In lieu of an abstract, here is a brief excerpt of the content:Decolonizing MemoryLaurence J. Kirmayer*, MD (bio)In this far-reaching essay, Emily Walsh explores the significance of memory for coming to grips with the enduring legacy of colonialism in psychiatry. She argues that "for reasons of self-preservation, racialized individuals should reject collective memories underwritten by colonialism." Psychiatry can enable this process or collude with the structures of domination to silence and disable those who bear the brunt of the colonialist history (...) of violence and its current global incarnations. In this brief commentary, I want to underscore the importance of Walsh's argument, link it to contemporary work in cognitive and social science on the dynamics of memory, and point to some resources for implementing these insights in health services and clinical practice.Memory as Psychological Process, Social Practice and Cultural InstitutionMemory is not simply an individual psychological process of accessing images, stories, and knowledge of the past, but a reconstructive process of building a narrative (Kirmayer, 1996). This narrative is profoundly shaped by available templates, metaphors and models that are provided by the tacit, normative and official histories of society (Hirst, Yamashiro & Coman, 2018). But memory is also shaped by cultural affordances that guide attention and by narrative practices, which depend on other people (Ramstead, Veissière, & Kirmayer, 2017). In effect, remembering is not a matter of reaching down into one's memory archive or sedimented experience, but an embodied and enactive process of thinking with and through others (Laanes & Meretoja, 2021; Veissière, Constant, Ramstead, Friston, & Kirmayer, 2020). Memory then depends on community and on a shared understanding of history and of possible futures through which one can anchor and elaborate one's individual story.A direct consequence is that disconnecting a person from others, disembedding them from their social milieu, will lead to disruptions in memory and in the continuity of self. When the environment is toxic, this severance may sometimes be (partly) beneficial—but it always comes at a cost. Figuring out those costs, making them explicit, and ensuring that those whose history is being suppressed or overwritten by others have a chance to reclaim and write their own, is an ethical and pragmatic imperative.The denial of vital memories (recent or remote, personal or collective) causes fractures in the self that may disorganize the individual, install false consciousness, and cement the exclusionary and disvalued position of colonized, racialized, and [End Page 243] marginalized subjects. This process is not only—or even primarily—about memory. It is part of the structure of everyday life, inscribed in institutions and practices where colonial histories, racism, and economic exploitation are deeply entangled. Representations of the past are part of the way we construe the present and anticipate the future—but not every interpretive frame is a memory; there are structures in and of the moment that condition how we think about ourselves in health and illness and these too convey interests and biases disguised as "just the way things are."Fanon's Politics of Postcolonial Memory and IdentityWalsh offers a reading of aspects of Fanon's philosophy to reveal the workings of colonialism in and through memory. She is concerned with specific subsets of collective memories that are affectively charged and related to the identity of a group (Wertsch & Roediger, 2008). These memories are collective not simply they are shared by or distributed among the members of a group but because they define or constitute the collective itself.History is written largely by the powerful who create dominant or 'master' narratives that serve their own projects of legitimation and self-mystification (Trouillot, 2015; Lindqvist, 2021). But the creation of dominant narratives is not solely the province of those in power. There are many kinds of self-serving collective memory (Baumeister & Hastings, 2013)—from those related to the creation of nation states, which may ignore not only colonized peoples, but all ethnicities, religions or linguistic groups subordinated to the ideals of the dominant group (Anderson, 2006; Gunew, 2013; van Alphen & Carretero, 2015), to other forms of collective identity, even to those created by liberatory movements. These are maintained by institutionalization, ceremonial repetition and reenactment... (shrink)

The anticipated social capabilities of robots may allow them to serve in authority roles as part of human-machine teams. To date, it is unclear if, and to what extent, human team members will comply with requests from their robotic teammates, and how such compliance compares to requests from human teammates. This research examined how the human-likeness and physical embodiment of a robot affect compliance to a robot's request to perseverate utilizing a novel task paradigm. Across a set of two studies, (...) participants performed a visual search task while receiving ambiguous performance feedback. Compliance was evaluated when the participant requested to stop the task and the coach urged the participant to keep practicing multiple times. In the first study, the coach was either physically co-located with the participant or located remotely via a live-video. Coach type varied in human-likeness and included either a real human, a Nao robot, or a modified Roomba robot. The second study expanded on the first by including a Baxter robot as a coach and replicated the findings in a different sample population with a strict chain of command culture. Results from both studies showed that participants comply with the requests of a robot for up to 11 min. Compliance is less than to a human and embodiment and human-likeness on had weak effects on compliance. (shrink)

