ABSTRACT:How does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.

Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning used (...) by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning used (...) by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

In Zermelo-Fraenkel set theory with the axiom of choice every set has the same cardinal number as some ordinal. Von Rimscha has weakened this condition to “Every set has the same cardinal number as some transitive set”. In set theory without the axiom of choice, we study the deductive strength of this and similar statements introduced by von Rimscha.

We study the relationships between definitions of compactness in topological spaces and the roll the axiom of choice plays in these relationships.

The willows and the hazel copses greenShall now no more be seenFanning their joyous leaves to thy soft lays.[Milton, Lycidas, Ll. 42-44] It is my thesis that the reader is always making sense , and in the case of these lines the sense he makes will involve the assumption of a completed assertion after the word "seen," to wit, the death of Lycidas has so affected the willows and the hazel copses green that, in sympathy, they will wither and die (...) . In other words at the end of line 43 the reader will have hazarded an interpretation, or performed an act of perpetual closure, or made a decision as to what is being asserted. I do not mean that he has done four things, but that he has done one thing the description of which might take any one of four forms—making sense, interpreting, performing perpetual closure, deciding about what is intended. Whatever he has done he will undo it in the act of reading the next line; for here he discovers that his closure, or making of sense, was premature and that he must make a new one in which the relationship between man and nature is exactly the reverse of what was first assumed. The willows and the hazel copses green will in fact be seen, but they will not be seen by Lycidas. It is he who will be no more, while they go on as before, fanning their joyous leaves to someone else's soft lays . Nature is not sympathetic, but indifferent, and the notion of her sympathy is one of those "false surmises" that the poem is continually encouraging and then disallowing. Stanley E. Fish, professor of English at Johns Hopkins University, is the author of John Skelton's Poetry, Surprised by Sin: The Reader in Paradise Lost, and Self-Consuming Artifacts: The Experience of Seventeenth-Century Literature. His other contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , "A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time" . See also: "Professor Fish on the Milton Variorum" by Douglas Bush in Vol. 3, No. 1; "Stanley Fish's 'Interpreting the Variorum': Advance or Retreat?" by Steven Mailloux in Vol. 3, No. 1; "Interpreting 'Interpreting the Variorum'" by Stanley E. Fish in Vol. 3, No. 1. (shrink)

In the summer of 1977, as I was preparing to teach Jacques Derrida’s Of Grammatology to a class at the School of Criticism and Theory in Irvine, a card floated out of the text and presented itself for interpretation. It read:WITH THE COMPLIMENTS OF THE AUTHORImmediately I was faced with an interpretive problem not only in the ordinary and everyday sense of having to determine the meaning and the intention of the utterance but in the special sense occasioned by the (...) fact that I didn’t know who the author named or, rather, not named by the card was. It might have been Derrida himself whom I had met, but only in passing. Or it might have been Derrida’s translator, Gayatri Spivak whom I had known for some time and who might well have put me on the publisher’s list. Or it might have been the publisher, in this case the Johns Hopkins University Press of whose editorial board I was then a member. In the absence of any explicit identification, I found myself a very emblem of the difficulties or infelicities that attend distanced or etiolated communication: unable to proceed because the words were cut off from their anchoring source in a unique and clearly present intention. That is to say, I seemed, in the very moment of my perplexity, to be proving on my pulse the superiority of face-to-face communication, where one can know intentions directly, to communication mediated by the marks of writing and in this case by a writing that materialized without any clues as to its context of origin. It may not have been a message found in a bottle, but it certainly was a message found in a book. (shrink)

