the realm of medical diagnosis. Drawing from the philosophy of medicine and epidemiology, the paper examines the technical, ethical, and philosophical dimensions of integrating generative models into healthcare. A case study featuring Emily underscores the pivotal support generative AI can offer in complex medical diagnoses. The discussion extends to the application of GANs and VAEs (...) in medical imaging, emphasizing their potential in improving diagnostics, treatment planning, and medical research. The paper further delves into challenges and controversies, addressing issues of anatomical accuracy, biases in training data, interpretability of AI-generated medical images, and ethical considerations, for example, the phenomenon of "Dr. Google" and its implications for self-diagnosis, particularly in the context of the increasing role of generative AI models in healthcare. The concluding section emphasizes the need for health literacy, responsible use of online information, and collaborative decision-making between patients and healthcare providers. We advocate for interdisciplinary collaborations to establish ethical guidelines and ensure responsible AI use in healthcare. (shrink)

Recent scientific advances in the field of gene editing have led to a renewed discussion on the moral acceptability of human germline modifications. Gene editing methods can be used on human embryos and gametes in order to change DNA sequences that are associated with diseases. Modifying the human germline, however, is currently illegal in many countries but has been suggested as a ‘last resort’ option in some reports. In contrast, preimplantation genetic diagnosis is now a well-established practice within reproductive (...) medicine. Both methods can be used to prevent children from being born with severe genetic diseases. This paper focuses on four moral concerns raised in the debate about germline gene editing and applies them to the practice of PGD for comparison: Violation of human dignity, disrespect of the autonomy and the physical integrity of the future child, discrimination of people living with a disability and the fear of slippery slope towards immoral usage of the technology, e.g. designing children for specific third party interests. Our analysis did not reveal any fundamental differences with regard to the four concerns. We argue that with regard to the four arguments analyzed in this paper germline gene editing should be considered morally as acceptable as the selection of genomes on the basis of PGD. However, we also argue that any application of GGE in reproductive medicine should be put on hold until thorough and comprehensive laws have been implemented to prevent the abuse of GGE for non-medical enhancement. (shrink)

The use of preimplantation genetic diagnosis (PGD) has expanded both in number and scope over the past 2 decades. Initially carried out to avoid the birth of children with severe genetic disease, PGD is now used for a variety of medical and non-medical purposes. While some human studies have concluded that PGD is safe, animal studies and a recent human study suggest that the embryo biopsy procedure may result in neurological problems for the offspring. Given that the long-term safety (...) of PGD has not been clearly established in humans, this study sought to determine how PGD safety is presented to prospective patients by means of a detailed website analysis. The websites of 262 US fertility centres performing PGD were analysed and comments about safety and risk were catalogued. Results of the analysis demonstrated that 78.2% of centre websites did not mention safety or risk of PGD at all. Of the 21.8% of centres that did contain safety or risk information about PGD, 28.1% included statements highlighting the potential risks, 38.6% presented information touting the procedure as safe and 33.3% included statements highlighting potential risks and the overall safety of the procedure. Thus, 86.6% of PGD-performing centres state that PGD is safe and/or fail to disclose any risks on their websites despite the fact that the impact of the procedure on the long-term health of offspring is unproven. This lack of disclosure suggests that informed consent is inadequate; this study examines numerous factors that are likely to inhibit comprehensive discussions of safety. (shrink)

