During a controversial Weekend Update, David Spade made the following joke with an image of Eddie Murphy behind him: "Look, children, it's a falling star – make a wish." The crack came at a time when Murphy's career was hurting, and he took offense, refusing to return to the show for twenty years. Like most areas of philosophy, there are a plurality of views when it comes to familial ethics. In this chapter, the author takes this opportunity to consider some (...) of them, and to figure out what each view would say about the Spade‐Murphy family feud. Good news for the Rileys and the Combs, the two families from Dysfunctional Family Feud who can't get through a sentence without being nasty to each other, there is a view of familial ethics that might excuse their behavior. It is known as the No Special Obligations View. (shrink)

Despite being written in 1941–1942, Long Day’s Journey into Night wasn’t released until 1956, two years after the author’s death. The Tyrone family is at the centre of the narrative, advancing the plot and creating further avenues for the characters to develop. The article explores the various aspects of the play that indicate that the Tyrones are a dysfunctional family. The critical analysis of the play and its various themes conclude that Tyrone in “Long Day’s Journey into (...) Night” displays many characteristics of a dysfunctional family while certain behavioural patterns of each one of the family are enough to show that the family is dysfunctional. The article presents a critical analysis of Eugene O’Neill’s Long Day’s Journey into Night. Various modes of reading were employed, including thematic analysis, close reading of the text, and a deconstructive reading of the play. These methods support the exploration of how the Tyrones are depicted as a dysfunctional family. James and Mary’s children, Edmund and Jamie, are central to the drama. Edmund is suffering from tuberculosis, while Mary struggles with a morphine addiction. The play is set at the Tyrones' Monte Cristo Cottage in seaside Connecticut, on a single day in August 1912, from roughly 8:30 a.m. until 12:00 a.m. The Tyrones are painted in a highly negative light as a dysfunctional family, as the parents and sons accuse, lash out, and harbor grudges against one another and in various situations. They possess traits that encourage pitiful and futile endeavours as well as strong desires for their circumstances to improve. (shrink)

In Expressing Our Attitudes, Mark Schroeder speculates about the relation between expressivism and relativism. Noting that “John MacFarlane has wondered whether relativism is expressivism done right,” he suggests that this may get things back to front: “it is worth taking seriously the idea that expressivism is relativism done right”. In this piece, motivated both by Schroeder’s suggestion and by recent work from Lionel Shapiro, I compare and contrast my version of expressivism with MacFarlane’s version of relativism. I identify some significant (...) differences concerning the treatment of linguistic disagreement, but conclude that despite these differences, MacFarlane’s version of relativism counts as a version of expressivism in my sense, in most of the respects that matter. (shrink)

The laws and ethical guidelines governing decision making for incompetent patients evolved from controversies in which family members refused life-sustaining interventions. These cases led to a consensus that advance directives to limit interventions should be respected and that a surrogate designated by the patient or specified by statute could refuse interventions, even when other relatives disagreed. Surrogate decision-making statutes and ethical principles about respect for delegated autonomy promote an active role for family members or other surrogates in medical (...) decisions for incompetent patients. Inviting surrogates to participate actively in medical decisions recognizes the importance of the patient's personal community and assures that decisions will reflect the patient's own preferences and values.The standard approach to decisions for incompetent adults gives advance directives priority over a surrogate's substituted judgment, which in turn has priority over assessments of the patient's best interest. A patient may express advance directives by appointing a proxy, stating specific preferences, or articulating general values. We use case examples to illustrate the limitations of all three types of advance directives. (shrink)

Immigration law is exceptional enough to deserve an administrative law focus of its own. The Administrative Procedure Act (APA) does not demand uniformity in adjudication. Therefore, it may be counterintuitive to argue that any one area of administrative adjudication is exceptional. Removal adjudication is indeed exceptional because it is an extremely dysfunctional system, it operates in a double void of fewer constitutional protections and without the protections of the APA, it relies on a vast network of civil detention, and (...) it is of a different genre than the type of regulation that drove the development of the APA. The exceptionality of removal adjudication demands a review of administrative law doctrine with this exceptionality in mind. (shrink)

we have recently seen the publication of several books on the narrative and identity of Pragmatism. Perhaps this is a sign that, after the first decade of the twenty-first century, scholars of Pragmatism now have the required distance or historical perspective to be confident about the history of Pragmatism in the twentieth century. In this paper, I examine the narratives of Pragmatism in Richard Bernstein’s The Pragmatic Turn and Colin Koopman’s Pragmatism as Transition.1 In spite of their differences, these scholars (...) argue for an inclusive “big-tent” Pragmatism.2 Their view of Pragmatism in America is optimistic and reconciliatory about the past, present, and future tensions that exist between pragmatist .. (shrink)

The author responds to Michelle Marder Kamhi’s reply to his review of her book, Who Says That’s Art? He takes her to task on a few issues, but largely sees this as a mere skirmish between two colleagues who agree on many fundamentals.

Written for both theoretical and practical purposes, Dysfunctional Culture discusses how to understand and identify political ideologies as cultural systems. Using examples related to family morality and reproduction, this book argues that belief in individual rights as the main basis for morality is not an adequate response to the moral challenges of the future.

ObjectiveThe family remains one of the most important relationship systems into early adulthood and provides an important foundation for lifelong mental health. Dysfunctional family cohesion can promote adjustment problems in adolescents and might also affect adolescents’ self-concept and strategies for coping with emotional distress. To test these relationships and the underlying mechanisms, we proposed a dual mediation model describing the associations between family cohesion and internalizing and externalizing problems, mediated by shame-proneness and expressive suppression.MethodsA sample of (...) 526 German-speaking adolescents aged 14 to 18 years from Austria, Germany, and Switzerland participated in an online self-report survey encompassing questionnaires on family cohesion, shame-proneness, expressive suppression, and psychological problems. We tested a path model to examine the indirect pathways of the associations between family cohesion and internalizing and externalizing problems via shame-proneness and expressive suppression, while controlling for age, gender, and guilt-proneness.ResultsWe found a significant dual mediation of the associations between family cohesion and internalizing and externalizing problems by shame-proneness and expressive suppression. The indirect pathways were all significant, except for the indirect pathway from family cohesion to externalizing problems via shame-proneness.DiscussionOur results provide a model for the mechanisms by which disrupted family cohesion can be related to psychological problems in adolescents. Expressive suppression emerged as crucial when considering the consequences of shame-proneness in adolescents, as it was only indirectly related to externalizing problems via expressive suppression. (shrink)