Ralph Rader's model of literary activity is built up from a theory of intention. A literary work, he believes, embodies a "cognitive act,"1 an act variously characterized as a "positive constructive intention" , "an overall creative intention" . To read a literary work is to perform an answering "act of cognition" , which is in effect the comprehension of this comprehensive intention, the assigning to the work of a "single coherent meaning" . Both acts—the embodying and the assigning —are one-time, (...) single-shot performances. They are "ends" in two senses; the overall intention is the end to which everything in the work must be contributory, and its comprehension is something the reader does at the end . Rader offers this model as if it were descriptive, as if it made explicit rules of behavior we unerringly follow, rules which underlie our "tacit or intuitive capacity" of intention producing and intention retrieving; but the model is, in fact, prescriptive since it quite arbitrarily limits this same capacity: authors are limited to no more than one positive constructive intention per unit, while readers or interpreters are limited to its discovery; whatever cannot be related to that discovery or interferes with it will either be declared not to exist or, if its existence cannot be denied, it will be labeled a defect, an "unintended and unavoidable negative consequence of the artist's positive constructive intention" . · 1. My argument will engage two of Rader's articles. They are "Fact, Theory, and Literary Explanation," Critical Inquiry 1, no.2 : 245-72, and "The Concept of Genre and Eighteenth-Century Studies," in New Approaches to Eighteenth-Century Literature: Selected Papers from the English Institute , pp. 79-115. In what follows they will be referred to as Fact and Concept along with the appropriate page number. Stanley E. Fish, professor of English at John Hopkins University, responds in this essay to Ralph W. Rader's "Fact, Theory, and Literary Explanation" . Professor Fish is the author of John Skelton's Poetry, Surprised by Sin: The Reader in Paradise Lost, and Self-Consuming Artifacts: The Experience of Seventeenth-Century Literature. His other contributions to Critical Inquiry include "Interpreting the Variorum" , "CRITICAL RESPONSE: Interpreting 'Interpreting the Variorum'" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , "CRITICAL RESPONSE: A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time". (shrink)

William James, like his father before him, devoted much attention to religion. He defended the human desire to have faith in something, or some being, whose existence could not be empirically defended. Faith generated a feeling of ease and peacefulness, and therefore could be considered a moral good. In The Varieties of Religious Experience James argued that faith could be discovered and enacted in unconventional ways.Mr. Schulte has redefined James’s thesis to support Alcoholic Anonymous 3rd edition. He claims that James (...) provided the germinal idea of the AA program according to the program’s cofounders Bill Wilson and Dr. Bob Smith. Schulte uses Varieties in an adulterate fashion: each of the 8.. (shrink)

We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a (...) detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

What I would add, and what Reichert seems unable to see, is that the facts of the text do not identify themselves. He faults Roskill for failing to see that coherence is not a function of the text but of "principles we bring to the text"; yet he himself does not see that the text, insofar as one can point to it, is produced by those same principles. Indeed, Reichert is continually doing the very thing for which he criticizes Roskill, (...) attributing to the text qualities and features that are the product of interpretive strategies. Thus, for example, he cites the instance of "the interpreter . . . noticing something in the text that makes his former reading seem implausible" as evidence that the text is at some level independent of interpretation; but noticeability is a function of what it is possible to notice given a particular set of assumptions: a reader innocent of the principles of typology would be incapable of "noticing" a typological pattern, whereas for a reader like Madsen, the pattern will seem to announce itself; and a reader who "notices" something he didn't "notice" before is a reader who is proceeding within a different set of interpretive assumptions. That which is noticeable, in short, can never be the means of confirming or constraining interpretations because it is always a product of one. The same argument dissolves the distinction, invoked by Reichert, between extratextual and textual evidence; it is not that such a distinction is never in force but that what counts as internal and external evidence will vary according to the interpretive principles one espouses. Just what is and what is not extratextual is a matter of continual debate, and when the debate has been concluded, it is not because the matter has been settled by the facts but because one set of interpretive principles has won the right to say what the facts are. Stanley E. Fish is the author of, among other works, Is There a Text in This Class: The Sources of Interpretative Authority. His contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Interpreting the Variorum" , "Interpreting 'Interpreting the Variorum'" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , and "A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation". (shrink)

The uneasy relation between violence and sanctity, between oppression and culture, underlies the dramatic action of Euripides' "Ion." Ion's monody ends with his threatening to shoot the birds who would soil the temple, or in other words, to protect purity through violence and death. The earlier part of his song also shows how the forces of exclusion and domination create sacredness. Ritual silence , restricted access to the aduton, ritual chastity, even the irreversible transformation of natural gardens into laurel brooms (...) and jugs of water all suggest how violence and domination create culture out of nature. The rape of Creusa epitomizes the relation between culture and violence. Her meeting with Ion reveals the psychological cost of social oppression and portrays the imperfect interdependence between moral feelings and legal institutions. Various dramatic devices portray the divisions in Creusa's mind that the injustice has created, devices including self-address, riddling speech, self-restraint, and silence. Her reluctance to pose her bold question to the oracle, and her displacement of the story onto the person of a raped "friend," show her resentful awareness that social institutions collaborate in the oppression. Ion's disillusionment echoes her resentment more theoretically. Together their comments show how moral rules and legal institutions, though fundamentally based on personal feelings such as shame and indignation, enact these feelings only imperfectly; the resulting dissonance in turn leads to further indignation and moral reflection. Finally, the allusions to fifth-century politics in Ion's speech on Athenian politics and elsewhere suggest that democracy itself depends on political domination and imperialism. (shrink)