RESUMEN Se desarrolló una investigación descriptiva transversal, con un enfoque cuantitativo, en la que la muestra fue seleccionada de manera intencional pura, no probabilística, según criterios establecidos por los autores del estudio. Quedó constituida por las variables del Sistema Comprehensivo Rorschach pertenecientes a 120 protocolos de sujetos con trastornos depresivos, de ellos 82 presentaron depresión moderada, y 38 depresión severa. Se aplicaron los siguientes métodos empíricos: entrevista, observación, Autoescala de Zung y Conde, y el Psicodiagnóstico de Rorschach. Los estadígrafos que (...) se utilizaron fueron el Test de Kolmogorov- Smirnov, el Test de Comparación de Proporciones y la prueba de Mann-Whitney. Como principales resultados se obtuvo que las variables del Sistema Comprehensivo Rorschach, que establecieron diferencias estadísticas altamente significativas entre los grupos de sujetos fueron: Lambda alta, Proporción afectiva baja, total de respuestas, las respuestas globales, Suma Ponderada de respuestas con el determinante color cromático y la Experiencia accesible. ABSTRACT A transverse descriptive investigation was developed, with a quantitative approach, in that the sample was selected in a pure intentional way, not probabilistic, according to criteria established by the authors of the study. It was constituted for the variables of the Rorschach Comprehensive System belonging to 120 protocols of individuals with depressive disorders, of them 82 presented moderate depression, and 38 severe depression. The following empirical methods were applied: interview, observation, Auto-scale of Zung and Conde, and Psycho-diagnosis of Rorschach. The statisticians used were the Test of Kolmogorov - Smirnov, the Test of Comparison of Proportions and the Mann-Whitney test. As main results, it was obtained that the variables of the Rorschach Comprehensive System, which established highly significant statistical differences between the groups of individuals were: tall Lambda, low affective proportion, whole of answers, the global answers, exaggerated sum of answers with the determinant chromatic color and the accessible experience. (shrink)

Background: Although convolutional neural networks (CNNs) achieve high diagnostic accuracy for detecting Alzheimer’s disease (AD) dementia based on magnetic resonance imaging (MRI) scans, they are not yet applied in clinical routine. One important reason for this is a lack of model comprehensibility. Recently developed visualization methods for deriving CNN relevance maps may help to fill this gap as they allow the visualization of key input image features that drive the decision of the model. We investigated whether models with higher accuracy (...) also rely more on discriminative brain regions predefined by prior knowledge. Methods: We trained a CNN for the detection of AD in N = 663 T1-weighted MRI scans of patients with dementia and amnestic mild cognitive impairment (MCI) and verified the accuracy of the models via cross-validation and in three independent samples including in total N = 1655 cases. We evaluated the association of relevance scores and hippocampus volume to validate the clinical utility of this approach. To improve model comprehensibility, we implemented an interactive visualization of 3D CNN relevance maps, thereby allowing intuitive model inspection. Results: Across the three independent datasets, group separation showed high accuracy for AD dementia versus controls (AUC ≥ 0.91) and moderate accuracy for amnestic MCI versus controls (AUC ≈ 0.74). Relevance maps indicated that hippocampal atrophy was considered the most informative factor for AD detection, with additional contributions from atrophy in other cortical and subcortical regions. Relevance scores within the hippocampus were highly correlated with hippocampal volumes (Pearson’s r ≈ −0.86, p < 0.001). Conclusion: The relevance maps highlighted atrophy in regions that we had hypothesized a priori. This strengthens the comprehensibility of the CNN models, which were trained in a purely data-driven manner based on the scans and diagnosis labels. The high hippocampus relevance scores as well as the high performance achieved in independent samples support the validity of the CNN models in the detection of AD-related MRI abnormalities. The presented data-driven and hypothesis-free CNN modeling approach might provide a useful tool to automatically derive discriminative features for complex diagnostic tasks where clear clinical criteria are still missing, for instance for the differential diagnosis between various types of dementia. (shrink)

Los acelerados cambios científicos tecnológicos y sociales exigen de los centros de Educación Superior la búsqueda de nuevas vías y el perfeccionamiento de las ya existentes para lograr egresados más competentes. La tutoría se identifica como un proceso educativo que debe favorecer el pleno desarrollo personal e integral del estudiante, en el que éste se conciba como sujeto activo y responsable de su propio proceso de formación. En este sentido cobra una especial importancia el proceso de interacción en el desarrollo (...) de la tutoría. El artículo tiene como objetivo fundamentar la importancia de dicha interacción, mediante un breve análisis teórico y la exposición de algunos resultados de su diagnóstico en el contexto de tres carreras universitarias. The accelerated social, scientific and technological changes demand of Higher Education centers, the search for new ways to create more competent graduates, as well as to improve the existing ones. Tutorship is identified as a teaching process that must favour the complete personal and comprehensive development of the student, in which he must be seen as an active individual responsible for his own formative process. This way, the interactive process of developing tutorship takes on special significance. This article aims at supporting the importance of such interaction, by means of a brief theoretical analysis and by setting out some results of its diagnostic in the context of three university degree courses. (shrink)

