Philosophical counselling is an approach that aims to assist people to deal with life events in an effective manner. As such, it is of interest to nurses who are concerned with helping clients who require assistance effectively to manage life events. The approach utilizes both ancient and contemporary philosophical promises and theories. On the promise side, it offers the belief that philosophy can be concerned with providing answers to the question of how people ought to live a good or (...) healthy life. On the theory side, it offers the belief that philosophical inquiry and theory can help people towards such answers. Thus the theory and practice of philosophical counselling is relevant to nurses whose practice aims to promote in their clients a good or healthy lifestyle. The practice of philosophical counselling, in a substance abuse centre, will be explored to demonstrate the theory and methods of the approach. (shrink)

Introduction. Healthcare workers (HCWs) should theoretically have the necessary education and environment to adopt a healthy lifestyle, and they supposedly also should have a higher participation rate in WHP programmes. HCWs are, for several reasons, considered to be a key group in health promotion, especially due to the fact that the healthcare system reaches a substantial number of people in need of lifestyle changes such as increased physical activity (PA) [5]. Furthermore, healthcare professionals are considered to be the (...) most credible source of health information [6]. HCWs' lifestyles can play an important role in increasing awareness among patients regarding lifestyle changes, because HCWs' own lifestyle habits and interests in lifestyle behaviour have been shown to positively influence their counselling practices and attitudes [6–7]. The international movement 'Health Promoting Hospitals and Health Services', which was initiated by the World Health Organization (WHO), highlights the importance of also focusing on the health and lifestyle of the employees. Methods. We conducted survey based on a standardized and adapted questionnaire that included socio-demographic data and points related to healthy lifestyle. We adhered to the latest recommendations on designing and reporting survey studies. Before conducting the study, the questionnaire was pretested among 5 experts and revised twice. The survey was conducted in Kazakh / Russian for respondents who speak two languages fluently at the choice of participants. The filling of the questionnaire took on average 45 minutes. We reported absolute numbers and percentages. Chi-square tests were used to compare responses between groups. Results were considered significant at a P value of < 0.05. Statistical analyses were performed using the application SAS OnDemand for academia (version 3.81, Carry, North Carolina, USA). Results. Our data revealed that nurses were more likely to adhere to healthy eating principles and to have a regular diet at home. GPs were more likely to consume fast food and add salt when food is not salted enough. Nurses were more likely to eat greens regularly. GPs had a stronger belief in the impact of diet on health. More nurses rated their diet as healthy. Media promotion significantly influenced GPs for changing diet towards healthier options. Eating patterns vary according to the risk of stress. Research shows that chronic stress influences the amount and types of consumed food, contributing to both overeating and malnutrition, and that stress hormones can lead to the development of obesity. GPs are more likely to have used tobacco products compared to nurses. GPs are more likely to smoke more than 10 cigarettes per day. GPs have a slightly higher belief in the necessity of a healthy lifestyle compared to nurses. GPs and nurses have different testing frequencies for Hepatitis B and C, with nurses testing more frequently. GPs are more likely to have sexual activity after drinking alcohol. Conclusion. It is known that a healthy lifestyle of doctors affects the attitude of patients and their motivation to change their lifestyle. Thus, the lifestyle patterns of health workers, as well as the understanding of the motivation of these patterns, are more likely to affect public health. (shrink)

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas’ theory of communicative action can (...) be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients’ everyday life it has to take into consideration the patient’s practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one’s preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient’s perspective. The implementation and adjustments of Habermas’ theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed. (shrink)

During an Australian qualitative and empirical study looking at lesbian, gay, bisexual, and transgender client's experiences of counseling, and counselor's experiences of working with minority clients, a large body of unsolicited data emerged related to experiences of religious-based homophobia. Analysis of the data suggests that a lifelong process of posttraumatic recovery for many lesbian, gay, bisexual, and transgender people follows prior experiences of religious-based homophobia. This paper discusses the sociological debate related to how counselors find themselves at the crossroad between (...) a healthy lifestyle model of homosexuality based in well established contemporary professional ethics versus long standing religious-based attitudes and constraints toward homosexuality. This intersection of conflicting beliefs generates a controversial social and political environment in which counselors must make a basic decision to either support minority clients according to ethical guidelines or to side with socially conservative constructs that, rightly or wrongly, rely largely on Western religious traditions. (shrink)

