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)

Mental health chatbots, along with computerised treatment in general, have gradually entered the realm of acceptability. This article looks at a chatbot called ReMind. It begins with an overview of the development of computerised mental health interventions, drawing links between the invention of cognitive behavioural therapy and automated therapy. The focus then moves to analysis of ReMind's conversational system. The bot acts as a sympathetic guide which directs the user to mental health activities, and as we will (...) see, a concept of mental health is produced through this system which is unique to the way that chatbot conversations are designed. The bot is tasked with interpreting the user's typed inputs in terms of keywords. Keywords are identified in terms of predetermined tags (‘sad’, ‘can’t sleep’, ‘relationship’, etc.). The bot then ‘predicts’ what the most appropriate response should be. ‘Prediction’ will be focused on to draw out how users interact with the bot in terms of conforming to the conversational logic imposed by the bot. This article illustrates a concept of mental health which is produced in the conversational dynamic between the users and the bot, and in how these conversations are directed on an abstract level by the ReMind company. The article concludes that the tautological cycle that the ReMind app facilitates represents a model of mental health which is correspondingly tautological in terms of users adopting an attitude of adaptation. This article addresses an urgent need to critically assess new forms of mental health interventions, and especially, technologically informed interventions. (shrink)

I am grateful to Anastasia Scrutton for opening up a very important area for thought, reflection, and practice. Her paper presents a fascinating argument for an understanding of depression that is framed as a potentially spiritually transformative experience with positive therapeutic implications. In doing so, she offers a way for theologians, philosophers, and practitioners to effectively perceive, understand, and engage with the spiritual dimensions of the experience of depression. As such, she has made an important contribution to the ongoing and (...) often fraught conversations around the role of spirituality in understanding mental health issues. The models she outlines neatly encapsulates a broad range of... (shrink)

Logic-Based Therapy, a modality of Philosophical Counselling, believes that humans suffer because of their faulty thinking patterns. It suggests antidotal reasoning and uplifting philosophies that help counselees refute these thinking patterns and adopt a healthier way of life. This paper investigates the possibility of using the influential ideologies found in Naruto in the framework of LBT, as suitable uplifting philosophies. The anime has been interpreted through the lens of Conversational Model Therapy, Japanese values, violence studies, etc.; (...) there is an unavailability of research on its connection with philosophical counselling. This paper aims to fill the gap by reviewing literature on concepts in counselling, LBT, and philosophical counseling. It also attempts at providing behavioral exercises for the readers to implement in their own life. (shrink)

The development of speech language therapy students into clinicians is an area of increasing interest as educators focus on how knowledge, skills and attitudes are taught and learnt within the profession. The personal journeys of students through experiences of service learning have potential to further our understanding of the impact of civic engagement on the student experience and their learning. This paper explores the journeys of first year speech and language therapy students through a Thematic Analysis of reflective (...) letters written by students to themselves at the beginning and completion of a service learning module. Analysis demonstrates development of interpersonal and preclinical skills as well as an understanding of attitudes and values inherent in the social model of disability. The skills and attitudes developed by the students through participation in the Conversation Partner Scheme are consistent with social model principles that support therapists to fully address the long-term, real life needs of clients with aphasia (the acquired communication disorder that frequently follows stroke). The interface between the social model of disability and the role of service learning in nurturing the attitudes and values which underpin this model are explored. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in favor (...) of basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

New class of therapies, including bipolar therapies (BPT) and paradoxical unipolar therapies (PUT) were firstly proposed in relation to a clinical insight and to some results of biological investigations, then they gave rise to mathematical modeling which brought a justification of these therapies, at least from a theoretical point of view. After recalling the mathematical model for the regulation of agonistic antagonistic couples, and reporting the fundamental types of control simulation by means of it, we point out the validity (...) of therapeutical applications inferred from this model. These therapy modalities, including BPT and PUT, now concern the following diseases: astrocytomas, epilepsia and trials on multiple sclerosis. Even if such attempts are in their early stage, noticeably for the last case where biological changes have mainly been studied, it seems that a large span of treatments is open to BPT and PUT. Improvement of these techniques in the future depends, in our opinion, on a parallel working on the dynamics of the mathematical model and the dynamics, perceived by clinical insight and confirmed by biological investigations, of the body reactions to such strategies. Justification of BPT and PUT was given, by resorting to the notion of pathological homeostasis which, too often, intervenes in order to nullify the effects of unilateral (not paradoxical) therapies. This research has elicited some therapies which use two agents with antagonistic effects or only an agent with effects similar to the agent already in excess in the body - in both cases at nearly physiological doses. (shrink)

The case of Xiang as described by Jane Carroll is indeed disconcerting well beyond the immediately apparent factors contained within the article. While Xiang’s direct medical expenses are excessive and his inability to pay for those expenses and further support his noncustodial family seem to be the main issues up for debate, Xiang, however, is likely going to need much more psychosocial support if he is to regain his previous independent functionality or retain any aspect of a quality of life (...) whilst continuing his indefinitely isolated treatment. In this response, I briefly outline the probable effects of Xiang’s current situation on his social identity and mental health as well as a potential way that we can minimize these adverse effects. (shrink)