The screening of in vitro embryos resulting from in vitro fertilization treatment for chromosomal abnormalities has as a primary aim to help patients achieve a successful pregnancy. Most IVF centers will not transfer aneuploid embryos, as they have an enhanced risk of leading to implantation failure and miscarriage. However, some aneuploidies, such as trisomy-21, can lead to viable pregnancies and to children with a variable health prognosis, and some prospective parents may request transfer of such embryos. I present two cases (...) where the testing for and detection of trisomy-21 can lead to conflicts between IVF professionals and patients and argue that in most such cases respect for choices of patients should prevail. (shrink)

This work provides a mindset for leadership to deal with the problem of unethical transgressions in South African communities and buisness. It provides a thorough and comprehensive diagnosis of leadership and morality, from an analysis of causes, to the compilation of remedies.

With a few exceptions, critical theorists have been late to provide a comprehensive diagnosis of neoliberalism comparable in scope to their extensive analyses of advanced welfare state capitalism. Instead, the main lines of critical theory have focused on questions of international justice which, while no doubt significant, restrict the scope of critical theory by deemphasizing linkages to larger political and economic conditions. Providing a critique of the Frankfurt School, Brian Caterino and Phillip Hansen move beyond its foundations, and (...) call for a rethinking of the bases of critical theory as a practical, freedom-creating project. Outlining a resurgence of neoliberalism, the authors encourage a fresh, nuanced analysis that elucidates its political and economic structures and demonstrates the threats to freedom and democracy that neoliberalism poses; the reformulation of a radical democratic alternative to neoliberalism, one that critically addresses its limitations while promoting an enhancement of communicative and social freedom. (shrink)

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this paper I (...) describe an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

BackgroundThe diagnosis and treatment of cancer are associated with psychological distress that often leads to a significant reduction in emotional and physical well-being and quality of life. Early detection of psychological distress is therefore important. This study aims to assess the psychological distress of inpatient cancer patients using routine clinical data. Furthermore, variables and problems most strongly associated with psychological distress should be identified.Materials and MethodsN = 1,869 inpatients were investigated using the National Comprehensive Cancer Network Distress Thermometer (...) and problem checklist to assess distress as well as multiple possible problem areas. Visceral oncological cancer was the most common tumor diagnosis, followed by skin cancer and urological cancer.Results65.9% of the sample experienced high levels of distress. Female sex, stage 4 of disease, and visceral and head and neck cancer emerged as risk factors for high distress. A younger age was significantly correlated with higher distress. The most frequently self-reported problems were fears, worry, and fatigue. Patients with all 3 of these problems had 24 times higher risk [odds ratio = 23.9] for high levels of distress than patients without these problems. Women reported significantly more practical, emotional, and physical problems than men. Younger and middle-aged patients reported increased levels of practical, family, and emotional problems compared with older patients.DiscussionAlmost two-thirds of the sample reported high levels of distress. The most frequently reported problem areas were emotional and physical problems. These results can help to identify patients with high risk for psychological distress and, therefore, be used to optimize psychosocial and psycho-oncological care for patients with cancer. (shrink)

When confronting the issues related to developments in modern medicine and biotechnology, we must repeatedly ask ourselves anew what can and cannot be justified in an ethical sense. For radically new ethical questions seem to arise through innovative techniques such as stem cell research or preimplantation diagnosis — and with them new areas of conflicting interests. If one scrutinizes the previous positions related to this subject, it becomes conspicuous that a multitude of questions has quickly piled up — however, (...) (as in the case of Germany) comprehensive and differentiated views have mostly been lacking. (shrink)

First authoritative and comprehensive study in the field of Inkblot Personality Test, this book describes the historical roots of the three major projective inkblot measures: the Rorschach, the Holtzman Inkblot Technique (HIT) and the Somatic Inkblot Series (SIS). It presents the extensive psychometric background work accompanying the normative data and diagnostic indicators along with indices for selecting executives in a business organization. The book begins with a detailed history of Hermann Rorschach and his early experiments with inkblots in the (...) diagnosis of mentally ill patients. Special attention is given to the administration and scoring of the Rorschach, with the sections detailing the systems developed by Klopfer and Exner. The HIT and SIS are also reviewed in detail, emphasizing their psychometric qualities. (shrink)