Reflective processing is a joint social action that develops in interaction. Using conversation analysis and discursive psychology, this article focuses on self-reflective turns of talk in group counselling for adults at risk of type 2 diabetes. We show how reflective processing unfolds in patterns of interaction, wherein group members take an observing, evaluating or interpreting position towards their own actions and experiences. Self-reflective talk is neither exclusively dependent on counsellors’ actions nor limited to the niches the counselling programme (...) structure offers. Self-reflective talk is one method of generating joint reflective processing. Such talk makes a topic available for discussion by connecting details of counselling with individuals’ experiences and enabling sharing. Self-reflective talk thus serves as a way for group members to participate in constructing a lifestyle problem, to invite or provide sharing of experiences and to display their orientation to the institutional task at hand. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional challenges. `Wise (...) Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

Approximately 47 percent of women ages fifteen to forty‐four are currently without children, and slightly more than 20 percent of white women in America will never bear children, the highest percentage in modern history. Many fertile women who are childless are voluntarily so. Although any competent person twenty‐one years or older is legally eligible for voluntary sterilization, many doctors refuse to sterilize childfree women. This essay explores various reasons a woman would want to continue in her childfree lifestyle, evaluates (...) the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization—both from the woman's and the physician's perspective—and assesses the legal status of voluntary sterilization for nonparous women. The essay also urges physicians to follow recommended guidelines for counseling women who, regardless of parity, desire sterilization and to provide this contraception if, after careful consideration, there are no outstanding health or other reasons that the procedure should not be performed. (shrink)

Direct-to-consumer genetic testing has been available for several years now, with varying degrees of regulation across different countries. Despite a restrictive legal framework it is possible for consumers to order genetic tests from companies located in other countries. However, German laypeople’s awareness and perceptions of DTC GT services is still unexplored. We conducted seven focus groups with German laypeople to explore their perceptions of and attitudes towards commercial genetic testing and its ethical implications. Participants were critical towards DTC GT. Criticism (...) was directed at health-related, predictive testing, while lifestyle tests were accepted and even welcomed to some extent. Participants expressed strong reservations regarding commercial provision of genetic diagnostics and expressed a lack of trust in respective companies. They preferred non-commercial distribution within the public healthcare system. Participants also expressed high expectations of physicians’ abilities to interpret information obtained via DTC GT companies and provide counseling. Legal restrictions on commercial distribution of genetic tests were opposed, with participants arguing that it should be available to consumers. DTC GT companies are not perceived as trustworthy when compared to the public healthcare system and its professional ethical standards and practices. Laypeople rated general consumer autonomy higher than their own concerns, thus recommending against strong legal regulation. We conclude that medicine’s trustworthiness may be negatively affected if commercial provision is not visibly opposed by the medical professions, while DTC GT companies may gain in trustworthiness if they adapt to standards and practices upheld in medicine. (shrink)

People should be allowed to decide how and where they wish to be tested for HIV without there being a formal requirement for pretest counsellingIn his paper, Ethics of HIV testing in general practice without informed consent, Fraser argues that pretest counselling and informed consent are pillars of the ethical conduct of HIV testing. In my response I want to look critically at these contentions. While I will agree with Fraser that it is always necessary to get informed consent (...) from a patient for an HIV test I will argue that an emphasis on pretest counselling as a prerequisite for testing can actually undermine a patient’s autonomy, the very principle that informed consent seeks to promote.This response will start with an analysis of Case Two as this highlights the fundamental importance of informed consent. It will then go on to look at Case One and show how the special application of informed consent in the field of HIV testing can, in certain circumstances, lead to a reduction in patient autonomy.CASE TWOIn Fraser’s second case a 43 year old married clergyman presented with a recurrent infection of his little toe and the preliminary lab reports queried Kaposi’s sarcoma. The general practitioner thought that because of the patient’s lifestyle there was little risk of HIV infection, “suggesting the possibility of HIV, when it is unexpected and the risk low, can in itself cause anxiety and distress”. On these grounds the GP did not call the patient in for an HIV test.Some might argue that the GP should have tested the clergyman. This could have been done in one of two ways: by seeking his explicit consent for an HIV test, or by getting blanket consent for a range of tests, including HIV, without HIV being explicitly mentioned. …. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Expose of a BreakdownIngrid HindellIregard my pension as a social wage, and even though I wish it took my disability and the extra costs that brings into consideration, eighteen years ago, I felt privileged to be able to work in the community, not in a sheltered workshop.At this time, a number of us worked voluntarily for numerous little organizations when the government cut their funding and in effect, took (...) away our jobs.It was around this time that I started a “stress cough.” Foolishly, I didn’t take much notice. I was enjoying “life”—studying, working, taking part in a documentary called “Untold Desires” and being a member of the “Friendship Group”—in which a group of us tackled the subject and nature of friendship for people with and without disabilities....The processes and the cohesion of the group brought up a lot of “stuff” for me that I wasn’t able to articulate. It made me question the wisdom of my lifestyle up to then—of marrying a person without a physical disability, for example.My mother used to tell me to tell him to tidy the flat, not in the least realizing that: i) it was distressing that I couldn’t do this; ii) that given all our interests it was difficult to tidy up. (This situation was also not helped, I now realize, by us trying to live and run home businesses from my small three–roomed accommodation behind my parent’s home, without enough support worker hours....)The flat was always cluttered, not conducive to encouraging a feeling of ease in us bringing clients onto the premises. As Robert’s massage workload grew, so did our underlying tension, I see now. And when I was starting to counsel other people with disabilities the situation was made worse....Added to this, my mother had, just prior to this period in our lives, stopped giving us our main meal because we were becoming more and more interested in eating organic and vegetarian food.At the same time, listening to other group members’ stories made me realize how “undervalued” people with disabilities are in society as I had been brought up in a loving extended family and had not long been “out.”It made me realize how much people with disabilities were constrained by lack of governmental funding for recreational—especially relationship options—with each other and with able–bodied people. The government was trying to close down little advocacy organizations that could keep this issue in the forefront of policy makers’ minds. No wonder I was getting close to breaking point! [End Page E1]When I got really bad, my husband almost went mad himself trying to cope with me. I had been the outgoing partner in the relationship for the past 12 years. Now I was getting panic attacks and clinging like poison ivy....And the therapists I went to at that stage didn’t help. The Naturopath was so expensive she made me much worse. She had told a “friend” of Rob’s that she would treat me for $30.00 a time. She did not say that she would present me with an ever– increasing bill every time I had an appointment—to pay her back when I could! And that her admin assistant would keep commenting, in my hearing, that people wouldn’t pay their bills on time.... At last, when the amount got to $450.00, I paid her all my savings, and managed to quit.I now also believe she treated me with a totally inappropriate therapy—colonic irrigation—for far too long, any natural therapist would say nowadays—five weeks!I believe it made my mental state worse. People say that an unquiet mind can stress the body into illness but I believe losing too much weight too fast as I certainly did, stressed my mind, instead of other way around.By this time I wasn’t only having panic attacks. I had slipped into, what I recently discovered, was a clinical depression. This brought in its wake, a terror so real, so all encompassing that I wonder I lived through a day of it—much less four... (shrink)