The first fruits of the literary career of St. Augustine, the great theologian and Christian philosopher par excellence, are the dialogues he wrote at Cassiciacum in Italy following his famous conversion in Milan in 386 AD. These four little books, largely neglected by scholars, investigate knowledge, ethics, metaphysics, the problem of evil, and the intriguing relationship of God and the soul. They also take up the ancient philosophical project of identifying the principles and practices that heal human desires in order (...) to attain happiness, renewing this philosophical endeavor with insights from Christian theology. Augustine's later books, such as the Confessions, would continue this project of healing desire, as would the writings of others including Boethius, Anselm, and Aquinas. -/- Mark Boone's The Conversion and Therapy of Desire investigates the roots of this project at Cassiciacum, where Augustine is developing a Christian theology of desire, informed by Neoplatonism but transformed by Christian teaching and practices. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on body responses (...) to threat and fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)

BackgroundThe Chinese version of the Mini-Mental State Examination and the Beijing version of the Montreal Cognitive Assessment are the most commonly used scales to screen for Alzheimer’s disease among Chinese patients; however, their consistency varies according to populations and languages. Equivalent conversion of MMSE-C and MoCA-BJ scores is important for meta-analysis.Materials and methodsMMSE-C and MoCA-BJ scoring were performed on the enrolled patients with AD. Consistency analysis of MMSE-C and MoCA-BJ scores of patients in the conversion groups was performed. The circle-arc (...) method was used to convert the MMSE-C scores of the conversion groups into MoCA-BJ scores, and the conversion formula was generated. The MMSE-C data of the verification group was converted to MoCA-BJ according to the formula, and the consistency analysis of the original MoCA-BJ of the verification group and the converted MoCA-BJ was performed to verify the conversion model.ResultsThe results of the consistency analysis of MMSE-C and MoCA-BJ in group A showed that the correlation coefficients of the total group, high education years subgroup, medium education years subgroup, and low education years subgroup were 0.905, 0.874, 0.949, and 0.874, respectively, with high consistency and statistical significance. After applying the circle-arc method for equivalent conversion, the consistency analysis results of the original and the converted MoCA-BJ of the patients in group B of the total group, high education years subgroup, medium education years subgroup, and low education years subgroup were 0.891, 0.894, 0.781, 0.909, respectively, with high consistency and statistical significance.ConclusionWe established and validated a model of MMSE-C and MoCA-BJ score conversion for Chinese patients with AD using the circle-arc method. This model could be useful for multi-centers clinical trials and meta-analysis. (shrink)

Professor Mark A. Yarhouse proposes an ‘identity synthesis’ model of sexual modification therapy for homosexuals. This model is meant primarily to target the process by which one’s sexual identity is synthesized, rather than the changing of sexual orientation itself. I highlight some of the advantages of Yarhouse’s model along with some of its potential pitfalls. My primary point of departure with Yarhouse concerns how one ought to direct those self-identified homosexual clients who fall within our clinical (...) sphere of influence and who, in the end, contrary to our better judgment, decide that they would like to pursue a course of “homosexualization.” Based on the “autonomy”-emphasizing aspects of the identity synthesis model, it appears that Yarhouse is willing to sanction the referral of certain clients to “therapists” who are willing to facilitate these clients’ homosexualization. I do not believe that Christians involved in the care of homosexuals can licitly participate in such referrals. (shrink)

Abstract.Since the gene splicing debates of the 1980s, the public has been exposed to an ongoing sequence of genetic and reproductive technologies. Many issue areas have outcomes that lose track of people's inner values or engender opposing religious viewpoints defying final resolution. This essay relocates the discussion of what is an acceptable application from the individual to the societal level, examining technologies that stand to address large numbers of people and thus call for policy resolution, rather than individual fiat, in (...) their application. A major source of guidance is the “Genetic Frontiers” series of professional dialogues and conferences held by the National Conference for Community and Justice from 2002 to 2004. Genetic testing, human gene therapy, genetic engineering of plants and animals, and stem cell technology are examined. While differences in perspective on the beginning of life persist, a stepwise approach to the examination of genetic testing reveals areas of general agreement. Stewardship of life, human co‐creativity with the divine, and social justice help define the bounds of application of genetic engineering and therapy; compassionate care plays a major role in establishing stem cell policy. Active, sustained dialogue is a useful resource for enabling sharing of religious values and crystallization of policies. (shrink)

The Calvinist view that man is predestined to be among the elect or the damned has profoundly influenced not only our views of criminals and deviants, but also the theoretical basis of correctional methods and psychotherapeutic techniques. In this provocative and original volume, Mordechai Rotenberg examines the impact of Protestant doctrine on Western theories of deviance. He explores the inherent contradiction between Protestant ethics, with its view of human nature as predestinated, and the "people-changing" sciences.Rotenberg presents empirical studies that show (...) how people's tendency to label themselves and others as deviant can be predicted on the basis of their exposure to Western socialization. He contrasts alienating individuals, the result of competitiveness and exaggerated independence fostered by socialization in Protestant societies, to the reciprocal individualism of Hassidic, Japanese, and other non-Western cultures. Examining the Protestant "bias" of Western behavioral sciences, Rotenberg examines modern theories of deviance and proposes alternative models. He compares traditional past-oriented insight therapy, grounded in Calvinist methods of introspection, self-torment, and conversion, with Hassidic notions of redemption and salvation."Rotenberg provides important historical and sociological insights into the intellectual origins of modern theories of deviance. His argument that Western behavioral science retains a Calvinist view of humanity will force most scholars to examine anew the assumptions and foundations of their own theories."--Gerald N. Grob, Rutgers University"A highly original work, which should be of great interest to anyone concerned with relevant behavior. It shows how macro-definitions in a society tend to lead people to think about themselves and their ills in certain ways--and thus to deviate in certain ways."--Richard A. Cloward, co-author, Regulating the Poor: The Functions of Public Welfare. (shrink)