Prenatal care and the practice of prenatal genetic testing are about to be changed fundamentally. Due to several ground-breaking technological developments prenatal screening and diagnosis (PND) will soon be offered earlier in gestation, with less procedure-related risks and for a profoundly enlarged variety of targets. In this paper it is argued that the existing normative framework for prenatal screening and diagnosis cannot answer adequately to these new developments. In concentrating on issues of informed consent and the reproductive autonomy (...) of the pregnant women the ethical debate misses problems related to the clinical pathway as a whole and to implicit normative attributions to clinical actions or the function of health care professionals. If, however, ethical debate would focus on the clinical context and on the ends of PND to a larger extent, it would be able to provide a more comprehensive analysis of the ethical challenges especially of the new technologies in order to be more adequately prepared for their implementation. (shrink)

If we read the central message of Caritas in Veritate (CV) through the lens of contemporary business ethics—and the encyclical does seem to invite such a reading (CV 40–41, and 45–47)—there is first of all a diagnosis of a crisis. Then, we are offered a response to the diagnosis: charity in truth , “the principle around which the Church’s social doctrine turns, a principle that takes on practical form in the criteria that govern moral action .” (CV 6) (...) In business ethics, the norms of personal and (especially) corporate responsibility are the natural correlates to “the criteria that govern moral action.” Using this as a point of departure, I propose to relate some recent scholarship in business ethics to the message of CV — with the suggestion that there is significant convergence. I argue, further, that the encyclical breaks new ground with its suggestion that, at the center of our moral thinking in business ethics lies a logic of contribution or gift. I discuss Benedict’s understanding of the crisis, and his exhortation to reach beyond conventional interpretations of corporate responsibility, under the following four headings: Diagnosing a Crisis , Institutionalizing Conscience , A Tripartite View of Corporate Responsibility, and Comprehensive Moral Thinking. (shrink)

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modernday casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the ‘open texture’ of its principles, etc.) and discusses some problems with casuistry as an (...) ‘anti-theoretical’ method. It is argued that casuistry so defined is ‘theory modest’ rather than ‘theory free’ and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting ‘deep’ interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, notwithstanding these problems, casuistry represents a promising alternative to the regnant model of ‘applied ethics’ (i.e., to the ritualistic invocation of the so-called ‘principles of bioethics’). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of ‘moral diagnosis’, and (5) be ever mindful of the limits of casuistical analysis. Keywords: casuistry, interpretation, methodology, pedagogy CiteULike Connotea Del.icio.us What's this? (shrink)

Nietzsche is perhaps best known for his diagnosis of the problem of nihilism. Though his elaborations on this diagnosis often include descriptions of certain beliefs characteristic of the nihilist (such as beliefs in the meaninglessness or worthlessness of existence), he just as frequently specifies a variety of affective symptoms experienced by the nihilist that weaken their will and diminish their agency. This affective dimension to nihilism, however, remains drastically underexplored. In this book, Kaitlyn Creasy offers a comprehensive (...) account of affective nihilism that draws on Nietzsche’s drive psychology, especially his reflections on affects and their transformative potential. After exploring Nietzsche’s account of affectivity (illuminating especially the transpersonal nature of affect in Nietzsche’s thought) and the phenomenon of affective nihilism, Creasy argues that affective nihilism might be overcome by employing a variety of Nietzschean strategies: experimentation, self-narration, and self-genealogy. (shrink)