McNamara, Laurence J Person-centred care is the mantra of contemporary health and aged care. Delivering such care effectively is an enormous challenge. Much effort goes into the basics of care delivery. In an era of limited resources and financial constraints the temptation arises for aged care in particular to ignore some of the non-measurable dimensions of care. This paper puts forward a range of issues that merit greater attention as we reflect on the realities of human ageing in Australia (...) today. If taken seriously, I suggest, they will contribute to the delivery and quality of person-centred care. (shrink)

Background Informed consent procedures for large population-based cohort studies should be comprehensive and easy-to-use. This is particularly challenging when participants from different socio-economic groups and multicultural ethnic backgrounds are involved. Recently, more and more studies have tried to use multimedia in informed consent procedures. We describe the development and testing of a digital informed consent app and elaborate on whether this may contribute to a comprehensive and practical procedure to obtain informed consent for public health research. Methods In a sample (...) of parents with young children, we used a mixed method approach to study the user experience of an informed consent app and evaluate whether it can be used to adequately inform people and register their consent. Through semi-structured interviews we investigated participants’ experiences with and opinions about the app, with a special focus on comprehensibility of the content and the usability of the app. Information retention questions were asked to evaluate to what extent participants could recall key aspects of the provided study information. Results The 30 participants in this study used the app between 4 and 15 min to give their consent. Overall, they found the app well-designed, informative and easy to use. To learn more about the study for which informed consent is asked, most of the participants chose to watch the animated film, which was generally found to convey information in a clear manner. The identification process was met with mixed reactions, with some feeling it as a secure way to give consent, while for others it contradicted their view of using data anonymously. Information retention questions showed that while all participants remembered various aspects of the study, fewer than half answered all four questions satisfactorily. Conclusion Our study shows that a well-designed informed consent app can be an effective tool to inform eligible participants and to record consents. Still, some issues remain, including trust barriers towards the identification procedure and lack of information retention in some participants. When implementing consent procedures that incorporate digital formats, it may be beneficial to also invest in a complementary face-to-face recruitment approach. (shrink)

The papers in this book address the broad issues of authority, leadership and organizational culture, whilst concentrating on other issues in-depth, such as inter-group conflict, and gender and race relations in the workplace.