Made up from parents and children from a previous union or marriage, often completed by children of the new couple, the recomposed or reconstituted family is problematic under the aspect of family-specific functions, relationships and roles. Being exposed to numerous sources of conflict, it is marked by many functional difficulties, which can lead to rupture and failure. For this unit in diversity to stand the test of time, it is necessary for all the members to engage in an (...) active and flexible involvement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 2. © 2015 by Feminist Studies, Inc. 259 Chloë Taylor Female Sexual Dysfunction, Feminist Sexology, and the Psychiatry of the Normal It is really weird that doctors should be the reigning experts on sex. —Leonore Tiefer1 The first volume of Michel Foucault’s The History of Sexuality provides a compelling and influential critique of the “sciences of sex.” In this work, Foucault suggests that there is (...) little that is scientific about the disciplines of psychoanalysis, psychiatry, and sexology that emerged in the nineteenth and twentieth centuries.2 In each case, Foucault argues that the authority of science is exploited to facilitate the regulation of sexuality in a biopolitical era in which the sex life of the population has become a crucial political stake.3 Sex, according to Foucault, is managed by doctors not so much to cure health problems as to enforce social norms, and sexual science does not provide the truth of sex or make people healthy, but naturalizes the monogamous, heterosexual, nuclear family.4 1. Leonore Tiefer, Sex Is Not a Natural Act and Other Essays (Cambridge, MA: Westview Press, 2004), 180. 2. Michel Foucault, The History of Sexuality: An Introduction (New York: Vintage, 1978). 3. Michel Foucault, The History of Sexuality: 133–160. See also Michel Foucault, Psychiatric Power: Lectures at the Collège de France 1973–1974 (New York: Palgrave -MacMillan, 2006) and Michel Foucault, Abnormal: Lectures at the Collège de France 1974–1975 (New York: Picador, 2003). 4. This is not to say that for Foucault doctors do not ever cure health problems or that their intentions are not to cure health problems. However, Foucault 260 Chloë Taylor Feminism has also posed powerful critiques of the sexual sciences. As Janice Irvine notes, feminist epistemology has rejected the purported neutrality of science, especially of the sciences that claim knowledge about sex and gender.5 Feminist and queer political theorists and activists have, moreover, “underscored the hollowness of solutions based on techniques” that are favored by sexologists; teaching men skills to resist premature ejaculation or to better stimulate their wives’ clitorises are not adequate resolutions to widespread and profound dissatisfactions with sex, gender, and marriage in a heterosexist and patriarchal society.6 As Irvine writes, Feminism and lesbian/gay liberation…challenged power inequalities between men and women and questioned the very concepts of maleness and femaleness, masculinity and femininity.…They presented alternatives to tradition and to expert power and authority. Therein lay their threat to American sexology.7 Given this antagonistic relationship, combining feminism and sexology has proved controversial. The work of feminist sexologist Shere Hite in the 1970s and 1980s was critiqued by sexologists and feminists alike: sexologists complained that the 1976 Hite Report was political and thus undermined the scientific prestige of sexology, while feminists criticized Hite for aspiring to a masculine scientific authority.8 Describing the relationship between feminism and sexology, Irvine notes that “the incompatibility of their concerns—science and market, on the one hand, versus shows that what we consider “healthy” is thoroughly political and that the effect of doctors’ practices is normalizing whatever their intentions may be. For two recent Foucauldian studies of the ways that medical and sexual science function to sexually normalize individuals and populations, see Ladelle McWhorter, Bodies and Pleasures: Foucault and the Politics of Sexual Normalization (Bloomington: Indiana University Press, 1999); and Ladelle McWhorter, Racism and Sexual Oppression in Anglo-America: A Genealogy (Bloomington: Indiana University Press, 2009). 5. Janice Irvine, Disorders of Desire: Sexuality and Gender in Modern American Sexology, rev. ed. (1990; repr., Philadelphia, PA: Temple University Press, 2005), 101. 6. Ibid. 7. Ibid. 8. Ibid., 117. Chloë Taylor 261 progressive political change, on the other—led…to a contentious and emotionally charged history.”9 Drawing on both Foucauldian and feminist perspectives, this article explores a new chapter in this history, examining self-described feminist sexologists’ responses to the psychiatric diagnoses of Female Sexual Dysfunction (FSD). While psychologists had pathologized female sexuality under the label of frigidity since the nineteenth century, sexual dysfunctions were relatively marginal in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1952. In the DSM-1, frigidity (like impotence) was... (shrink)

This study compared the family characteristics, victimization histories, and number of perpetration offenses of juvenile offenders who admitted to having had sex with animals to juvenile offenders who did not. The study found that 96% of the juveniles who had engaged in sex with nonhuman animals also admitted to sex offenses against humans and reported more offenses against humans than other sex offenders their same age and race. Those juveniles who had engaged in sex with animals were similar to (...) other sex offenders in that they also came from families with less affirming and more incendiary communication, lower attachment, less adaptability, and less positive environments. Those juveniles who had engaged in sex with animals reported victimization histories with more emotional abuse and neglect and a higher number of victimization events than other offenders. This would seem to indicate that sex with animals may be an important indicator of potential or co-occurring sex offenses against humans and may be a sign of severe family dysfunction and abuse that should be addressed in the arenas of psychological intervention, juvenile justice programs, and public policy. (shrink)