Institute for Biomedical Ethics, Geneva University Medical School * Corresponding author: Médecins Sans Frontières (OCG), rue de Lausanne 78, CH-1211 Geneva 21, Switzerland. Tel.: +41 (0)22 849 89 29; Fax: +41 (0)22 849 84 88; Email: philippe_calain{at}hotmail.com ' + u + '@' + d + ' '//--> Abstract Outbreaks of filovirus (Ebola and Marburg) hemorrhagic fevers in Africa are typically the theater of rescue activities involving international experts and agencies tasked with reinforcing national authorities in clinical management, biological diagnosis, (...) sanitation, public health surveillance and coordination. These outbreaks can be seen as a paradigm for ethical issues posed by epidemic emergencies, through the convergence of such themes as: isolation and quarantine, privacy and confidentiality and the interpretation of ethical norms across different ethnocultural settings. With an emphasis on the boundaries between public health investigations and research, this article reviews specific challenges, past practices and current normative documents relevant to the application of ethical standards in the course of outbreaks of filovirus hemorrhagic fevers. Aside from commonly identified issues of informed consent and institutional review processes, we argue for more clarity over the specification of which communities are expected to share benefits, and we advocate for the use of collective definitions of duty to care and standard of care. We propose new elaborations around existing normative instruments, and we suggest some pathways toward more comprehensive approaches to the ethics of research in outbreak situations. CiteULike Connotea Del.icio.us What's this? (shrink)

Background: The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary. Research objective: This study aimed to offer a comprehensive and clear definition of patient advocacy. Research design: A total of 46 articles and 2 books published between 1850 and (...) 2016 and related to the concept of patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach. Ethical considerations: This study was approved by the Research Ethics Committee of Tarbiat Modares University. Findings: The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources). Discussion and conclusion: The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system. (shrink)

Noninvasive prenatal testing promises to enhance women's reproductive autonomy by providing genetic information about the fetus, especially in the detection of genetic impairments like Down syndrome. In practice, however, NIPT provides opportunities for intensified manipulation and control over women's reproductive decisions. Applying Miranda Fricker's concept of epistemic injustice to prenatal screening, this article analyzes how medical professionals impair reproductive decision-making by perpetuating testimonial injustice. They do so by discrediting positive parental testimony about what it is like to raise a child (...) with DS. We argue that this testimonial injustice constitutes a twofold harm: people with DS and their family members who claim that parenting a child with DS may be a rewarding and joyous experience are harmed when they are systematically silenced, disbelieved, and/or denied epistemic credibility by medical professionals, and pregnant women are harmed since they might make poorly informed choices without access to all relevant information. The broader implication of the analysis is that epistemic justice is a precondition of reproductive autonomy. We conclude by calling for federal oversight of the acquisition and dissemination of information that prospective parents receive following a positive diagnosis of DS to ensure that it is comprehensive and up to date. (shrink)

Global health and environmental wellbeing are mutually reinforcing and interdependent. This mutuality invokes two major analytical orientations: it emphasizes a direct nexus between ecological strategies and global health outcomes. These in turn revitalize the essential quest for comprehensive policies and responsible strategies for enhancing both ecology and health within the discourse of sustainability. With orientation towards political conception of corporate responsibility, I problematize the root questions of the democratic embeddedness of the firm under conditions of weakened institutional structures. I (...) highlight the inherent power relations in global health and ecological governance through literature mapping. I address the question: Why and how might ecological strategies be embedded in corporate day-to-day actions to produce optimal outcomes that have positive effects on global health and human dignity? Besides resource and ethical/political constraints, there are several micro-political, geopolitical, industrial, institutional and structural impediments to ecological and health sustainability. This grim diagnosis is clearly a description of a ‘disturbingly fascinating’ pathology of global capitalism whose industrial effects culminate in the accumulation of more profits for a few at the expense of the ecological sustainability of the majority. That notwithstanding, there are several grounds for optimism with a move from anthropocentrism to humanistic eco-centrism via deliberative democratic procedures. Here, the centrality of human dignity is emphasized. This study provides an interdisciplinary theoretical model that seeks to reorient strategies towards restoration, protection, mitigation, adaptation, harm avoidance and innovative sustainability of the whole economic gamut and biodiversity that supports global health. Thus, I rearticulate ecological sustainability in terms of its most fundamental means and end: sustainable global health and the tutelage of human dignity. (shrink)

This essay aims to reorient current theorizing about luck as an aid to our discerning this concept's true philosophical significance. After introducing the literature's leading theories of luck, it presents and defends counterexamples to each of them. It then argues that recent luck theorists’ main target of analysis—the concept of an event's being lucky for a subject—is parasitic on the more fundamental notion of an event's being a stroke of luck for a subject, which thesis serves as at least a (...) partial diagnosis of the leading theories’ failure. Next, it develops an analysis of strokes of luck that utilizes insights from the recent luck literature. Finally, having set out a comprehensive new analysis of luck—the Enriched Strokes Account of lucky events—the essay revisits the initial counterexamples to the literature's leading theories and argues that the Enriched Strokes Account properly handles all of them. (shrink)

BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who (...) were enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

Infertility specialists may be confronted with the ethical dilemma of whether to disclose misattributed paternity (MP). Physicians should be prepared for instances when an assumed father’s evaluation reveals a condition known for lifelong infertility, for example, congenital bilateral absence of vas deferens (CBAVD). When there is doubt regarding a patient’s comprehension of his diagnosis, physicians must consider whether further disclosure is warranted. This article describes a case of MP with ethics analysis that concludes that limited nondisclosure is most consistent (...) with a physician’s principled duties to inform, to respect patients’ autonomy, and to employ nonmaleficence (including the avoidance of psychosocial harms). (shrink)

Definition of the problem: Doctor-patient-conversation is still a great challenge for doctors and patients despite intense discussion, legal normation, and multiple efforts. It seems to be particularly difficult in cases of telling the truth about diagnosis or prognosis which can be threatening to the patient.Method: It is shown by two case studies that the patient directs a specific need to the doctor which has been neglected in both the ethics discourse and in practical medicine: the need to evaluate the (...) patient's options for action at an argumentative-critical level. Derived from a general theory of language functions a model of doctor-patient-conversation is developed which allows for both ideal case typology as well as for problem analysis. Referring to a Three-Stages-Model of Doctor-Patient-Dialogue, an integrative model “Language and Relationship Between Doctor and Patient” is formulated which permits a better understanding of the processes and difficulties between doctor and patient.Conclusion: The integrative model presented may help to realize a more comprehensive doctor-patient-conversation. It may help as well to decide which of the components of this conversation may be selectively sufficient. Consequences for the conceptualization of the physician's role as well as the scope of the model in practice are discussed. (shrink)

Over the last few years, automatic facial micro-expression analysis has garnered increasing attention from experts across different disciplines because of its potential applications in various fields such as clinical diagnosis, forensic investigation and security systems. Advances in computer algorithms and video acquisition technology have rendered machine analysis of facial micro-expressions possible today, in contrast to decades ago when it was primarily the domain of psychiatrists where analysis was largely manual. Indeed, although the study of facial micro-expressions is a well-established (...) field in psychology, it is still relatively new from the computational perspective with many interesting problems. In this survey, we present a comprehensive review of state-of-the-art databases and methods for micro-expressions spotting and recognition. Individual stages involved in the automation of these tasks are also described and reviewed at length. In addition, we also deliberate on the challenges and future directions in this growing field of automatic facial micro-expression analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:About and Beyond Comorbidity:Does the Crisis of the DSM Bring on a Radical Rethinking of Descriptive Psychopathology?Massimiliano Aragona (bio)Keywordscomorbidity, nosography, phenomenology, philosophy of scienceThe problem of psychiatric comorbidity is part of a series of difficulties of the current diagnostic system which at once were considered as a consequence of the way the system itself is organized (Aragona 2006). It was then believed that a Kuhnian reformulation of the contemporary (...) debate on the problems of the psychiatric diagnosis was very useful because it allowed clarification in a comprehensive picture of the many rivulets of conceptual research in that field.In their comments Zachar (2009) and Banzato (2009) seem to agree with my analysis of psychiatric comorbidity (Aragona 2009a) when it stresses that abnormally high frequencies of co-occurrence are to be explained, in important respects, as a consequence of the way mental disorders are operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM; also showing the importance of conceptual clarification to deal with this sort of only apparently pure factual problems). On the contrary, they are both unconvinced of the appropriateness and/or fruitfulness of the use of the Kuhnian technical terms and theory in this context.It could be said that the major aim of the paper was to let clinicians understand the effect of conceptual decisions on what would otherwise seem as a simple empirical finding (in this case, high levels of comorbidity), and that this result seems to be achieved in any case, thus minimizing the importance of a disagreement about the philosophical terms as a pure terminological dispute. Nevertheless, in my work the Kuhnian model had a significant role in the clarification of this matter and it also suggests to the reader a range of possible consequences that are not trivial (Zachar, for example, says to be skeptical about the possibility of a crisis and also about the possibility that a new paradigm could eliminate what I call the [End Page 29] comorbidity anomaly). As a consequence, some of the Kuhnian concepts that seemed to be at odds in this context have to be considered in detail to justify my analysis and its consequences. For reasons of space, I avoid a point-by-point reply to all the comments and I concentrate my discussion on three main points. First, I discuss the background of Kuhn's definition of terms such as anomaly and paradigm, as well as my own reasons for using them. In doing so the details of the psychiatric items under study that I wanted to highlight through the use of these philosophical concepts should emerge more clearly. Second, I discuss the problem of having distinguished between artifactual and real comorbidity. Third, I reconsider some of these problems, looking for their implications for future psychopathological research.Anomalies and ParadigmsBanzato (2009) stresses that comorbidity cannot be a truly Kuhnian anomaly because it is an anticipated side effect of the initial setup of the DSM, and not some unexpected discovery that violates the paradigm-induced expectation. This is a basically correct account of the most known version of Kuhnian anomalies; that is, the tale of some evident nature's failure to conform to clear paradigm expectations, which immediately forces researchers to recognize its importance as a possible source of crisis. However, as is the case for many other Kuhnian terms, he discussed anomalies in several scripts and there are other possible versions of its meaning. In particular, Kuhn (1977, XVII) highlighted that only in very rare cases are anomalies completely unexpected and come out of blue to announce an imminent crisis that leads to a large revolution. More frequently, scientific revolutions are much more smaller, like the discovery of oxygen, and in these cases the process is so gradual that historians find it difficult to say exactly when a discovery was made and who did it. Even in these much smaller cases the usual prelude to changes of this sort is the awareness of anomaly, but here anomalies are not extraordinary events; rather, they are "countless discrepancies between theory and experiment [that] during the course of his career, every natural scientist again and again notices and passes by" (Kuhn... (shrink)

BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years (...) ago. This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice. (shrink)

Volume 21 of _The Annual of Psychoanalysis_ is especially welcome for bringing to English-language readers timely contributions from abroad in an opening section on "Psychoanalysis in Europe." The section begins with a translation of Helmut Thomae's substantial critique of the current state of psychoanalytic education; Thomae's proposal for comprehensive reform revolves around a redefinition of the status of the training analysis in analytic training. Diane L'Heureux-Le Beuf's clinical diary of an analysis focusing on the narcissistic elements of oedipal conflict (...) probes the degree to which the analytic method can be applied to "nonstructured" analysands. And Nella Guidi shows the clinical value of supplementing Freud's notion of unobjectionable positive transference with the complementary notion of unobjectionable negative transference. Section II, on "Psychoanalysis and Hysteria," offers original contributions to Freud scholarship in the form of Jules Glenn's reconsideration of Dora's "Dynamics, Diagnosis, and Treatment"; William McGrath's analysis of the way Freud's hostility to religious superstition gained expression in his early work on hysteria; and Marian Tolpin's self-psychological reprise on the case of Anne O. The section concludes with Elisabeth Young-Bruehl and Sarah Cummin's provocative "What Happened to 'Anorexie Hysterique'?" which questions the contemporary separation of anorexia from hysteria and explore the sociohistorical reasons the separation came about. Section III, "Clinical and Theoretical Studies," begins with Nancy Kobrin's discussion of Freud's ideas about autonomy, including the terms Freud used and the way Strachey translated them into English. Her goal is to deepen our understanding of how Freud spoke and thought about an individual's sense of self. Frank Summers shows how object relations principles, which are shared by various object relations theories, can inform the conduct of analysis at all levels of pathology, including neurosis. And Henry Smith examines the meaning and value of the "analytic surface," a metaphor that highlights the relationship between the analyst's attention and the patient's attention. A final section on "Applied Psychoanalysis" offers contemporary examples of applied analytic inquiry in anthropology, art, and literature. Roy Grinker, III and Roy Grinker, Jr., in a methodological contribution to psychoanalytic anthropology, examine what is revealed when a native people are asked to retell a story introduced by them by their Western observers. Danielle Knafo explores the art and life of the Mexican surrealist Frida Kahlo through the concepts of the mirror, the mask, and the masquerade. And David Werman closes the volume with a comparative study of Edgar Allan Poe's and James Ensor's obsession with revenge, and the role it played in Poe's writing and Ensor's etchings, respectively. Bringing readers the influential reform proposals of Thomae, a rich sampling of recent Freud scholarship, applied contributions traversing three disciplines, and original clinical contributions reflecting American and European sensibilities, Volume 21 of _The Annual_ is true to the spirit of this distinguished series. It testifies to the scope of analytic inquiry, and it exemplifies the yield of such inquiry in the hands of gifted scholars and clinicians. (shrink)