In lieu of an abstract, here is a brief excerpt of the content:Grounding Psychiatry in the Body and the Social WorldLaurence J. Kirmayer, MD, FRCPC, FCAHS, FRSC (bio)The sensing body is like an open circuit that completes itself only in things, in others, in the surrounding earth.—David Abram (2012)Giulio Ongaro has written an interesting set of papers that aim to advance our thinking about ‘externalist’ (i.e., social) approaches to psychiatry by rehearsing an enactivist account of mental disorder and elaborating an (...) ethnographic example of social explanation rooted in a different cultural ontology and system of healing. I am completely onboard with his calls for more attention to the social world in psychiatric theory, research, and practice. What is especially novel in his work is the use of ethnographic research to inform philosophical thinking about psychiatry.Despite my enthusiasm for this effort, I have three concerns with his argument that I can only briefly outline in this commentary: i) the lack of attention to a large body of work in social epidemiology, psychosomatics, and cultural psychiatry that speaks directly to the goals of the biopsychosocial (BPS) approach and that vitiates much of the recent critique of that model; ii) the use of an ethnographic example to idealize an ‘externalist’ system of medicine that patently cannot address the many social structural and sociophysiological processes that psychiatry needs to understand; and iii) most importantly from a philosophical perspective, the fact that the enactivist framework he endorses actually breaks down the distinctions between internalist/externalist psychiatry and naturalist/constructivist ontologies around which he organizes his critique and proposed remedy (Kirmayer & Ramstead, 2017).Integration and the BPS ApproachOngaro’s first paper begins by acknowledging the recent critiques of the BPS approach that claim the BPS leaves vague or underspecified the ways in which the biological, psychological and social domains interact to give rise to mental disorders and how they can be included in systematic case formulation to guide assessment and treatment [End Page 315] intervention. Ongaro notes that current efforts to elaborate an embodied, enactivist approach to psychiatry hold the promise of outlining a more systematic approach to the relationship between levels or domains in the BPS. However, he argues this still leaves psychiatry with excessive emphasis on ‘internalizing’ explanations that appeal to biological or psychological processes within the person to characterize mental disorders. He suggests that this needs to be complemented by an externalizing approach that gives due weight to social processes. The dominant approaches leave the social world underspecified and he notes psychiatry lacks an “ontology of the social.”To some extent, this recent critique—not by Ongaro but by some of the authors he cites—reveals a lack of familiarity or engagement with a rich literature in social epidemiology, psychosomatics and sociosomatics that has long demonstrated the close links between social and physiological processes (Krieger, 2021). This research has produced multiple examples of these relationships detailing their mechanisms and dynamics in ways that do not privilege internal processes. There is no problem identifying many specific instances of these links; for example, research has examined how exposure to racism and discrimination results in increased risk for psychiatric disorders (Kirkbride et al., 2024). We have listed many other such mechanisms related to depression in a recent paper (Gómez-Carrillo & Kirmayer, 2023). This work does not yield a single overarching model or explanation but reveals diverse kinds of mechanisms that interact in a multilevel system that includes both dynamic and linguistic modes (Gómez-Carrillo et al., 2023). Integration occurs in the functioning of this system and cannot be captured in any monolithic theory. This is not a limitation of the BPS, simply a reflection of the complexity of human beings.Can we have a general theory of the links between dimensions or domains in the BPS or will it always remain a piecemeal account that depends on the details of specific systems? Given the many different kinds of processes involved, it seems unrealistic to expect a totalizing theory. If so, both research and clinical work need practical ways to assess the myriad pathways and processes involved in psychiatric disorders in order to formulate cases efficiently, identify a manageable subset of factors to consider in a... (shrink)

Recent neuroscience research makes it clear that human biology is cultural biology - we develop and live our lives in socially constructed worlds that vary widely in their structure values, and institutions. This integrative volume brings together interdisciplinary perspectives from the human, social, and biological sciences to explore culture, mind, and brain interactions and their impact on personal and societal issues. Contributors provide a fresh look at emerging concepts, models, and applications of the co-constitution of culture, mind, and brain. Chapters (...) survey the latest theoretical and methodological insights alongside the challenges in this area, and describe how these new ideas are being applied in the sciences, humanities, arts, mental health, and everyday life. Readers will gain new appreciation of the ways in which our unique biology and cultural diversity shape behavior and experience, and our ongoing adaptation to a constantly changing world. (shrink)

Book reviewed in this article: Long Term Care: Principles, Programs and Policies. By Rosalie A. Kane and Robert L. Kane. Long Term Health Care: providing a Spectrum of Services to the Aged. By Philip W. Brickner, Anthony J. Lechich, Roberta Lipsman, and Linda K. scharer.

Speculations of this last type have existed from a much earlier period in the Eastern civilizations, particularly in those areas affected by Hindu philosophy. For example, in the Sánkhya or Yoga-Sútras by Patánjali, we find a very radical distinction between the external world and the individual soul or self. But for Sánkhya, the "external world" includes everything that could possibly be an object of consciousness--physical objects and their relationships, sensations and imaginations, dreams, memories, expectations, etc. In other words, for Sánkhya, (...) our thoughts or desires, far from being the "cause" of the external world as in some forms of Western idealism, are simply other aspects of the external world itself, that is, merely particular items in the totality of our consciousness. On the other hand, the individual soul or self is only the spectator of this consciousness and not ordinarily conscious of itself. If the self were to become conscious of "itself" in the same way that it was conscious of all other objects, all that it would really be aware of would be another object of consciousness---the mere idea of itself, while it would remain the unknown knower. Nevertheless, realizing that a completely "unconscious self" would be simply a postulate of thought and therefore part of the external world, the Sánkhya-Sútras emphasize that the self can become aware of itself by another and more intuitive means. (shrink)