The authors of the "Saṃnyāsa Upaniṣads", manuals of ascetic lifestyle and practice, recommend that wanderers renounce behavioral standards of their formerly Brahmin householder life, including ritual purity and familial duties. Patrick Olivelle argues that these ascetics are thereafter considered impure and corpse- or ghoul-like, clearly lacking in dharma. However, these Upanisads counsel pursuing mental purity and moral behavior, and modeling oneself after the perfection of the Absolute. This essay investigates ascetic notions of purity and identity, and virtues such as (...) non-violence and kindness cultivated in forest isolation. Is ascetic dharma universal in intent, and is it conceptually opposed to householder dharma? What type of ethics is admired by the authors, what type deprecated? Olivelle's position is reevaluated, as is Jeffrey Kripal's notion that monistic mysticism does not support ethics adequately. (shrink)

Preimplantation genetic testing for polygenic disorders (PGT-P) has been commercially available since 2019. PGT-P makes use of polygenic risk scores for conditions which are multifactorial and are significantly influenced by environmental and lifestyle factors. If current predictions are accurate, then absolute risk reductions range from about 0.02% to 10.1%, meaning that between 10 and 5,000 in vitro fertilization patients would need to be tested with PGT-P to prevent one offspring from becoming affected in the future, depending on the condition (...) and the number of embryos available. Survey and interview data reveal that patients and the public have largely favorable views regarding the use of PGT-P for disease prevention; however, clinicians and professional organizations have many reservations. The use of PGT-P raises multiple social and ethical concerns including the need for adequate counseling, the setting of realistic expectations, the application of distributive justice, the impact of environmental and social determinants of health, and the potential exacerbation of health inequities. Clinicians expressed significant concerns relating to the cost of PGT-P, the potential time-consuming counseling for reproductive endocrinologists and genetic counselors, the intentional creation of supernumerary embryos, and patients’ unrealistic expectations regarding “healthiest disease-free” embryos. Furthermore, current evidence lacks long-term outcome data and generalizability. Prior to offering PGT-P to patients, additional clinical validation studies are needed. Also, ethical and social considerations raised by PGT-P should be carefully delineated. Systemic practices to increase equitable access to unbiased genetic counseling and reproductive services would be desirable prior to the ethical implementation of PGT-P. (shrink)

Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of (...) patients with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle. (shrink)