IntroductionCerebral visual impairment results from damage to cerebral visual processing structures. It is the most common cause of pediatric visual impairment in developed countries and rising in prevalence in developing nations. There is currently limited understanding on how neurologic, developmental, and ophthalmic factors predict outcome for pediatric CVI.MethodA retrospective manual chart review of pediatric CVI patients seen at the tertiary pediatric hospital neurology and neuro-ophthalmology service between 2010 and 2019 was conducted. Patients were stratified into severity groups, and followed over (...) time to identify outcome predictors. Collected baseline characteristics included perinatal, genetic, developmental, and neurologic history, along with neuroimaging and fundoscopic findings on examination. Longitudinal data collected included age, seizure control, and type of therapy received. Linear mixed-effect models were used for longitudinal CVI grade outcome analysis.ResultsA total of 249 individuals spanning 779 patient visits were identified. Mean age at diagnosis was 18.8 ± 16.8 months. About 64.3% were born at term age. Perinatal history revealed hypoxic ischemic encephalopathy in 16.5%, intraventricular hemorrhage in 11.6%, and seizures in 21.7%. At presentation, 60.3% had a diagnosis of cerebral palsy and 84.7% had developmental delay. Among all subjects, 78.6% had epilepsy; 33.8% had an epileptic encephalopathy, with spasms/hypsarrhythmia being most common. Abnormal neuroimaging was present in 93.8%. Genetic anomalies were present in 26.9%. Baseline visual examination revealed no blink-to-light in 24.5%; only BTL in 34.5%, fixation/tracking in 26.5%, and optokinetic drum follow in 14.4%. Longitudinal data analysis showed that perinatal history of HIE, a positive epilepsy history, using multiple epilepsy medications, cerebral palsy, and abnormal fundoscopic findings were all negatively associated with CVI grade change over time. After controlling for significant confounders, receiving any type of therapy [early childhood intervention, physical and occupational therapy, refractive error correction or glasses] was significantly associated with longitudinal improvement in CVI grade compared to patients who did not receive any therapy, with glasses yielding the largest benefit.ConclusionThis study offers extensive insights into neurologic, developmental and ophthalmologic features in patients with moderate to severe CVI. In concordance with previous findings, aspects of perinatal history and epilepsy/seizure control may help inform severity and prognosis in the general neurology or ophthalmology clinic. Conversely, these aspects, as well as genetic and specific epilepsy traits may alert vision health care providers in the clinic to pursue visual evaluation in at-risk individuals. Longitudinal follow-up of CVI patients showed that interventional therapies demonstrated vision function improvement greater than no therapy and maturational development. (shrink)

Conversational agents (CA) are thought to be promising for psychotherapy because they give the impression of being able to engage in conversations with human users. However, given the high risk for therapy patients who are already in a vulnerable situation, there is a need to investigate the extent to which CA are able to contribute to therapy goals and to discuss CA’s limitations, especially in complex cases. In this paper, we understand psychotherapy as a way of dealing (...) with existential situations and position CAs in the context of the therapeutic experience of patients. This experience is determined by the patient’s unique personal context and specific therapy goals. We suggest that psychotherapy is a fundamentally dialogical activity, because it crucially involves work on the self and one’s self-narrative. This brings us to our central question: is it possible for CAs to engage in a productive therapeutic dialogue, given their limitations as epistemic agents? We will discuss several of those limitations, show how these undermine the possibility of engaging in a therapeutic dialogue, and illustrate those limitations through discussions of the cases of grief and abuse. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number (...) of subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response To June Boyce-Tillman, “Towards an Ecology of Music Education”Elizabeth BauerJune Boyce-Tillman explores the values implicit in the Western musical traditions that also dominate music education. She examines the five interlocking areas of materials, expression, construction, values, and spirituality and how these areas create a more holistic way of conceptualizing the musical experience within music education. By describing the divide between the values of system A and system B, (...) Boyce-Tillman reminds us that these issues are persistent and demand our constant attention as music educators. She supports the conviction that music [End Page 186] curricula should not be dictated by a national curriculum. Instead, education should be a powerful way of supporting the dominant value system of a culture. As an educator focusing on the population of students with special needs, I find myself agreeing with her advocacy of holistic education and suggest that she look at the model of special education to implement this ecology of music education. Boyce-Tillman's proposal evokes a number of responses, of which I will mention two.My first response is to her belief in the individual within the community. This is often problematic in current educational circles. States and countries are being held to standardized curricula. While in and of themselves standards are not bad because they set educational expectations, dictated curricula do not allow for individuality and creativity. Special education addresses this problem by the use of an individualized education plan (IEP). This plan is devised to meet the abilities and capabilities of each individual student. An IEP states the educational goals for the student with special needs for one academic year. Although the IEP contains year-long educational goals, it also contains the methods for how a student will meet those goals. No two students with special needs will have the same educational curriculum. This idea is supported by humanistic ideas in that the individual child is more important than a fixed curriculum. Furthermore, the IEP is developed by all teachers working with the child. For example, a child with Down syndrome normally works with a speech therapist, physical therapist, occupational therapist, general education teacher, and several other subject specific teachers (music, art, physical education, and so on). During the creation of the IEP, all therapists and teachers work together to devise the best educational plan for the student. This helps to ensure continuity between therapies and teaching methods.Currently, many music teachers are excluded from the process of devising the IEP. This also supports Boyce-Tillman's ideas on how national curricula often support the dominant value systems and reinforce the notion of subjugating other value systems. However, I propose that the inclusion of the music teacher in the IEP process because music class is one of the easiest ways to make the student with special needs feel part of a community. The music classroom supports the idea of working together to accomplish a common goal.My second response relates to the valuing of process. While Western culture has typically placed value on product, the converse is true in special education. Throughout the devising of the IEP, the process of learning is valued. Although special education teachers have an ultimate goal for what the student is to accomplish, it is more important to examine the process of how the student achieves that goal. Furthermore, students with special needs are not given rigid time-lines in which they have to accomplish a goal. Instead, a student is allowed to move at his or her own pace. [End Page 187]Moreover, while the students with special needs are moving at their own pace, they are also nurtured by the teacher. In the United States it is common for students with special needs to be educated in the classroom with their nondisabled peers. This is referred to as inclusion. For certain parts of the day, the students with special needs may leave the regular classroom and receive tutoring in certain subject areas by the special education teacher. Many teachers who do not have experience in teaching students with special needs have noticed how the students with special needs achieve more when they are with their special education... (shrink)