Patients with bipolar disorder may experience family dysfunction, which might result in worse psychosocial functioning through environmental and psychological factors. Research investigating the mediating role of social support, resilience and suicidal ideation on family and psychosocial functioning in BD is rare. The study aims to explore the predicting and mediating effects of social support, resilience and suicidal ideation on family and psychosocial functioning in BD patients. Two hundred forty-six patients with BD and sixty-nine healthy controls were recruited. (...) The Family Assessment Device, Functioning Assessment Short Test, Social Support Rating Scale, Connor-Davidson Resilience Scale and Beck Scale for Suicide Ideation were used to assess family functioning, psychosocial functioning, social support, resilience and suicidal ideation, respectively. Bipolar patients exhibited worse family and psychosocial functioning than healthy controls. Family functioning, social support, resilience and suicidal ideation significantly predict psychosocial functioning in the bipolar group. Social support, resilience and suicidal ideation indirectly mediate the effect of family functioning on psychosocial functioning in bipolar patients. Cross-sectional design and mixed sample including acute and remitted stages. Treatments for patients with bipolar disorder should be combined with family strategies that are formulated to improve psychosocial functioning. An emphasis should be placed on enhancing social support and resilience while paying attention to suicidal ideation. (shrink)

Described as a gem in Islam, intellect can lead all individual and social behaviours towards balance, appeal and godliness. Given the utmost importance of protecting intellect in this divine religion, everything from eating and drinking to reading, listening and entertainment is thus considered haram [ viz. remains prohibited] if it makes threats to the health of mind and soul. In general, narcotics and substance abuse in all forms can have crushing and all-encompassing effects, that is, inflict heavy blows on the (...) body, soul, mind, willpower and religion in a person and consequently destroy life in the family and society. The continuation of life as well as the stability and survival of this holy institution accordingly depends on many factors, including addiction tendency (AT) and sexual dysfunction (SD). It is also obvious that the balance and optimal use of sexual instinct on the accepted path of religion will be the key to the family health and strength. Altogether, the role of AT and SD on intention to divorce (ITD) in Indonesian Muslim couples ( n = 450) was investigated in 2022 in this study, wherein one partner had previously attended addiction treatment centres over the last 6 months. The study results ultimately demonstrated that AT could induce SD and consequently raise ITD among Muslim couples. Contribution: The study results confirmed the harmful impacts of AT on SD among Muslim couples, which could increase their ITD. In view of this, it was suggested to promote religious teachings in the family to benefit from their positive effects. (shrink)

The current study looked at the impact of board of director characteristics on corporate social responsibility (CSR) in the Pakistani setting. The study further added to the body of knowledge by comparing the impact of board characteristics in family versus non-family businesses in an emerging market. The study’s sample consists of 139 non-financial Pakistan Stock Exchange (PSX) listed firms from 2008 to 2019. The level of CSR among sample firms was assessed using a multidimensional financial approach. The random-effect (...) model was employed to test the study’s hypotheses. The findings support the dysfunctional view of the role of the board of directors’ in family-owned businesses. Overall, board size and CEO duality have a significant negative impact on CSR, whereas board independence has a significant positive impact. While these findings applied to both family-owned and non-family-owned businesses. It was discovered that among family-owned businesses, boards tend to look after the interests of family members, and thus are less likely to support CSR. The findings of this study will assist regulatory authorities, investors, and financial analysts in understanding CSR practices in Pakistani firms, allowing them to review the role of the board of directors in CSR among family and non-family-owned firms. (shrink)

In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? Presumably everyone (...) wants the same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each. (shrink)

Individuals with Parkinson’s disease and temporal lobe epilepsy have hallucinations and mild cognitive dysfunction. The objective of this work was to study dreams in PD and TLE patients using a common functional model of dream production involving the limbic and paralimbic structures.Dreams were characterised in early-stage PD and TLE patients with dream diaries classified by the Hall van de Castle system and were compared with matched controls.In PD, there were significant differences between patients’ dreams and those of controls: animals, physical (...) aggression, and a befriender were more common in patients, and aggressor and bodily misfortunes were less common. The dreams of patients with frontal dysfunction showed more aggressive features.TLE patients had lower recall than PD patients and a higher proportion of dreams involving family and familiar settings, lower proportions involving success, and a higher incidence of frontal dysfunction.The dreams of PD and TLE patients share important features. (shrink)

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, (...) middle-aged males who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one’s family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum. (shrink)

During the past few years, the IRBIT domain has emerged as an important add‐on of S‐adenosyl‐L‐homocystein hydrolase (AHCY), thereby creating the new family of AHCY‐like proteins. In this review, we discuss the currently available data on this new family of proteins. We describe the IRBIT domain as a unique part of these proteins and give an overview of its regulation via (de)phosphorylation and proteolysis. The second part of this review is focused on the potential functions of the AHCY‐like (...) proteins. We propose that the IRBIT domain serves as an anchor for targeting AHCY‐like proteins towards cytoplasmic targets. This leads to regulation of (i) intracellular Ca2+ via the inositol 1,4,5‐trisphosphate receptor (IP3R), (ii) intracellular pH via the Na+/HCO3− cotransporters (NBCs); whereas inactivation of the IRBIT domain induces (iii) nuclear translocation and regulation of AHCY activity. Dysfunction of AHCY‐like proteins will disturb these three important functions, with various biological implications. BioEssays 30:642–652, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient (...) : a role-play -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

This paper explores the biographical and cultural sources that inspired the decision of Janusz Korczak to make his life’s vocation the education of young children from dysfunctional families. This decision emerged out of the radical version of humanism he embraced. His identification of children as the population his humanist ethos must serve, distinguishes it from other versions of humanism. The paper explores the role his sense of self and his identification with Poles, Jews, and humanity play in the composition (...) of this humanism. It identifies the hybridity of his cultural identifications as its heart. It proposes that the tensions between these identifications in general, and his non-Jewish Jewish identification that situated him as being ‘a part of’ and ‘apart from’ Polish society in particular, induced Korczak to create a universal religion of children in which religious, ethnic, or physical distinctions do not generate prejudice, intolerance, and violence. (shrink)

Argues that psychotherapy's claim to be a universal scientific practice that objectively treats ahistorical illnesses is untenable. PT is a cultural product, so it both reflects and reproduces its cultural context. Because cultural context is in part composed of moral traditions embedded in political structures, PT is unavoidably a moral practice with political consequences. Implicit moralities in current practices are discussed. Philosophical hermeneutics in PT practice are offered as an alternative. In a discussion of intersecting traditions, it is suggested that (...) a hermeneutic perspective can portray the keeping of family secrets as a commitment to a particular moral code, rather than the products of a "dysfunctional family." If PT theories can be changed so that they are more historically situated, and if PT practices can be changed to use hermeneutics, then a different moral frame can be put forth. 2012 APA, all rights reserved). (shrink)