This paper examines the journals of Frances W. Willard, founder and organ izer of the Woman's Christian Temperance Union in the United States, and their revelations about the gender battle that raged within the psyche of Willard and other young women of her day. The failure of organized Chris tianity to provide solace or unbiased counsel to women such as Willard is apparent in a close reading of Willard's work. Within the pages of her journals, the struggle she faced is (...) obvious on almost every page; her strug gle with what society said she should do, and what she knew she was capable of doing, is present for all to see. The paper argues that because, however, lived in the United States within a short window of nineteenth- century time, she was able to form a 'Boston Marriage' with a young woman who provided her with the comfort and support she needed. The Boston Marriage, arguably, was available only for relatively well-to-do, white-middle-class women of an educated class, who had attended col lege and, because they were able to find a 'service' career of some kind, could live together in harmony. Enlightened families, like that of Henry James, were able to support female members of their class who did not 'fit in' to societal norms of the day and accept their lifestyle, while negat ing the sexuality of it. Organized religion, however, did not, and it is the failure of her church to help her find a way of life she can tolerate about which Willard writes. You shall not lie with a male as with a woman; it is an abomination. So God created humankind in his image, in the image of God he created them; male and female he created them. (shrink)

Ian Kennedy extols the virtues of self-determination by patients: they should make their own decisions about medical treatment after being given advice by their doctors; for doctors to make such decisions on their patients' behalf is authoritarian and unacceptable (I). I present a case where, despite thorough consultation and counselling, the decisions made by the patient and supported by her doctors were found to be consistently inappropriate to her changing lifestyle.

Daniel Caner's monograph, a reworking of a University of California at Berkeley doctoral dissertation, maintains the high standards that we have come to expect from the series of books on Late Antiquity overseen by Peter Brown. His book provides a detailed examination, with meticulous documentation, of the phenomenon of wandering and begging monks that appeared in the late 4th and early 5th centuries, especially in the eastern Mediterranean region and North Africa, during the formative period of Christian monasticism. These monks (...) shunned cenobitic life and manual labor, living off alms from the faithful and offering spiritual instruction and counseling in return. They claimed that through this form of ascetic poverty they were following the apostolic lifestyle advocated by Jesus Christ when he sent out his twelve disciples to wander without staff, or purse, or bread or money, to preach and heal the sick (Lk. 9:3). Among the proponents of such ascetic poverty were Alexander the Akoimetos and Isaac, a Syrian monk who settled in the Dalmatos monastery in Constantinople. Such vagrant monks, leading large and unruly groups of followers, obviously could pose a threat to the tranquility of urban settlements, and frequently were at odds with the local bishops who sought to control them. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Living with Blindness and Fibromyalgia while Occupying AgingKatherine SchneiderI’m blind from birth and in middle age developed fibromyalgia. I’ve retired from a thirty year career as a clinical psychologist and am working on my third book tentatively titled “Occupying Aging: Delights, Disabilities and Daily Life.” My relationship with medical professionals includes gratitude (without good care I would not be alive) and also frustration for assumptions often made about my (...) abilities. I write from the perspectives of an impatient patient, woman living in the United States, former provider of mental health services, person with both invisible and visible disabilities, and boomer moving into the world of the aged. My stories are mine of course, but when I swap medical stories with blind friends, similar happenings abound.When my mom fell down the stairs at a friend’s house, five months pregnant with me, she was told to go to bed for the next four months to save the pregnancy. Thus began the impact of health care professionals on me. I was born a month premature and spent my first month in an incubator. In 1949 it wasn’t known that the enriched oxygen atmosphere in an incubator would cause blindness. At least one lawsuit was filed against physicians and a hospital by a person blinded in this way. A large out–of–court settlement was received. The way I look at it, the health care community did the best they knew and without enough oxygen, I would have died.Early in my life, my parents took me to several ophthalmologists to see what could be done for my vision. Family folklore has it that I could smell a hospital as we entered and would begin howling. These early traumatic experiences may have led to my current healthy lifestyle so I don’t have to go to doctors much now. By about age five, it was clear that nothing could be done about my vision. For the next twenty years my forays into the health care system were for tonsillitis, sprains, and the usual childhood ills.In my early twenties, I developed acute glaucoma in one eye—caused, I’m convinced, by birth control pills. In seeking treatment for this condition, I encountered the first truly insensitive physician I’d met, who said, “Your eyes aren’t doing you any good; let’s take them out.” I was horrified! They were my eyes. I was attached to them, psychologically as well as physically. It turned out that a simple operation relieved the pressure and allowed me to keep my eyes. True, they are not the best looking big brown eyes around, but they did come with the package.Life with blindness seemed quite straightforward until my early forties, when I developed extreme fatigue and pain all over. I was worried. I knew a blind woman who had developed multiple sclerosis and I admired her, but I did not want to walk in her brave footsteps. Then a college student came to see me with the same symptoms and said that she had recently been diagnosed with fibromyalgia. I am often very empathetic with people’s concerns, but this time she complimented me by saying, “You’re great! You seem to know just how I feel.” I sagely counseled her about portioning out her energy carefully, prioritizing, using short cuts, and taking elevators when possible. Being an adult [End Page 216] student used to overachieving, she did not like what I was saying, but said she’d try to follow my advice because she could no longer do it all.What finally broke through my own denial was the day coiling up a hose and dragging it to the basement for the winter took me an hour. It left me totally exhausted and I figured that even being middle aged couldn’t account for feeling that awful.After a thorough physical and plenty of blood work to rule out Lyme disease and multiple sclerosis, I was diagnosed with fibromyalgia and placed on low doses of antidepressants to help me sleep through the night. The medication worked and I began to feel like myself again. My battle to accept that... (shrink)