Every man experiences dreams and imaginations, the nature of which is admittedly subjective. It is perfectly possible for me to propose that this same lack of objectivity may characterize all experience. I may conceive that I am a god making the world for my own amusement, being real beyond the reality of this my dream. But this imagined god-head is merely the dream of an idle moment, for I cannot seriously suppose that were I to dream I would dream in (...) exactly this way. Had I the making of this world, it would be a braver, better world than it is. Braver? Better? On second thought, I am not so sure. I would want it to be a better world, but could I make it a better world? Could I spin from my imagination the grandeur and beauty of the universe of stars, the wealth and complexity of the invisibly minute, the beauties of nature, the truths of mathematics, the harmonies of music, the world of meaning everywhere? Could I? I doubt it. For I fail to understand even trivial things: I find myself failing even in unimportant projects. And if I fail in these, the least parts of my universe, could I so ably create the whole? There are, thus, two ways in which this doctrine fails to do more than amuse me for the moment. Did I create this dream, I would aim higher and achieve less. (shrink)

La présente contribution propose une étude de la périphérie gauche au sein d’un corpus oral multigenres, représentant douze activités de communication orale, annoté syntaxiquement et prosodiquement. La segmentation discursive du corpus en unités de base du discours (BDU) résulte d’une coïncidence entre unités syntaxiques et prosodiques, correspondant à des encodages linguistiques distincts mais complémentaires. Partant du postulat selon lequel ces unités discursives remplissent une fonction cognitive dans la planification et l’interprétation du discours, nous nous intéressons à l’étude de leur périphérie (...) gauche. Ce lieu, qui constitue le point d’ancrage du message, joue en effet un rôle important dans la négociation de la structure discursive. Dans l’objectif d’étudier les stratégies discursives à l’œuvre dans les différents genres du corpus, nous faisons l’inventaire des types formels observés et étudions finalement les fonctions discursives que ces éléments périphériques peuvent revêtir. (shrink)

Das allgemeine Prinzip der „Relativität der Begriffe” — vom Verfasser a. a. O. dargelegt — behauptet, dass ein und dieselbe Situation der Wirklichkeit auf verschiedene Weisen beschrieben werden kann, die sprachlich und begrifflich zwar verschieden sein mögen, doch grundsätzlich die gleichen bleiben. Die verbalen oder begrifflichen Unterschiede führen uns zu der falschen Annahme, dass den Elementen, welchen im Denken oder im sprachlichen Ausdruck weniger Bedeutung zugemessen wird, auch weniger Bedeuten in Wirklichkeit zukommen, oder dass sie weniger real sind.Die bedeutendste Anwendung (...) dieser Lehre auf die Biologie betrifft die Interpretation des „Individuellen”. Soll man das Individuum als eine Einheit verstehen, oder kommt der Begriff der Einheit einerseits den Teilen zu, wie z. B. Zellen, Molekülen und Atomen, oder andererseits höheren und synthetischen Einheiten wie z.B. Klassen, Arten, dem „élan vital”, u.s.w. ? Alle diese drei Ansichten haben etwas für sich, doch stehen auch jeder entscheidende Gegengründe gegenüber, so dass die einzig-mögliche Schlussfolgerung die Annahme der Begriffsrelativität ist. Jeder der drei Standpunkte ist nur in so weit wahr, als er etwas Positives beibringt, falsch jedoch solange er nur die beiden andern leugnet.Le principe de la relativité des concepts, ayant une application générale dans toutes: parties de la philosophie et de la science, est développé ailleurs par l'auteur. Ce principe propose qu'une situation quelconque peut être discutée dans plusieurs manières, se différant entre elles dans le choix des mots ou des concepts, tout en étant au fond indentiques. Les differences linguistiques ou conceptuelles nous mènent à l'assomption fausse que les éléments moins importants dans la pensée ou dans le langage sont moins importants dans la nature, ou même que ces éléments sont moins réels.En biologie, ce principe a une importance notable en ce qui concerne l'interprétation de l'individu. Doit-on entendre par l'individu les cellules, les molécules, les atomes, et les autres éléments qui le composent; ou bien l'individu même; ou encore doit-on oublier et l'individu et les éléments qui le composent, et baser sa philosophie sur les entités synthétiques telles que les espèces, les genres, et l'élan vital ? Chacune de ces trois opinions a des considérations en sa faveur; mais chacune d'elles se bute à des objections plus considérables encore qui l'empêchent d'être acceptée. La seule conclusion qui semble être possible est l'adoption du principe de la relativité des concepts, et l'assomption que chaque manière d'envisager l'individu est valide tant qu'elle a quelque chose de positif à dire; chaque manière est fausse quand elle nie Ja validité des autres points de vue. (shrink)