Children remain largely absent from sociolegal scholarship on sexual violence. Taking an intersectional approach to the analysis of attorneys’ strategies during child sexual assault trials, this article argues that legal narratives draw on existing gender, racial, and age stereotypes to present legally compelling evidence of credibility. This work builds on Crenshaw’s focus on women of color, emphasizing the role of structures of power and inequality in constituting the conditions of children’s experiences of adjudication. Using ethnographic observations of courtroom jury trials, (...) transcripts, and court records, three narrative themes of child credibility emerged: invisible wounds, rebellious adolescents, and dysfunctional families. Findings show how attorneys use these themes to emphasize the child’s unmarked body, imperceptible emotional responses, rebellious character, and harmful familial environments. The current study fills a gap in sexual assault research by moving beyond trial outcomes to address cultural narratives within the court that are inextricably embedded in intersectional dimensions of power and the reproduction of social status. (shrink)

In this unique and exhilarating autobiography, Allan Jones – Canada’s first blind diplomat – vividly describes how an untreatable eye disease slowly decimated his visual world, most challengingly during his postings in Tokyo and New Delhi, and how he discovered and took to heart the revelatory Indian philosophy that changed his life. Advaita Vedanta, the most iconoclastic and liberating of the classical Indian philosophies, profoundly altered the author’s experience of self and world. He found that the true self, as distinct (...) from the individual ego, far exceeds the boundaries of individuality. It lies beneath sightedness or blindness and is absolutely unaffected by the latter. This welcome shift of perspective was reinforced by startling discoveries in contemporary physics, evolutionary biology, and developmental psychology that are fully consistent with Advaitic metaphysics. As for the practical applications of metaphysics, this book demonstrates step by step how Advaitic insight and practice significantly reduce physical and psychological tension. The most telling examples have to do with adjustments compelled by extreme circumstances. Thus Jones describes how he drew upon Advaitic mindfulness techniques to maintain his white cane mobility skills in the teeth of permanent spinal, nerve, and muscle pain. The arc of Beyond Vision moves from the claustrophobically personal to the openness of the transpersonal. It begins in a dysfunctional family background, breaking out into a full life encompassing an adventurous foreign service career, spiritual exploration, and an unconventional kind of marital love. (shrink)

In this paper, the author addresses the problem of socialisation of children with a history of disabilities and mental retardation by means of visual arts. It is important to look at the very sphere of life of these categories of children. As a rule, these children, for the most part, live in dysfunctional families, which makes it almost impossible to provide them with a form of socialization. This article focuses on the extent to which and how a programme of (...) socialisation of these children can be achieved through the medium of visual arts. At the moment there are works of modern pedagogues who have devoted their scientific researches to this problem, but there are few teachers-artists who deal with this problem. In this article the author devotes his creative attention to this issue and reflects on what means of fine arts and visual literacy can develop and guide in the right direction the socialization of children and young people with disabilities by means of fine arts. A number of scientific works devoted to this problem are seriously reviewed. The author is actively trying to draw the attention of the teaching community to the problem of prevailing social conditions, to reach an educational and cognitive level and, as a consequence, to a better product of the set task of socialization of children with special needs and disabilities in the learning process by means of subject disciplines: drawing, painting, composition, printmaking, etc. (shrink)

Jesus' story -- A family affair -- Whose story are you in? -- Hatred that passes understanding -- Evidence of the invisible -- A family feud -- What is it to you? follow me! -- Wild blessing -- What's a cheeseburger? -- The road to Oz -- Christian Anti-Semitism -- Israel time line -- Jewish intellectual contribution.

Despite recent advances in the research related to air pollution and associated adverse cardiovascular events, the combined effects of air pollution, climate change, and SARS‐CoV‐2 infection on cardiovascular health need to be researched further. This Commentary addresses their impacts on cardiovascular health in the approximately 25 million people with a severe form of inherited hypercholesterolemia, called familial hypercholesterolemia (FH). The arterial endothelium in these individuals is potentially under multiple attacks caused by particles of both endogenous and exogenous origin. Thus, they (...) have a lifelong highly elevated level of circulating low density lipoprotein (LDL) cholesterol which drives premature atherosclerosis. The high levels of LDL particles, often associated with an elevated level of circulating lipoprotein(a) particles, are both capable of inducing and maintaining endothelial dysfunction. Such pre‐existing endothelial dysfunction can be exacerbated by exposure to SARS‐CoV‐2 viral particles, by exposure to fine particulate matter generated by climate change‐associated wildfires, and by dehydration during deadly heatwaves linked to the globally rising temperatures. The external factors can severely worsen the pre‐existing endothelial dysfunction, and thereby significantly increase the risk of a cardiovascular event in the exposed FH patients. (shrink)

This article employs descriptive and explorative methods concerning father absence and missional parenting. It identifies numerous ramifications caused by father absence and the failing role of men. Father absence has been a serious social issue in South Africa, which has become more tenacious in post-colonial South Africa because of economic reasons, untold fatherhood, refused fatherhood, fatherhood accountability, divorce and dissolution of households. This social issue influenced and affected both family and society dysfunction and created a vicious cycle of poverty (...) in many South African homes. This article aimed to lessen the predicament of fatherlessness by considering the role of missional parenting where the father and mother form a partnership and collaborate for the family’s progress and actualise God’s pre-eminent plan for families in South Africa. The literature review and methodology provided rich insights and considerable knowledge to help support families who do not have a father figure and men in their fatherly role. Missional parenting is gospel-centred and can be a detriment to father absence. Parents follow the example of Jesus Christ as saviour in missional parenting. Contribution: This article employed a descriptive and explorative modus operandi and explored a respective method to effectuate family disharmony in the context of South Africa. It endorses the journal’s focus on church and family in the field of Missiology and Practical Theology. A fatherless South Africa because of the social ill of father absence is a concerning issue. (shrink)