The scientific discovery of a range of genetic mutations has meant that people with a strong family history of cancer can find out whether they are at risk of developing cancer well before they have any symptoms. Genetic testing has opened up the possibility for otherwise healthy mutation carriers to access prophylactic treatments in order to minimise their risk. These include surgery to remove at-risk body parts, treatment with cancer drugs, medical surveillance strategies, self-surveillance and change in lifestyle. Clinical (...) experience to date has shown considerable resistance to the uptake of medical preventative measures despite their promise of risk reduction. This paper provides a summary review of the available literature on the medical, psychological, counselling and social aspects of genetic testing and the use of risk-reducing treatments by people who have been diagnosed with a genetic predisposition to cancer. It acknowledges what has been learned from these approaches but points to the similarity of the philosophical underpinnings of most of the research. It concludes by tentatively making some suggestions, informed by the literature, about new directions for guiding our understanding the genetically at risk and the factors that influence their decision-making. (shrink)

This paper argues that the slogans “A Woman's Right to Choose” and “The Personal is the Political” typify different traditions within feminist thinking; one emphasizing rights and equality, the other the unconscious and the personal. The author responds to both traditions by bringing together mind and body, and reason and emotion, via the figure of the copula. The copula expresses an alternative model of identity which indicates that value can be produced only in relation.Let us say that the problem is (...) violence. At its most naive: how can the sexual relation, which is supposedly full of love, be violent?I mean the sexual relation in its resonances and ambiguity—to indicate the relation between the sexes, and the relation between lovers. In no way can the relation be confined to love, either heterosexual or homosexual, since it is often a contest. It cannot be reduced solely to a social relation, because in one of its aspects it addresses the most intimate subjectivity.In a certain feminist lifestyle advocacy, those women who are in same sex relations avoid sexual violence by avoiding men, and those who are in heterosexual relationships strive to find the “right kind”—that is, relationships of respectful and supportive love—rejecting all signs of aggression, from sexist disparagement and emotional cruelty to sexual humiliation and physical assault, as “abuse.”Strangely, this dichotomy does not explain the proximity of passion and aggression, whether in love between men and women or in same-sex relationships between feminist women. As rational counsel, it resists the important sense in which the erotic is, and is even valued as, the excess of the rational. And as an analysis of the oppression of women it defeats itself, for to insist on masculinity as violence itself, and/or on the sexual relation as properly governed by reason, seems to miss the point of both love and feminism.Stranger still, feminisms, which set out to address and redress the oppression of women, have become rivalrous themselves. Are these aggressions a legacy of the intellectual world they must take place in. Have we overlooked an aspect of the relation between sisters? Feminism has not addressed the question of aggression in feminism as anything more than contamination.Perhaps, after all, the thing that feminism has not yet successfully addressed is love. The “battle between the sexes” has not rendered the ambivalence of the heterosexual relation. As a species of theory, feminism has relished the rigor of distinction and has not found it easy to tolerate the proximity of opposites.And yet, in evoking the body, some feminisms approach closer to this difficulty. It remains to take up the relation between the body and the concept more thoroughly, in order to find out whether sexual difference could ever be philosophical. (shrink)

In Practical Philosophy Education, besides the learning of conceptual knowledge and working with an introspective method, students are actively engaged whereby they are played in a new form as a language game. The negative attitudes and the pretending performances were revised from the exercise of answering questions to asking question, and then to continue asking. 1957 Coffee proposes the “cross-questioning” model of using knowledge to play the “game” of philosophy. This playing experience is passed down intellectually in the form of (...) language game, which is to be replayed sentimentally in a theater game. As a pedagogic, the previous philosophical activities are exemplified in the younger generation’s way of learning and “replaying”. As a lifestyle, the historical classical thinking is continued, while the old games of philosophers are played with new and refreshing rules. (shrink)