The paper investigates whether the changes in cognitive appraisal and coping strategies related to initiation of insulin treatment onset mediate the effect of temperament on changes in positivity ratio among diabetic patients. Temperament, cognitive appraisal, coping strategies and positivity ratio were assessed among 278 patients: just before conversion to insulin therapy and then one month later. Mediation analysis indicated that endurance and briskness were directly connected to changes in positivity ratio, whilst the effect of perseveration on positivity ratio was (...) indirect via changes in negative appraisal, emotion- and problem-focused coping. The results confirm the stressful nature of the initiation of insulin treatment, and the assumptions of Lazarus’ model of stress and regulative role of temperament. (shrink)

We investigate a typology of socially and ethically risky phenomena emerging from the interaction between humans and large language model (LLM)-based conversational systems. As they relate to the way in which humans attribute social identity components, such as role and face, to LLM-based conversational systems, we term these phenomena 'social misattributions.' Drawing on classical theories of social identity and recent debates in the philosophy of technology, we argue that these social misattributions represent higher-order forms of anthropomorphisation of (...) LLM-based conversational systems that are not justified by their technical capabilities and follow from the social context of conversational interactions. We discuss the risks these misattributions pose to human users, including emotional manipulation and unwarranted trust, and propose mitigation strategies. Our recommendations emphasise the importance of fostering social transparency and exploring approaches, such as frictional design, that are currently promoted in the research domain of human-centred artificial intelligence. (shrink)

Unconscious Incarnations considers the status of the body in psychoanalytic theory and practice, bringing Freud and Lacan into conversation with continental philosophy to explore the heterogeneity of embodied life. By doing so, the body is no longer merely an object of scientific inquiry but also a lived body, a source of excessive intuition and affectivity, and a raw animality distinct from mere materiality. The contributors to this volume consist of philosophers, psychoanalytic scholars, and practitioners whose interdisciplinary explorations reformulate traditional psychoanalytic (...) concepts such as trauma, healing, desire, subjectivity, and the unconscious. Collectively, they build toward the conclusion that phenomenologies of embodiment move psychoanalytic theory and practice away from representationalist models and toward an incarnational approach to psychic life. Under such a carnal horizon, trauma manifests as wounds and scars, therapy as touch, subjectivity as bodily boundedness, and the unconscious 'real' as an excessive remainder of flesh. Unconscious incarnations signal events where the unsignifiable appears among signifiers, the invisible within the visible, and absence within presence. In sum: where the flesh becomes word and the word retains its flesh. Unconscious Incarnations seeks to evoke this incarnational approach in order to break through tacit taboos toward the body in psychology and psychoanalysis. This interdisciplinary work will appeal greatly to psychoanalysts and psychoanalytic psychotherapists as well as philosophy scholars and clinical psychologists. (shrink)

This book presents systemic psychotherapy to integrative counsellors by using the most common counselling modalities and turning them into systemic approaches. The Systemic Model for Integrative Counsellors teaches systemic theory and techniques gradually, delving into various ways for integrative counsellors to think from a systemic perspective, reframing a client's presenting problem as emerging from relationships and social context. The chapters discuss how to combine person-centred counselling with a systemic outlook, how to combine psychodynamic theory with ideas about circularity and (...) relationships, and outlines ways to use cognitive-behavioural therapy, action techniques, drama techniques, gestalt therapy, and many counselling approaches systemically with individual clients. The author's conversational writing, accompanied with case studies and in-depth explanations of counselling techniques and theories, makes the material interactive and accessible. A Systemic Approach to Integrative Counselling will provide qualified and trainee counsellors with an in-depth systemic outlook on counselling modalities. It is also a helpful guide for scholars and researchers in related fields. (shrink)