This volume offers a critical examination of the early works of Vladimir Solov'ëv, Russia's most famous and systematic philosopher. It presents a philosophical critique of his early writings up to 1881 from an immanent viewpoint and examines Solov'ëv's intended contributions to philosophy against the background of German Idealism, including Schopenhauer, and the positivism of his day. Examining contemporary reactions to his writings by leading figures of his day, such as Chicherin and Kavelin, The Early Solov'ëv and His Quest for Metaphysics (...) reveals the small but vibrant philosophical community in Russia during the immediate decades before the Bolshevik Revolution. It provides a detailed discussion of Solov'ëv's confrontation with his philosophical opponents and shows how his emphasis on developing a metaphysical ontology rather than epistemology exerted a virtual paradigmatic influence on Russian philosophy for years to come. This volume also sets Solov'ëv's writings against a detailed intellectual biography of these early years, drawing on letters to friends and relatives including reminiscences, and challenges many of the received claims concerning his actions and positions, particularly his alleged youthful mystical visions. In addition, the book features two appendices: one that sketches the early Russian reception of French positivism against which Solov'ëv reacted in the name of metaphysics and another that presents a fascinating look at the Solov'ëv family background, which produced at once intellectual as well as dysfunctional members. Presenting a rare picture of the non-Marxist intellectual scene in 19th century Russia, The Early Solov'ëv and His Quest for Metaphysics will be of interest to graduate students and researchers looking for a philosophically informed approach to this unique thinker and era. (shrink)

There is an important family of philosophical positions which deserve the name “realism”, and there is a natural diagnosis of what all these positions share in common. There is also an important family of philosophical positions which deserve the name “antirealism”, and there is a natural diagnosis of what all these positions share in common. These two families are feuding, but the nature of the conflict between them is far from clear. When we extract the definition which realists (...) would give for their position, and the definition antirealists would give for their position, we find that the antirealists do not see themselves as denying quite the same thing that the realists see themselves as asserting. I will begin by discussing the self-definition of some realists. (shrink)

Like feuding relatives at a family barbecue, economists and moral philosophers often like to pretend they have nothing to do with each other. Economists pose as value-neutral scientists who have no need for airy-fairy moral theory; yet they regularly dispense the sorts of prescription and advice that cry out for ethical analysis. Philosophers likewise view themselves as having loftier concerns than vulgar economics; but by conducting their ethical and political theorizing in ignorance of economic principles, they are unable to (...) avoid recommending policies that would be unworkable or disastrous in practice. This, at any rate, is how Leland Yeager sees the situation, and it is hard to disagree with him; ethics and economics need to learn from one another. (shrink)

In October 2000, the UN Security Council unanimously adopted Resolution 1325 on "Women, Peace and Security", calling for women's full and equal participation in all aspects of conflict prevention, resolution and peacebuilding. The world is at last recognizing that gender issues and peace are inextricably connected, and that women's involvement in peace efforts is essential for the prevention of renewed conflict. Given the need for women's involvement in peace and security issues, we must address the reasons why women's influence is (...) limited, why they still do not have access to power or leadership roles, while their level of participation in the armed forces is minimal to non-existent. Meanwhile, wars rage. This paper argues that to think through the deeper connections between gender issues and peace is to engage in an unsettling, necessarily philosophical inquiry about the nature of modern ethical life— as a dysfunctional system of separate and competing ethical imperatives: family and state, public and private, individual and state, masculine and feminine. My inquiry is conducted from the standpoint of Hegel's philosophy. In the Phenomenology of Mind. Hegel draws upon the tragedian Sophocles for his insight that once upon a time in the ancient world, universal ethical substance divided itself into distinct ethical spheres of human and divine law. Human relationships to these ethical worlds were shaped by gender. The division of ethical substance precipitated conflicts that eventually caused the ancient world to collapse. For Hegel, the project of modernity is all about the recovery, in self-conscious form, of a harmonious ethical life, through reconciliation of conflicting ethical worlds. Hegel's philosophy of modern life has its shortfalls, but is a powerful resource for the argument that gender justice is a condition for long-lasting peace. (shrink)

_The Widening Scope of Shame_ is the first collection of papers on shame to appear in a decade and contains contributions from most of the major authors currently writing on this topic. It is not a sourcebook, but a comprehensive introduction to clinical and theoretical perspectives on shame that is intended to be read cover to cover. The panoramic scope of this multidisciplinary volume is evidenced by a variety of clinically and developmentally grounded chapters; by chapters explicating the theories of (...) Silvan Tomkins and Helen Block Lewis; and by chapters examining shame from the viewpoints of philosophy, social theory, and the study of family systems. A final section of brief chapters illuminates shame in relation to specific clinical problems and experiential contexts, including envy, attention deficit disorder, infertility, masochism, the medical setting, and religious experience. This collection will be of special interest to psychoanalytically oriented readers. It begins with a chapter charting the evolution of Freud's thinking on shame, followed by chapters providing contemporary perspectives on the role of shame in development, and the status of shame within the theory of narcissism. Of further psychoanalytic interest are two reprinted classics by Sidney Levin on shame and marital dysfunction. In both depth of clinical coverage and breadth of perspectives, _The Widening Scope of Shame_ is unique in the shame literature. Readable, well organized, and completely up to date, it becomes essential reading for all students of this intriguing and unsettling emotion and of human development more generally. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Growing Up: Seeing Myself for Who I Am and Loving ItKerry MagroLast weekend, I traveled to see my cousin. He had graduated from St Mary’s Seminary in Baltimore and was being ordained as a Roman Catholic priest. The event was attended by many of my family members. Several of the littlest attendees struggled with all the commotion, some were said to be shy, some didn’t want to be (...) crowded, and parents and caregivers did what they could to make it easier on them. Watching those kids trying to cope with a family event, which was different and a bit confusing, brought back a flood of memories of my own childhood. Nothing was simple about my childhood.My life has been “interesting” for sure. As a young child I faced many challenges. Until the age of two and a half I was nonverbal. Even though later I would gain speech, my developmental delays and sensory integration dysfunction issues caused great [End Page 202] difficulty for myself and my parents. I was evaluated by professionals and was diagnosed with an autism spectrum disorder–pervasive developmental disorder not otherwise specified (PDD–NOS) at the age of four.Thoughts of that difficult time filled my head when watching the children at this family function. My uncles, aunts and cousins couldn’t possibly know my struggles in those years. They weren’t present for all the interventions and therapy sessions I endured. Today, they don’t see me as someone different or disabled. I still have some obstacles to overcome in my development but rather than bemoan where I am or where I have been I have chosen to accept myself as I am. Although some may say I have a disability I choose to embrace my abilities and to celebrate them. I’m glad I’ve stayed on a path that has led me to become an independent adult. I am now a national motivational speaker, a Master’s graduate, owner of a non–profit corporation and soon to be an author.But what about this word “disabled”? Since I was six years old I seemed to have been tagged with this word by those around me. They all considered autism as a disability. I didn’t even know I had autism until I was 11. But I was very aware of people defining me as being disabled. It had to be the reason I was being placed in Special Ed classes, for the hours I had to travel to doctors and therapies: occupational therapy, physical therapy, speech therapy. I was being called disabled and I didn’t know why. Of course the signs were there for me that I had a problem. In daycare many things confused and frightened me: loud noises, wind, water, transitions. I cried constantly, a lot more than everyone else. I had terrible tantrums (lying on the floor kicking and screaming) to the confusion and consternation of the adults and caregivers around me. I attended two different daycare centers and was asked to leave both of them. I couldn’t even make the transition from the door of a daycare center to my parent’s car without fighting, screaming and crying uncontrollably.It’s now hard to believe that my difficulty with sensory integration dysfunction, transitions and social interactions lasted for almost 15 years of my life. During those years there were many confusing, frightening and painful episodes for me, my parents and others around us.Like most kids with these types of deficits, we tried to find splinter skills to help me compensate. I have hyper–mobility of the joints making buttoning and fine motor tasks almost impossible. I also have dysgraphia, which makes it difficult for me to hold a pen or pencil to write. Even with therapy I never learned to ride a bicycle. One bright side to the hyper–mobility was being able to learn to type 100 words per minute.My sensitivity to water, wind and loud sounds was extreme. I fought my parents each time they tried to get me into the bathtub. I hated going on the swings because I couldn’t feel my feet on the ground... (shrink)