The World Health Organisation recently listed air pollution as the most significant threat to human health. Air pollution comprises particulate matter (PM), metals, black carbon and gases such as ozone (O3), nitrogen dioxide (NO2) and carbon monoxide (CO). In addition to respiratory and cardiovascular disease, PM exposure is linked with increased risk of neurodegeneration as well as neurodevelopmental impairments. Critically, studies suggest that PM crosses the placenta, making direct in utero exposure a reality. Rodent models reveal that neuroinflammation, neurotransmitter imbalance (...) and oxidative stress are triggered following gestational/early life exposure to PM, and may be exacerbated by concomitant mitochondrial dysfunction. Gestational PM exposure (potentiated by mitochondrial impairment in the metabolically active neonatal brain) not only impacts neurodevelopment but may sensitise the brain to subsequent cognitive impairment. Having reviewed this field, we conclude that strategies are urgently required to reduce exposure to PM during this sensitive developmental period. (shrink)

Informed consent is a key condition for prenatal screening programmes to reach their aim of promoting reproductive autonomy. Reaching this aim is currently being challenged with the introduction of non-invasive prenatal testing (NIPT) in first-trimester prenatal screening programmes: amongst others its procedural ease—it only requires a blood draw and reaches high levels of reliability—might hinder women’s understanding that they should make a personal, informed decision about screening. We offer arguments for a renewed recognition and use of informed consent compared to (...) informed choice, and for a focus on value-consistent choices and personalized informational preferences. We argue for a three-step counselling model in which three decision moments are distinguished and differently addressed: (1) professionals explore women’s values concerning whether and why they wish to know whether their baby has a genetic disorder; (2) women receive layered medical-technical information and are asked to make a decision about screening; (3) during post-test counselling, women are supported in decision-making about the continuation or termination of their pregnancy. This model might also be applicable in other fields of genetic (pre-test) counselling, where techniques for expanding genome analysis and burdensome test-outcomes challenge counselling of patients. (shrink)

Informed consent is a key condition for prenatal screening programmes to reach their aim of promoting reproductive autonomy. Reaching this aim is currently being challenged with the introduction of non‐invasive prenatal testing (NIPT) in first‐trimester prenatal screening programmes: amongst others its procedural ease—it only requires a blood draw and reaches high levels of reliability—might hinder women’s understanding that they should make a personal, informed decision about screening. We offer arguments for a renewed recognition and use of informed consent compared to (...) informed choice, and for a focus on value‐consistent choices and personalized informational preferences. We argue for a three‐step counselling model in which three decision moments are distinguished and differently addressed: (1) professionals explore women’s values concerning whether and why they wish to know whether their baby has a genetic disorder; (2) women receive layered medical‐technical information and are asked to make a decision about screening; (3) during post‐test counselling, women are supported in decision‐making about the continuation or termination of their pregnancy. This model might also be applicable in other fields of genetic (pre‐test) counselling, where techniques for expanding genome analysis and burdensome test‐outcomes challenge counselling of patients. (shrink)

Critiques existing theoretical approaches and practices of philosophical counseling and presents a new model.

In the research we focus on the construction of the sexual lifestyles of young people—undergraduates—in Slovakia and ask “which cultural sources are used?” and “which cultural demands exert pressures on these constructions?” The analysis was based on the answers respondents provided to a questionnaire relating to the preferences of values, aspirations regarding partner and sexual life as well as the socio-economic background of respondents. On the basis of the factor analysis and other steps, we obtained five groups of respondents with (...) different lifestyles: 1. Liberal—free, 2. Partner—monogamous, 3. Natural—instinctive, 4. Hedonistic—free, 5. Submissive—partner. The research proves that while constructing their sexual lifestyles, young people experience confusion as to their personal interests, preferences, internal orientation of partner relationships, and culturally prescribed norms of monogamous relationships. (shrink)

School Counselling in a Chinese Context discusses research in school counselling in the Chinese context of Hong Kong schools and various educational settings, and provides a contextualized understanding of counselling issues. This book highlights key contextual conditions for counselling in Hong Kong a Chinese society. The sub themes addressed in the book include school practices and teacher perspectives on guidance, counselling, behaviour support and school discipline; whole-school guidance program for identity construction; school counselling for (...) ethnic minority students; contextual influence of the use of play therapy; school counselling for students with minority sexual orientation; Chinese cultural influence on counselling, etc. The book also develops new theoretical orientations to understanding various issues of counselling as arisen in the Chinese society of Hong Kong and helps school practitioners to develop culturally responsive approaches to school counselling for personal growth, spiritual and emotional education. The themes addressed in the book include: School practices and teacher perspectives on guidance, counselling, behavior support and school discipline School counselling for ethnic minority students Contextual and cultural influence of the use of play therapy School counselling for students with minority sexual orientation Chinese culture influence on parental participation in counselling School Counselling in a Chinese Context will be of interest to postgraduates and researchers in the field of Counselling, school psychology, child development and Chinese studies. ". (shrink)