Background: Informed consent is a legal as well as ethical prerequisite in clinical research. For dementia research, informed consent can be a problem if subjects with dementia, whose capacity for understanding and thus also decision making might be limited, are to be exam- ined. This might result in exclusion of dementia patients from research, as capacity for understanding and decision making are often equated with the ability for rational decision making. However, this valuation has been criticized at times for attaching (...) too much impor- tance to the cognitive aspect of decision making. -/- Methods: This qualitative study investigates the actual consent procedure of a clini- cal research study in Germany with regard to dementia patients’ subjective and objective understanding of informed consent information. Research participants were ten dementia patients, who volunteered in two clinical research studies, as well as their caregivers. Data were collected by use of semi-structured interviews. -/- Results: It was determined that the patients’ comprehension of informed consent infor- mation was rather limited. However, a number of patients were quite aware of this. In con- trast, all caregivers claimed to have fully understood the provided information, while their objective comprehension was also incomplete. Several participants indicated that they did not attach much importance to the information given in the consent procedure and that their consent did not primarily depend on this information. Rather, participation in the research study for them seemed to be more of a problem-focused coping strategy for dealing with their diagnosis of dementia. -/- Conclusion: For research ethics these results raise the question whether the currently prevailing emphasis on the cognitive aspect of autonomous decision making, i.e., compre- hension, may be too one-sided, and to what extent the “volitional” aspect in giving consent should be given greater consideration. (shrink)

Background: Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures, complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the (...) values underlying informed consent. Methods: Over a 2-week period in April 2014 we conducted semistructured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute’s requirements for consent, and the researchers’ strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. Results: Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors’ accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. Conclusions: We argue that while building and maintaining trusting relationships in research is important—not least in developing countries—strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out. (shrink)

If we suppose that reasonable belief is reasonable not because it has a foundation but because it is self-correcting, and that bodies of reasonable belief are self-correctable in virtue of their web-like internal structure, then it becomes natural to ask for explicit accounts both of self-correction itself, and of the web-like internal structure that makes self-correction possible: The theory of rational belief change. ;In this essay we study qualitative, logical theories of rational belief change, in particular the AGM account, and (...) its offshoot, the theory base account. Throughout, however, we use quantitative, probabilistic models as foils. ;We first undertake a systematic, critical study of the AGM account, focusing especially on its "possible worlds" formulation and on its theory of belief revision. According to the AGM account we can represent AGM revision by simple computations over total preorders of possibilities. We investigate iterated AGM revision from this perspective, and prove that symmetry considerations familiar from social choice theory essentially determine a particular ordering dynamics. These symmetry arguments put an upper bound on the sorts of responsiveness we can expect from the AGM model of rational belief change. The most widely criticized feature of the AGM account is its "recovery" condition on belief contraction. We show how to deflect all existing criticisms to recovery by paying close to attention to exactly which beliefs are given up in a particular case. The principal cost of this strategy is that the AGM account becomes harder to apply and to test. ;Theory base accounts add a layer of syntactically-encoded information to the AGM model. We show that this approach fails comprehensively: that it cannot successfully coordinate the syntactic layer of information with underlying contents or with necessary ordering information, and that it sanctions demonstrably irrational belief changes. Our diagnosis is, in part, that the theory base account conflates two distinct sorts of nonmonotonic belief change. ;Lastly, we summarize our current research into quantitative accounts of rational belief change, focusing on a model that generalizes irreducibly two-place probability, and that has the AGM account as a limiting case. (shrink)

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