When Oxford published Emotion and Adaptation, the landmark 1991 book on the psychology of emotion by internationally acclaimed stress and coping expert Richard Lazarus, Contemporary Psychology welcomed it as "a brightly shining star in the galaxy of such volumes." Psychiatrists, psychologists and researchers hailed it as a masterpiece, a major breakthrough in our understanding of the emotional process and its central role in our adaptation as individuals and as a species. What was still needed, however, was a book for general (...) readers and health care practitioners that would dispel the myths still surrounding cultural beliefs about emotion and systematically explain the relevance of the new research to the emotional dramas of our everyday lives.Now, in Passion and Reason, Lazarus draws on his four decades of pioneering research to bring readers the first book to move beyond both clinical jargon and "feel-good" popular psychology to really explain, in plain, accessible language, how emotions are aroused, how they are managed, and how they critically shape our views of ourselves and the world around us. With his co-author writer Bernice Lazarus, Dr. Lazarus explores the latest findings on the short and long-term causes and effects of various emotions, including the often conflicting research on stress management and links between negative emotions and heart disease, cancer, and other aspects of physical and psychological health. Lazarus makes a strong case that contrary to common assumption, emotions are not irrational--our emotions and our analytical thought processes are inextricably linked.While not a "how-to" book, Passion and Reason does describe how readers can interpret what lies behind their own emotions and those of their families, friends, and co-workers, and how to manage them more effectively. Exploring fifteen emotions in depth, from love to jealousy, the authors show how the personal meaning we give to the events and conditions of our lives trigger such emotions as anger, anxiety, guilt, and pride. They provide fascinating vignettes to frame a "biography" of each emotion. Some are composite case histories drawn from Dr. Lazarus's long career, but most are stories of people the Lazaruses have known over the years--people whose emotional fears, conflicts, and desires mirror readers' own. The Lazaruses also offer a special chapter on the diverse strategies of coping people use in managing their emotions, and another, "When Coping Fails," on psychotherapy and its approaches to emotional stress and dysfunction, from traditional Freudian psychoanalysis to continuing research into relaxation techniques, meditation, hypnosis, and biofeedback.Packed with insight and compellingly readable, Passion and Reason will enrich all readers fascinated by our emotional lives. (shrink)

In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family, social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems. In this article, I consider the grounds on which such claims might be supported. I argue that problems should (...) not be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument—that schizophrenia is not within diagnosed patients—does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment. (shrink)

This paper provides a detailed study of fraud in practice through an empirical investigation of B.P.Sayers, a family-owned stockbroking firm that had been in existence for over 100 years and that collapsed due to the fraudulent activities of the firm's junior partner. An interpretive narrative methodology has been employed which has resulted in the development of a detailed understanding of fraud and moral breakdown in organizations, resulting from a failure of responsibility that arises from a dysfunctional work identification (...) and its moral implications. In developing this account of fraud, the conceptual framework utilized is drawn from the moral philosophical work of Emmanuel Levinas who explicated how the breakdown of social relations of responsibility results, in turn, in moral breakdown. (shrink)

Agency is the human capacity to freely choose one’s thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, (...) it is argued that to respect the autonomy of individuals, it is essential to establish their agency. (shrink)

The 2012 film The Sessions tells the story of a man with polio who loses his virginity by undergoing Surrogate Partner Therapy (SPT). In light of ensuing controversy surrounding the legal and moral status of SPT, this article uses Norman Daniels’ framework of fair equality of opportunity in health to argue that SPT is a legitimate form of treatment for sexual dysfunctions and should be evaluated alongside other such treatments. I begin by showing how sexual dysfunctions constitute deviations in normal (...) species functioning. I then show that sexual capacities are a matter of fair equality of opportunity because they affect the ability to cultivate the sexual intimacy that is crucial for forming a family and often necessary for maintaining a healthy one. Recognizing that some might object to SPT as a form of prostitution, I proceed by showing how the treatment might avoid some of the objections raised against prostitution, and conclude by affirming that societies committed to fair equality of opportunity in health should work to make SPT legal and safe. (shrink)