Unhealthy lifestyle contributes significantly to the burden of disease. Scarce medical resources that could alternatively be spent on interventions to prevent or cure sufferings for which no one is to blame, are spent on prevention or treatment of disease that could be avoided through individual lifestyle changes. This may encourage policy makers and health care professionals to opt for a criterion of individual responsibility for medical suffering when setting priorities. The following article asks whether responsibility-based reasoning should be (...) accepted as relevant for fair and legitimate healthcare rationing. The luck-egalitarian argument that inequalities in health expectancies that derive from unchosen features of people’s circumstances are unjust and should be compensated, while inequalities that reflect personal choices of lifestyle may not, is discussed. It seems that while a backward-looking interpretation of individual responsibility cannot be relevant as a criterion of priority setting, a forward-looking conception of responsibility may be approved.Within all modern societies healthcare authorities are facing difficult priority setting problems. Various criteria for rationing medical intervention have been proposed due to scarcity of resources. Until now, individual responsibility for medical suffering has been given little attention in the public or in academic debate. This is about to change. As Alexander Cappelen and Ole Norheim have pointed out in a recent article in this journal, unhealthy lifestyle contributes increasingly to the burden of disease. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge.1 In this article the following question is addressed: should responsibility-based arguments be accepted as relevant to meeting healthcare rationing fairly and legitimately? I will argue that while a backward-looking conception of individual responsibility should not be endorsed, a forward-looking notion of responsibility may be approved. (shrink)

The article is devoted to understanding a healthy lifestyle in old age, significant limitations and differences that arise with age and redefine many basic ideas about health. The article begins by identifying basic ideas about healthy aging, which are questioned and clarified through an analytical analysis of dense interviews (the author’s terminology for qualitative interviews, the closest analogue of which in the Russian-speaking environment is in-depth interviews) with old people. Field work took place in the Republic of Khakassia in (...) three cities: Abakan, Chernogorsk and Abaza. A total of 12 interviews were conducted with older people receiving long-term care services. Based on the received narratives, five conditions accompanying aging were identified: living in illness; accepting limitations; loneliness; support and withdrawal from others; emotional depression. Through a critical understanding of the life world of aging, four signs of a healthy lifestyle in old age are identified: attention to the old man, the need for the old man, the value of aging and the presence of a goal in life for the old man. Modern social policy in Russia is based on only one component of “attention to the elderly” (although other components are also declared by law), through the organization of long-term care, the development and implementation of rehabilitation means, and the creation of an accessible environment. But the most important elements remain the formation of the need for the old man among significant loved ones (relatives and others), joint agreement, the formation of goal-setting in the old man in life and the promotion of the value of aging as such. The article proposes an agenda for further research to more accurately shape domestic policies in the field of aging. (shrink)

_ Source: _Volume 28, Issue 2, pp 103 - 131 Although the distinction between counsel and command in Hobbes’s works, especially _Leviathan_, has been often acknowledged, it has been little studied. This article provides background and analysis of this critical distinction by placing it in conversation with the works of Henry Parker and in the context of the English Civil War, especially as regards the discussion of prudence, interests and crisis. In so doing, three conclusions can be drawn. First, it (...) becomes clear that for both Parker and Hobbes, counsel serves as a foundation to their arguments about the placement and function of sovereignty. Second, in grounding their arguments about sovereignty in the discourse of counsel, both authors – intentionally or unintentionally – undermine the previously critical discourse of counsel. Finally, we see that especially Hobbes’s engagement with and overthrow of the discourse of counsel profoundly alters of the terms and focus of modern political debate, moving from a ‘monarchy of counsel’ to a discussion of political sovereignty. (shrink)

Mobile lifestyle is a comparatively little studied phenomenon, although the development of information and communication technologies significantly changes almost all manifestations of our life. Mobility, network capital, social and humanitarian technologies are becoming substantial conditions for successful employment. The purpose of the article is to analyse the results of the sociological project where youth of Latvia and Belarus became the object of research, in order to determine problems of mobile lifestyle in the aspect of employment through general and (...) special perception of young people of two countries with differing economic systems. (shrink)

I offer a method for philosophical counseling that is contrasted with Marinoffs. This version of philosophical counseling is primarily epistemic and suggests therapy as the examination of the justification of a client's beliefs, with a goal of enabling the client to change belief systems if the client so chooses.