There is a ‘catch 22’ situation about applying coercion in psychiatric care. Autonomous choices undeniably are rights of patients. However, emphasizing rights for a mentally-ill patient could jeopardize the chances of the patient receiving care or endanger the public. Conversely, the beneficial effects of coercion are difficult to predict. Thus, applying coercion in psychiatric care requires delicate balancing of individual-rights, individual well-being and public safety, which has not been achieved by current frameworks. Two current frameworks may be distinguished: the civil (...) liberty approach and the Stone model. Both frameworks are restrictive, and not respectful of human dignity. In a civil liberty approach, individuals who are severely mentally-ill but not dangerous would be denied care because they do not meet the dangerousness threshold or because the use of coercion will not lead to rebirthing of autonomy. This is unsatisfactory. Albeit involuntary interventions such as talk therapies, peer-support etc., may not always lead to rebirthing of autonomy or free patients from mental illness; they can however help to maintain the dignity of each mentally ill patient. In place of these frameworks, this study proposes a new ethical framework for applying coercion in psychiatric care that is respectful of human dignity. Specifically, it draws on insights from the African ethico-cultural system by using the Yoruba concept Omo-olu-iwabi to develop this new framework. This way, the study shows that only a more respectful approach for applying coercion in psychiatric care can lead to the careful balancing of the competing interests of individual's rights, individual's well-being and public safety. (shrink)

In recent years, “deliberation” has become the byword of many political theorists, most of whom identify deliberation with reasoned conversation. Among the most forceful advocates of deliberation as conversation are Jürgen Habermas and, to a greater or lesser extent, his successors who style themselves “deliberative democrats.” For them, the more political decision‐making approximates the ideal of a reasoned public conversation among free and equal individuals, the more legitimate and rational it will be. “Outcomes,” they say are democratically legitimate if and (...) only if they could be the object of a free and reasoned agreement among equals. Their deliberative model produces more rational decision‐making, they say, because it conveys information, impels individuals to order their preferences coherently, and by making persons articulate good reasons in public leads them “to think from the standpoint of all involved.”. (shrink)

Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual's sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this article, we discuss the ethics surrounding such a possibility, and call for the development of legal (...) and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions. (shrink)

Although it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects (...) of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model. (shrink)

In this paper, we apply the perspective of intra-organismal ecology by investigating a family of ecological models suitable to describe a gene therapy to a particular metabolic disorder, the adenosine deaminase deficiency (ADA-SCID). The gene therapy is modeled as the prospective ecological invasion of an organ (here, bone marrow) by genetically modified stem cells, which then operate niche construction in the cellular environment by releasing an enzyme they synthesize. We show that depending on the chosen order (a choice (...) that cannot be made on \textit{a priori} assumptions), different kinds of dynamics are expected, possibly leading to different therapeutic strategies. This drives us to discuss several features of the extension of ecology to intra-organismal ecology. (shrink)

This chapter seeks to advance two central claims: 1) that the therapy-enhancement distinction is not an absolute one; and 2) that the social model of disability can be applied as at least one possible criterion for evaluating the ethics of enhancement. First, I address the limits of the therapy-enhancement distinction by showing that some accepted forms of therapy are indeed enhancements in their own right. The line between enhancement and therapy in medicine is therefore not (...) clear-cut, but nor is the difference between enhancement and disability straightforward either, as I argue. I discuss how some forms of apparent enhancement may in fact make people disabled from a social point-of-view, for they would not be able to function well in a society “fine-tuned” towards the current average range of abilities. Enhancement is therefore a slippery notion, and one that brings into relief questions of equity and of oppression. If enhancement is meant to be a key stepping stone on the path towards a posthuman condition, as some claim, then the ambiguous nature of enhancement surely throws into the question the coherence of the “post” in “posthuman.”. (shrink)

In this paper, we discuss the perspective of intra-organismal ecology by investigating a family of ecological models. We consider two types of models. First order models describe the population dynamics as being directly affected by ecological factors (here understood as nutrients, space, etc). They might be thought of as analogous to Aristotelian physics. Second order models describe the population dynamics as being indirectly affected, the ecological factors now affecting the derivative of the growth rate (that is, the population acceleration), possibly (...) through an impact on non-genetically inherited factors. Second order models might be thought of as analogous to Galilean physics. In the joint paper, we apply these ideas to a situation of gene therapy. (shrink)

The idea of philosophy as a kind of therapy, though by no means standard, has been present in metaphilosophical reflection since antiquity. Diverse versions of it were also discussed and applied by more recent authors such as Wittgenstein, Hadot and Foucault. In order to develop an explicit, general and systematic model of therapeutic philosophy a relatively broad and well-structured account provided by Martha Nussbaum is subjected to analysis. The results obtained, subsequently, form a basis for a new (...) class='Hi'>model constructed around the set of notions intrinsically connected with any, philosophical, psychological, or medical, form of therapy. The conceptual framework of: disease and its symptoms, the health ideal, the process of treatment with its techniques, therapeutic theory, physician, patient, and the physician-patient relationship is constructed and investigated in the context of its possible metaphilosophical use. An illustrative application of this scheme to philosophical therapy developed by Stoicism is, then, discussed. Finally, the issue of the therapeutic metaphilosophy's scope as well as the problem of therapeutic philosophy's specificity and integrity are briefly indicated. (shrink)