In a provocative essay, Sarah Kamens recommends the literature of postcolonial theory as a remedy for some of the limitations of current psychiatric theory and practice. Her provocation lies not advocating engagement with this literature, which certainly has much to offer psychiatry, but in the way she chooses to energize her argument by contrasting two very different phenomena: the experience of hearing voices and the use of ghost-writing in the psychiatric literature. Although Ka-mens acknowledges these phenomena come from “distant teleological (...) and experiential realms,” in both cases, she suggests, there are hidden authors who may be experienced or understood as hauntings. In this brief commentary, I will... (shrink)

The R-Being is, by definition, that entity which possesses all qualities which, expressed in English adjectives, begin with the letter R. It is of course unknown, at the commencement of our inquiry, whether any such entity exists, but it is nevertheless possible to determine the characteristics which such a being, whether existent or not, must possess.

There are no new fallacies under the sun, any more than there are any new methods of reasoning. Therefore, the Fluxive Fallacy is nothing new. Yet, pointing out the Fluxive Fallacy and giving it a name has a distinct advantage in that it directs one's attention to errors which, without the advantage of a definite name and description, might pass unobserved.

What does a Utilitarian mean by happiness when he says that it is the good? Specifically, pleasure. But how many different kinds of experiences are included under this term? It appears that as the word was used by Bentham, and indeed by almost all other hedonists, it had so wide an extension that it included all experiences not properly termed "unhappiness." Partly, however, because of the identification of happiness with pleasure and the absence of pain, and partly because of a (...) failure to emphasize by frequent explanation the difference between the meanings of terms as used by hedonists and the same terms in common usage, there has existed at all times a disposition to assume that hedonists intended a narrower meaning than they actually did. Even in hedonistic writings there has been a tendency to make a distinction between the usages accorded "pleasure" and "happiness," the former as used more frequently to refer to pleasures of the moment, and the latter to a long continued state of felicific feeling; or a distinction is made between "pleasure" as used when referring to happiness which has an immediately obvious physiological origin and "happiness" to felicific feeling of all types. Nevertheless, the terms are not used consistently in this way, and on the whole it would be better to think of "pleasure" and "happiness" as interchangeable in the writings of Jeremy Bentham and many others. (shrink)

Conflicts of interest are common and exist in academia, government, and many industries, including pharmaceutical development. Medical journal editors and others have recently criticized “the pharmaceutical industry,” citing concerns over investigator access to data, approaches to analysis of clinical trial data, and publication practices. Merck & Co., Inc. is a global, research-driven pharmaceutical company that discovers, develops, manufactures, and markets a broad range of human and animal health products, directly and through its joint ventures. Although part of its mission is (...) to provide a superior rate of return to its investors, Merck does not believe this creates an irreconcilable conflict of interest, particularly in activities concerning clinical drug development. We employ rigorous scientific methods to design, conduct, analyze, and report results of clinical trials in the development of innovative drugs and vaccines, with a focus on meeting unmet medical needs and with an ethic that puts the interests of the patient first. This article describes Merck’s approaches to potential conflicts of interest in drug development, particularly with regard to clinical trials. We believe that proprietary interests of the Company can be respected while observing objectivity and transparency in communicating clinical research results. The standards for the review of manuscripts reporting such trials for peer-reviewed publication should be the same, whether they are from Merck or elsewhere. (shrink)