While the ethical significance of caregivers in neurological research has increasingly been recognized, the role of caregivers in brain- computer interface (BCI) research has received relatively less attention. Objectives: This report investigates the extent to which caregivers are mentioned in publications describing implantable BCI (iBCI) research for individuals with motor dysfunction, communication impairment, and blindness. Methods: The scoping review was conducted in June 2024 using the PubMed and Web of Science bibliographic databases. The articles were systematically searched using query terms (...) for caregivers, family members, and guardians, and the results were quantitatively and qualitatively analyzed. Results: Our search yielded 315 unique studies, 78 of which were included in this scoping review. Thirty-four (43.6%) of the 78 articles mentioned the study participant’s caregivers. We sorted these into 5 categories: Twenty-two (64.7%) of the 34 articles thanked caregivers in the acknowledgement section, 6 (17.6%) articles described the caregiver’s role with regard to the consent process, 12 (35.3%) described the caregiver’s role in the technical maintenance and upkeep of the BCI system or in other procedural aspects of the study, 9 (26.5%) discussed how the BCI enhanced participant communication and goal-directed behavior with the help of a caregiver, and 3 (8.8%) articles included general comments that did not fit into the other categories but still related to the importance of caregivers in the lives of the research participants. Discussion: Caregivers were mentioned in less than half of BCI studies in this review. The studies that offered more robust discussions of caregivers provide valuable insight into the integral role that caregivers play in supporting the study participants and the research process. Attention to the role of caregivers in successful BCI research studies can help guide the responsible development of future BCI study protocols. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 35-41 [Access article in PDF] The Rationality of Psychosis and Understanding the Deluded Matthew R. Broome Campbell's important and influential paper (Campbell 2001) has framed the debate that Bayne and Pacherie (2004) most explicitly, and Klee (2004) and Georgaca (2004) more implicitly, engage in. Campbell has offered two broad ways of thinking about explanations of delusions—the empirical and the rational. He offers some (...) criticism of the former and an endorsement of the latter. Campbell uses examples from clinical psychopathology to illustrate his argument and Bayne and Pacherie in turn employ these. Campbell discusses the eponymously named delusions of Capgras and Cotard—the former a subtype of delusional misidentification and the latter a delusion whose content is colored predominantly with nihilistic and possibly hypochondriacal themes. Campbell, Bayne and Pacherie, and Klee discuss the empirical data in relation to such delusions and as an aid to discussing the empirical model more generally. It does seem a little unfortunate that these delusions, which are less than typical, become the focus of Campbell's paper, and Bayne and Pacherie's criticism of his work. Delusions are remarkably heterogeneous; this indeed may be part of the reason why there is so much difficulty in reaching a definition as Klee discusses, and occur in a wide variety of mental and neurological illnesses. The most common delusions are those of persecution and reference (World Health Organization [WHO] 1973) and typically occur in schizophrenia. By contrast, delusional misidentification occurs most commonly in patients with dementia, delirium, and focal cognitive impairment, but can occur in other functional psychoses such as an affective or schizophrenic psychosis. The most common form of delusional misidentification is not that of either the exotic Capgras or Fregoli syndromes but delusional misidentification for place; thus, although Bayne and Pacherie's arguments against Campbell may still hold, delusional misidentification tends to occur in the context of a patient believing that they are at home or on holiday rather than in hospital and may not necessarily involve close family members or other intimate relationships. Similarly, Cotard's syndrome tends to occur in the context of a severe depressive illness with mood-congruent psychotic symptoms, typically in an elderly individual. It does not have to have the content that the deluded is dead, but can include beliefs, for example, that the world no longer exists or that their internal organs are not present. Thus, a patient with either Capgras' or Cotard's syndrome is likely to differ from patients with delusions of persecution. They would [End Page 35] have different diagnoses, probably be older, and have a greater likelihood of structural abnormalities of the brain on imaging and consequent neuropsychological dysfunction. That is not to say that patients with schizophrenia have normal cerebral anatomy and neuropsychology, but rather that the Capgras' and Cotard's patients are likely to have neurological quality to their presentation that is clinically relevant, rather than what commonly the case in schizophrenia and the other functional psychoses, where the neurological abnormalities are only currently important at the level of academic research. Empirical Models of Delusion Formation Different delusions may not have that much in common, nor may the patients who believe in them. This in turn relates to the empirical paradigm that both Campbell and Bayne and Pacherie discuss. It is true that current research, and indeed the clinical practice of cognitive behavioral therapy for psychosis, is indebted to the work of Maher and it is within his legacy which we work. This, however, is not to say that we think his initial formulation was correct. Maher's (1988, 1992) work focused attempts in explaining delusions—both to support and refute his thesis that delusions are the consequence of normal cognitive mechanisms seeking to explain an anomalous sensory experience. Such a view initially led to work demonstrating delusions in the absence of anomalous perceptions, the presence of reasoning biases in the deluded population, and the possibility that abnormal sensory experience may be consequent upon biased cognitive processes (Garety and Freeman 1999). More recent work has demonstrated the prevalence of... (shrink)

Psychopathy is increasingly in the public eye. However, it is yet to be fully and effectively understood. Within the context of the DSM-IV, for example, it is best regarded as a complex family of disorders. The upside is that this family can be tightly related along common dimensions. Characteristic marks of psychopaths include a lack of guilt and remorse for paradigm case immoral actions, leading to the common conception of psychopathy rooted in affective dysfunctions. An adequate portrait of (...) psychopathy is much more complicated, however. Though some neural regions and corresponding functions are commonly indicated, they range across those responsible for action planning and learning, as well as emotional processes. Accordingly, a complete fine-grained map of all neural mechanisms responsible for psychopathy has not been realized, and even if it were, such a map would have limited utility outside of the context of surgical or chemical intervention. The utility of a neural-level understanding of psychopathy is further limited by the fact that it is only applicable in the clinical identification of individual subjects, and the neuro-chemical/biological correction of those subjects after they are positively identified as psychopaths. On the other hand, an information processing model of moral cognition provides for wider-ranging applications. The theoretical and practical implications for such a feasible working model of psychopathic personalities are assessed. Finally, this chapter raises the possibility of directed modification of social-environmental factors discouraging the development of psychopathic personalities in the first place, modifications which are also open to simulation and testing in terms of the same model of moral cognition. (shrink)