Large-scale language technologies are increasingly used in various forms of communication with humans across different contexts. One particular use case for these technologies is conversational agents, which output natural language text in response to prompts and queries. This mode of engagement raises a number of social and ethical questions. For example, what does it mean to align conversational agents with human norms or values? Which norms or values should they be aligned with? And how can this be accomplished? (...) In this paper, we propose a number of steps that help answer these questions. We start by developing a philosophical analysis of the building blocks of linguistic communication between conversational agents and human interlocutors. We then use this analysis to identify and formulate ideal norms of conversation that can govern successful linguistic communication between humans and conversational agents. Furthermore, we explore how these norms can be used to align conversational agents with human values across a range of different discursive domains. We conclude by discussing the practical implications of our proposal for the design of conversational agents that are aligned with these norms and values. (shrink)

Persons who identity as LGBTQ+ should be treated with respect, compassion, and sensitivity. Under the guise of helping such persons, legislation is surreptitiously appearing in several countries seeking to ban so-called conversion therapy. While the definition of the term remains concerningly vague, the terms of enforcement for alleged offences tend to be precisely delineated, often including provisions that curtail Christian catechesis, teaching, and preaching in the areas of human dignity and sexuality. These problematic and repressive initiatives can prevent access (...) to any psychotherapy that is not strictly gender-affirming. This article reviews and assesses conversion therapy in support of a judicious approach to the practice, accurately understood. It reviews past abuses and misunderstandings while considering the merits of conversion therapy and related therapeutic and pastoral approaches. Concerns about gender-affirming interventions are considered, especially for youth and teenagers, and efficacy claims around conversion therapies and related psychotherapies are also discussed. (shrink)

Cette étude qualitative propose une modélisation multimodale des constructions subordonnées en conversation spontanée, à partir de leur action sur les cadres interprétatifs. Les subordonnées ont longtemps été décrites en linguistique comme des éléments dépendants qui complètent des éléments primaires. Cependant, la Grammaire Cognitive a remis en question ce point de vue en montrant que l'emboîtement syntaxique ne reflète souvent que le point de départ choisi par les locuteurs pour véhiculer leur message. Les subordonnées sont des pratiques interactionnelles qui offrent une (...) reconstruction interprétative du discours. Les différents types syntaxiques de subordonnées font référence à différents cadres interprétatifs dans l'expérience du locuteur. La sélection de ces différents cadres est exprimée par le nombre différent d'indices de frontière prosodiques et gestuels produits en co-occurrence avec chaque type syntaxique de subordonnée. (shrink)

PurposeThe purpose of this study to shed light on the importance of social media hosted content related to socially-motivated discussions. Moving from the field of communication for development, the research leverages social media as a powerful tool for collecting and analyse peer-to-peer communication towards the conceptualization of eVoices of Unheard. The deep understanding of these conversation can generate recommendations for organizations and governments designing and providing interventions fostering local socio-economic development.Design/methodology/approachThe study presents a large-scale analysis of social media interactions on (...) the topic “#favela” to generate insights into a social network structure, narrative contents and meaning generated.FindingsStructurally, the analysed networks are comparable with those presented in current academic literature; automatic text analysis confirmed the promise of the inner value of communication for development opening the floor to conceptualization of the “eVoices of unheard”, which is the collective and conscious use of social media to mediate community discussions about tangible and intangible issues related to socio-economic development.Originality/valueFramed within the rise of interactive communication for development this research show that social media an support the notion of voice proposed by Couldry moving from process towards value thereby understanding intangible issues related with socio-economic development. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Psychoanalysis and Buddhism: An Unfolding DialogueDavid R. LoyPsychoanalysis and Buddhism: An Unfolding Dialogue. Edited by Jeremy D. Safran. Boston: Wisdom Publications, 2003, Pp. xvii + 443.In the burgeoning literature on Buddhism and psychoanalysis/psychotherapy, Psychoanalysis and Buddhism: An Unfolding Dialogue stands out. True to its subtitle, the format is designed to encourage genuine dialogue. Following an excellent introduction by the editor, Jeremy D. Safran, all of its nine chapters (...) are by experienced therapists who are also committed to Buddhist practice; several of them are teachers within their respective traditions. Each chapter is followed by the commentary of an established psychoanalyst (many of them associated with the journal Psychoanalytic Dialogues), and after that there is a reply by the original chapter author. The conversations are given plenty of space to develop; several chapters are over fifty pages long. In most cases the commentators rise to the occasion, with sympathetic but trenchant interrogations. The result is a fascinating discussion that raises the interaction between Buddhism and psychology to a higher level of intensity and insight.Safran's introduction looks at the different cultural contexts of psychoanalysis and Buddhism. He focuses on their own internal tensions, especially a shared one between agnosticism and faith. Recent psychoanalysis has shifted from a rationalistic, ego-oriented approach toward a relational and constructivist understanding of [End Page 363] the multiple self, a perspective more open to various narratives. "It has become clear that psychoanalysis is not a science in the same sense that physics or chemistry are, but rather a secular form of spirituality. In some ways it functions to fill the void once filled by religion" (p. 2). This shift to a therapy of faith and commitment highlights a similar tension within Buddhism, for example between the rationalist approach of Nāgārjuna's Karikas and the devotionalism of Pure Land Buddhism. In contrast to the classical Freudian emphasis on the reality principle controlling the pleasure principle and the Mādhyamikas' radical deconstruction of all narratives, letting go of the need to understand and control can lead to awe and reverence in the face of life's mystery. The advantage of a comparison between psychoanalysis and Buddhism is that each can help the other avoid crystallizing into an orthodoxy that tends to lose its liberative power.Several of the contributors refer to Freud's recommendation that the analyst keep an "evenly-suspended attention," and they emphasize how their Buddhist practice helps them to do this. In chapter 4, "An Analyst's Surrender," Sara Weber describes a difficult case study that began to flourish when there was "a shift in the nature of holding." Instead of trying to "fix" the patient, she surrendered herself to deeper, lesser-known areas of her patient's being and her own. She refers to Lacan: although we need others as mirrors, there is always an element of illusion in any organized meaning we frame for ourselves. The solution is to employ models loosely, allowing one's therapeutic techniques as well as one's clients to be in flux. She concludes by emphasizing that the analyst's role as "holder" of the patient "is insufficient unless we see it as a special case of that more profound faith in being that is temporarily embodied in ourselves" (p. 189). In chapter 3, "The Dissolving of Dissolving Itself," Robert Langan offers a personal and phenomenological meditation that plays with multiple perspectives as a way to reflect on the "in-between," the openness that both Buddhism and psychoanalysis at their best encourage: keeping room in the analytic process for paradox and contradiction, for gaps and emptiness.In chapter 6, Barry Magrid eloquently defends the need for analytic work as well as Buddhist practice. "Too often, it seems that both students and teachers have mastered their pain but succumbed to their impulses, experienced a oneness with all beings but remained in conflict with their families, discovered the emptiness of the self but continued to abuse their authority, found peace on their cushions but not in their lives" (p. 257). Yet we should not conclude that Buddhism and analysis are concerned with different aspects of our lives. "Like psychoanalysis, Zen practice is a... (shrink)