Let κ denote a regular uncountable cardinal and NS the normal ideal of nonstationary subsets of κ. Our results concern the well-known open question whether NS fails to be κ + -saturated, i.e., are there κ + stationary subsets of κ with pairwise intersections nonstationary? Our first observation is: Theorem. NS is κ + -saturated iff for every normal ideal J on κ there is a stationary set $A \subseteq \kappa$ such that $J = NS \mid A = \{X \subseteq (...) \kappa:X \cap A \in NS\}$ . Turning our attention to large cardinals, we extend the usual (weak) Mahlo hierarchy to define "greatly Mahlo" cardinals and obtain the following: Theorem. If κ is greatly Mahlo then NS is not κ + -saturated. Theorem. If κ is ordinal Π 1 1 -indescribable (e.g., weakly compact), ethereal (e.g., subtle), or carries a κ-saturated ideal, then κ is greatly Mahlo. Moreover, there is a stationary set of greatly Mahlo cardinals below any ordinal Π 1 1 -indescribable cardinal. These methods apply to other normal ideals as well; e.g., the subtle ideal on an ineffable cardinal κ is not κ + -saturated. (shrink)

Together Professor Bush and Mr. Mailloux present a problem in interpretation not unlike those that were the occasion of the paper they criticize: Professor Bush takes the first section of the paper more seriously than I do, and Mr. Mailloux complains that I do not take it seriously enough. In their different ways they seem to miss or slight the playfulness of my performance, the degree to which it is an attempt to be faithful to my admitted unwillingness to come (...) to, or rest on, a point. Professor Bush seems to think that I am mounting an attack on the Variorum. Let me say at the outset that I intended no such attack, that I am sorry if anything I wrote gave that impression, and that I regret any offense that may have been taken. Professor Bush and I view the Variorum from different perspectives, both of which seem to me to be perfectly legitimate. He views it as a document, while I view it as a text. As a document, as a record and history of research and interpretation, it is a model of its kind, full, judicious, and above all, honest. The editors pay us the compliment of not pretending to an impossible objectivity. They leave us the valuable record of their own occasional disagreements, and thus suggest that they know very well that theirs is an interim report. My inquiry is into the significance of that report; it is not a brief against the compiling of its materials but an attempt to put to them a question the editors quite properly do not ask: what does the history of the effort to determine the meaning of Milton's poems mean? In short, I am extending the scope of interpretation to include the interpreters themselves and, rather than attacking the Variorum, taking one step further the task it has so well begun. Stanley E. Fish's "How to Do Things with Austin and Searle: Speech Act Theory and Literary Criticism" was published in the Special Centennial Issue of Modern Language Notes, Summer 1976. His contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Interpreting the Variorum" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , "A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time". (shrink)

Biological scientists, like scientists in other disciplines, are uncertain about whether or how to use their knowledge and time to provide society with insight and guidance in handling the effects of inventions and discoveries. This article addresses this issue. It presents a typography of structures in which scientists may contribute to social understanding and decisions. It describes the different ways in which these contributions can be made. Finally it develops the ethical arguments that justify the view that biological scientists have (...) social responsibilities. (shrink)

One of the major assumptions of John Zaller's RAS model of public opinion is that people need explicit cues from partisan elites in order to evaluate persuasive messages. This puts the public in the position of a passive audience, unable to scrutinize information or make independent decisions. However, there is evidence that people can, under some circumstances, evaluate and use information independently of elite cues. Thus, patterns of public opinion in the months before the Iraq war are inconsistent with the (...) predictions of Zaller's model. While the RAS model usually accounts for the dynamics of public opinion quite well, the situations in which it fails provide us with critical insights into the limits of elite influence. (shrink)