Psychopathy is increasingly in the public eye. However, it is yet to be fully and effectively understood. Within the context of the DSM-IV, for example, it is best regarded as a complex family of disorders. The upside is that this family can be tightly related along common dimensions. Characteristic marks of psychopaths include a lack of guilt and remorse for paradigm case immoral actions, leading to the common conception of psychopathy rooted in affective dysfunctions. An adequate portrait of (...) psychopathy is much more complicated, however. Though some neural regions and corresponding functions are commonly indicated, they range across those responsible for action planning and learning, as well as emotional processes. Accordingly, a complete fine-grained map of all neural mechanisms responsible for psychopathy has not been realized, and even if it were, such a map would have limited utility outside of the context of surgical or chemical intervention. The utility of a neural-level understanding of psychopathy is further limited by the fact that it is only applicable in the clinical identification of individual subjects, and the neuro-chemical/biological correction of those subjects after they are positively identified as psychopaths. On the other hand, an information processing model of moral cognition provides for wider-ranging applications. The theoretical and practical implications for such a feasible working model of psychopathic personalities are assessed. Finally, this chapter raises the possibility of directed modification of social-environmental factors (including at the meta-organizational level) discouraging the development of psychopathic personalities in the first place, modifications which are also open to simulation and testing in terms of the same model of moral cognition. (shrink)

The American system of long‐term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved ones often at considerable cost to (...) themselves.As the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties. The supply of unpaid family caregivers will become limited, as the ratio of people in the category of ages forty‐five to sixty‐four compared to those who are eighty and older shrinks from just above seven to one in 2010 to just above four to one in 2030. Paid caregivers will be needed to take up the slack, yet they are poorly paid, work under very difficult conditions, and receive little respect from the health care system. In this essay, I discuss the circumstances facing these paid home‐care workers and a possible path forward, illustrating the current problems by drawing on interviews I conducted for a book‐length study published in 2017. (shrink)

The present study aims to identify contextual and psychological factors of proneness to radicalization and violent extremism operationalized through the Militant Extremist Mindset scale consisting of three distinct aspects: Proviolence, Vile World beliefs, and trust in Divine Power. A community sample of 271 high school students from Belgrade and Sandžak regions in Serbia completed: a 24-item MEM scale; contextual measures including a 6-item scale of family dysfunction and a 4-item composite measure capturing exposure to a harsh school environment and (...) peer abuse ; psychological measures including the 9-item Right-Wing Authoritarianism scale, the 5-item Social Dominance Orientation scale, and the 20-item UCLA Loneliness scale. A path analysis was conducted with contextual factors on the first and psychological factors on the second level of the model predicting the three factors of MEM. LON was positively predicted by FDys and HSE, SDO by HSE only, while RWA was positively predicted by FDys only. Contextual and psychological factors accounted for 27% of the variance in PV, 15% of the variance in VW, and 31% of the variance in DP. Obtained findings reveal a complex interplay of contextual and psychological drivers in the prediction of different aspects of RVE and build upon existing knowledge on risk factors associated with RVE. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.4 (2004) 299-301 [Access article in PDF] The Right Not to Know: A Challenge for Accurate Self-Assessment Ruth F. Chadwick Anderson and Lux present a very interesting and thought-provoking argument for the view that accurate self-assessment is a requirement for personal autonomy. What I want to suggest is that although this may be helpful in the context with which these authors are primarily concerned, namely (...) psychiatry and brain dysfunction, it is of less value to an account of autonomy more widely construed. I want to look at a possible counterexample, taken from another area of medicine, namely genetics.Toward the end of their article Anderson and Lux consider three objections to their position. I shall not discuss them all. My concern is with the third, that inaccurate self-assessment sometimes promotes autonomy, because knowing the truth about one's weaknesses is sometimes very debilitating. It is commonly argued that "you can if you think you can" and vice versa. As they point out, there are some complex issues involved here, in that if the result of the positive thinking is the ability to do the thing in question, then how can the self-assessment be deemed to have been inaccurate in the first place? They go on, however, to say that "it is unclear that inflated self-assessments yield benefits in contexts where what is required is not just effort but competence" (290).Now it has been argued, by some, in the context of genetics, that the proper understanding of autonomy may imply a "right not to know" facts about oneself. In other words, this is not just a matter of accurate or inaccurate assessment of the relevant facts about oneself; rather, what may be involved is a deliberate decision not to have access to facts that may be relevant to that assessment. There are clearly cases in which genetic information appears to be pertinent to an accurate self-assessment, as the following example suggests. Suppose there is information "available", through genetic testing, that would affect one's chances of having children, or of having children without a particular genetic disorder, and, knowing that such information is available, a couple decides not to avail themselves of this. This is clearly an inaccurate self-assessment, but is their autonomy compromised?It might be thought that the reasons for this decision not to know could be relevant. If they have no family history of any particular genetic disorder, it could be regarded as subjectively reasonable to decline such testing as might be offered. Anderson and Lux, however, argue that whether or not a self-assessment is accurate depends on externalities. In other words, A's self-assessment is not to be assessed as accurate, or [End Page 299] not, according to what it is subjectively reasonable to believe; it has to be measured against the facts. The more that the possibilities of genetic testing increase, the more that "facts" of this nature will be available, including in the context of psychiatry.It might be objected that genetic information is not the type of information that is relevant in this context. In so far as it is predictive and probabilistic it is, arguably, different from the type of diagnostic information involved in the cases discussed by Anderson and Lux. It is not the place here, however, to discuss in general terms the thesis of "genetic exceptionalism" with regard to medical information. The important point is refusal of access to information that may be relevant to an accurate self-assessment. Historically, people have been mistaken in their self-assessment because of lack of information—for example, lack of understanding of facts about the reproduction process has led individuals automatically to blame the woman partner of a couple for infertility. And, as Anderson and Lux rightly point out, being autonomous is compatible with making mistakes, and indeed requires the freedom to make mistakes, it would look rather different if a person continued to hold this without any attempt to avail himself of the relevant—and now available—information... (shrink)