Enhancement is a basic principle of modern sport. Their increase of achievement is usually attributed to the sportsmen’s natural assessment, their health, their training methods and their employment. In contrast, increase in output by pharmacological means is outlawed. The modern medical techniques created a whole range, by which sportsmen are supported. Consequently, sometimes difficult decisions with concrete medications develop. It is not always clearly to be differentiated whether something is a pharmacological interference, which serves the therapy or leads however (...) to the outlawed increase in output. At present Enhancement is in discussion, a phenomenon, which is related to doping in sports, but which concerns achievement-increasing use of medicines not only in sportsmen. -/- Leistungssteigerung ist ein Grundprinzip des modernen Sports. Gewöhnlich werden für die Steigerung der Leistung die natürliche Veranlagung der Sportler, ihre Gesundheit, ihre Trainingsmethoden und ihr Einsatzwille veranschlagt. Leistungssteigerung durch pharmakologische Mittel ist dagegen geächtet. Die modernen medizinischen Techniken haben einen ganzen Bereich geschaffen, durch den die Sportler bei der Erbringung ihrer Leistung und deren Erhalt unterstützt werden. Dabei entstehen mitunter schwierige Entscheidungsfragen bei konkreten Medikationen. Nicht immer ist klar zu unterscheiden, ob etwas ein pharmakologischer Eingriff ist, der der Therapie dient oder aber zur geächteten Leistungssteigerung führt. Gegenwärtig wird über Enhancement diskutiert, ein Phänomen, das mit dem Doping verwandt ist, aber leistungssteigernde Verwendung von Medikamenten bei Gesunden im Allgemeinen, also nicht nur bei Sportlern, betrifft. (shrink)

This paper presents findings from a linguistic and psycho-social analysis of nine design dialogues which sets out to investigate the interweaving of transactional and interpersonal threads in collaborative work. We sketch a model of the participants' positioning towards their own or their partner's design proposals, from association to dissociation towards the proposals, together with the conversational cues which indicate this positioning. Our aim is to integrate the role of interpersonal relationships into the study of co-operation, to stress the (...) importance of this dimension for the quality of collective work and to reflect on its potential for integration into the design of dialogue systems. (shrink)

Previous plan‐based models of dialogue understanding have been unable to account for many types of subdialogues present in naturally occurring conversations. One reason for this is that the models have not clearly differentiated between the varoius ways that an utterance can relate to a plan structure representing a topic. In this paper we present a plan‐based theory that allows a wide variety of utterance‐plan relationships. We introduce a set of discourse plans, each one corresponding to a particular way that an (...) utterance can relate to a discourse topic, and distinguish such plans from the set of plans that are actually used to model the topics. By incorporating knowledge about discourse into a plan‐based framework, we can account for a wide variety of subdialogues while maintaining the computational advantages of the plan‐based approach. (shrink)

Conversation is one of the main contexts in which we are conducting inquiries. Yet, little attention has been paid so far in pragmatics or epistemology to the process of inquiry in conversation. In this paper, we propose to trigger such an investigation through the development of a formal modelling based on inquisitive pragmatics—a framework offering a semantic representation of questions and answers, along with an analysis of the pragmatic principles that govern questioning and answering moves in conversations geared towards information (...) exchange. Our starting observation is that an interrogative inquiry in a conversation takes the form of a finite sequence of questioning and answering steps, and appears thereby as an inherently temporal process. The central notion of interrogative protocol introduced in this paper precisely aims to capture the temporal dimension of inquiry. Interrogative protocols are defined as branching-time tree structures encoding all the possible sequences of questioning and answering steps—i.e., all the possible inquiry paths—that can subsequently occur in a starting conversational situation in accordance with the principles of inquisitive pragmatics. They provide us with a formal environment to define and investigate the epistemological notions of interrogative inquiry and interrogative consequence in conversational contexts. One of the main interests of the resulting framework is to enable a formal investigation of central epistemological issues relative to interrogative inquiry under the form of computational problems. We frame three key inquiry problems along this line, and we then propose an algorithmic procedure for solving them in the restricted case where the inquirer has at her disposal a finite number of questions in her inquiry. We conclude by relating our approach to Wiśniewski’s Erotetic Search Scenarios and Hintikka’s Interrogative Model of Inquiry. (shrink)

Innovative therapy is the name we give to novel medical interventions, radically different from the standard of care, provided in order to benefit a patient, rather than to acquire new knowledge. They are paradigmshifting, not incremental, responses to serious patient problems that standard medical care inadequately addresses. Innovative therapies are often devised by clinicians, not basic science researchers; they do not follow the linear model of basic research, to translation, to clinical research, to application. Instead, they come from (...) thinking backwards from the patient’s circumstances, and forward from deep knowledge of how the body functions, to challenge the limits of current mechanisms for effecting cures. (shrink)

In his extensive description of the heuristic approach to psychoanalytic therapy, Peterfreund discusses the strategies used by both patient and therapist as they move toward discovery and deeper understanding.

In his article Banicki proposes a universal model for all forms of philosophical therapy. He is guided by works of Martha Nussbaum, who in turn makes recourse to Aristotle. As compared to Nussbaum’s approach, Banicki’s model is more medical and less based on ethical argument. He mentions Foucault’s vision to apply the same theoretical analysis for the ailments of the body and the soul and to use the same kind of approach in treating and curing them. In (...) his interpretation of philosophical therapy, there are, however, some controversial issues, to which we would like to call attention: -/- Is restoring health by a philosophical method of treatment – health understood as a person’s ability to reach his/her vital goals – a convincing explication of philosophical therapy in general? In order to answer this question, it may be useful to look at Plato. It is not only Platonism (and especially Neo-platonism since Plotinus) that questions the idea that therapy is necessarily connected with „vital goals“. Buddhist and Gnostic philosophies are questioning „the vital“ in general. The immense effort in the history of philosophy to liberate the mind from the body casts doubt on the project to explain philosophical therapy solely in analogy to medical therapy. -/- According to Banicki a therapeutic philosophy has to identify the diseases it attempts at curing. There are, however, reasons for associating the term therapy with suffering/risk rather than disease. If a therapy aims at reducing the fear of death, as for example many classical philosophical therapies do, then there is no disease to be cured. A model based on chances and risks also has the advantage that the Buddhist and Stoic reinterpretation of desires/emotions as “diseases” can be dropped in contemporary philosophical therapy. -/- Banicki mentions the comparison of therapies as one of the primary goals of modelling. Methods should be verified by a statistical correlation between method and therapeutic success and/or by a theory which justifies the method. Some forms of therapies, however, avoid theory-specific terms and concepts in favor of an unprejudiced interpretation of the patient’s statements. Others share the (Nietzschean) aspiration to explore and change measures of value. If the therapeutic process is seen as a unique phenomenon, then there can be no theory and no statistics with co-occurrences. -/- According to Banicki philosophical therapy has to describe techniques which qualify as genuinely philosophical. Techniques like maieutics and hermeneutics, however, are antique philosophical “inventions”, which were later adopted by psychotherapy. If meditation is accepted as a therapeutic tool – as it was in ancient times – then there is not only a methodical but also an emotional relation to religion. If finally, the Socratic search for a good life is seen as one of the characteristics of philosophical therapy, then delimitation even turns into a criterion for non-philosophical therapies. The search for a good life requires an interdisciplinary approach. -/- For the concretization of the formal structure, we suggest a typology of therapies, which is based on chances and risks. Such a typology has the advantage, that it can model conflicting (and even opposing) forms of therapies. The variety of therapeutic goals and methods is a consequence of the historical development towards conceptual freedom. (shrink)

Drama therapy has been found to improve various facets of mental health while aging. It provides opportunities for personal growth and creative expression and enhances group relationships. Drama therapy is a widely acknowledged way to explore the life stories in late life. However, only a handful of studies have empirically explored the value of drama therapy for the aging population. This conceptual analysis was designed to address this need by developing a new integrative model of drama (...) therapy. The analysis is based on the review of the results of four studies that explored the integration of life-review and playback theater as a drama therapy approach for older adults. The therapeutic process focused on the exploration of life-crossroads stories, a short unique technique which enables the participants to craft a harmonious view of their life stories in a short-term dramatic creative group process. Combining the four results yielded a multidimensional model which points to three potential transformative routes: the evolution of the life story, the evolution of improvised dramatic expression, and the expansion of social engagement. The transformative routes are described through the lens ofrole theoryin drama therapy. (shrink)

We study satisfiability and infinite-state model checking in ICPDL, which extends Propositional Dynamic Logic (PDL) with intersection and converse operators on programs. The two main results of this paper are that (i) satisfiability is in 2EXPTIME, thus 2EXPTIME-complete by an existing lower bound, and (ii) infinite-state model checking of basic process algebras and pushdown systems is also 2EXPTIME-complete. Both upper bounds are obtained by polynomial time computable reductions to ω-regular tree satisfiability in ICPDL, a reasoning problem that we (...) introduce specifically for this purpose. This problem is then reduced to the emptiness problem for alternating two-way automata on infinite trees. Our approach to (i) also provides a shorter and more elegant proof of Danecki's difficult result that satisfiability in IPDL is in 2EXPTIME. We prove the lower bound(s) for infinite-state model checking using an encoding of alternating Turing machines. (shrink)