The concept of lifestyle-related diseases and individual responsibility for health has played an important role in debates on the fair allocation of increasingly scarce health-care resources. In this article, we examine this discussion through the prism of solidarity. Based on an understanding of solidarity as shared practices reflecting a collective commitment to carry ‘costs’ (financial, social, emotional or otherwise) to assist others, we analyse frequent arguments in the debate and, in particular, the tool of risk-stratification. We then offer a (...) solidarity-based approach to understanding risk in the context of lifestyle-related diseases, and draw a number of conclusions on how health policy informed by solidarity should approach priority setting in health care. (shrink)

Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications. Shared decision-making is a central aspect of patient counselling but is complicated by significant knowledge gaps. Stakeholder interests can be in conflict; exploring these tensions (...) can help patients to evaluate their options and inform their deliberations. We argue that uniform, evidence-based recommendations for pregnancy after solid organ transplantation are needed. Conducting research, including patient-engaged studies, in this area should be priority for the transplant community. (shrink)

Various approaches and methods are used in philosophical counselling. Two main trends can be observed: the first is the use of contemplative methods and the second constitutes approaches based on dialogical critical thinking. The author defends the idea that developing philosophical counselling on the basis of critical thinking presupposes that it is possible for counsellor and client to hold a philosophical dialogue where the relationship is one of expert/lay person. J. Šulavík has described this relationship in greater detail. (...) In the Socratic model, the philosopher and the lay person hold a dialogue whereby they ascertain opinions via inductive comparison and by defining things, creating a shared concept. While the Platonic and Enlightenment models were grounded in the authority of the expert philosopher, in the Socratic and postmodern models, the expert philosopher loses the power to manipulate those who know “less”. Lay people are not passive consumers of a particular “optimal” philosophy but through their own “philosophising” create philosophy and tailor it for themselves. While philosophising, therefore, the philosopher does not take on the role of “producer” of philosophy but of “adviser” (consultant). It is therefore supposed that people have a general need for philosophy and that ultimately they should create and reflect upon their own philosophy. (shrink)

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self‐understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self‐evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth‐value, but only in terms (...) of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti‐realist account of self and life‐history, undermines the distinction between self‐knowledge and self‐deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth‐value, then the way is left open to clients to generate the most morally convenient self‐interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self‐understanding. To do this, I offer a broadly realist account of self and reflective self‐evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action‐guiding and truth‐oriented self‐understanding. (shrink)

Counsel for Kings: Wisdom and Politics in Tenth-Century Iran. By Louise Marlow. 2 vols. Edinburgh Studies in Classical Arabic Literature. Edinburgh: Edinburgh University Press, 2016. Pp. xv + 344, viii + 384. $220, £150.

Counseling Ethics for the 21st Century prepares students to address ethical issues arising in contemporary counseling practice. Drawing on their own clinical and practical experiences, authors Elliot D. Cohen and Gale Spieler Cohen present detailed, realistic, and engaging clinical case studies along with a comprehensive five-step model that can be used to manage the complex ethical problems raised throughout the book. Each chapter focuses on particular virtues in the context of examining a particular counseling issue, including online counseling, digital record (...) keeping, and social media. Students will be empowered to define problems, identify relevant facts, conduct ethical analyses, and make the best decisions for their clients. (shrink)

In the current era patient autonomy is enormously important. However, recently there has also been some movement back to ensure that trust in the doctor's skill, knowledge and virtue is not excluded in the process. These new nuances of informed consent have been referred to by terms such as beneficent paternalism, experience-based paternalism and we would add virtuous paternalism. The purpose of this paper is to consider the history and current problematic nature of counselling and consent. Starting with the (...) tradition founded by Hippocrates we trace and seek to understand how relevant aspects of the patient-doctor relationship have evolved under the influences of subsequent moral theories. Finally we tentatively endorse certain modes of counselling in the current era in order to promote morally sound, good clinical practice. (shrink)

The prospects of enhancing cognitive or motor functions using neuroscience in otherwise healthy individuals has attracted considerable attention and interest in neuroethics (Farah et al., Nature Reviews Neuroscience 5:421–425, 2004; Glannon Journal of Medical Ethics 32:74–78, 2006). The use of stimulants is one of the areas which has propelled the discussion on the potential for neuroscience to yield cognition-enhancing products. However, we have found in our review of the literature that the paradigms used to discuss the non-medical use of stimulant (...) drugs prescribed for attention deficit/hyperactivity disorder (ADHD) vary considerably. In this brief communication, we identify three common paradigms—prescription drug abuse, cognitive enhancement, and lifestyle use of pharmaceuticals—and briefly highlight how divergences between paradigms create important “ethics blind spots”. (shrink)

Contributions to this study are drawn both from health professionals engaged in genetic counselling and from observers and critics with backgrounds in law, philosophy, biology, and the social sciences. This diversity will enable health professonals to examine their activities with a fresh eye, and will help the observer-critic to understand the ethical problems that arise in genetic counselling practice, rather than in imaginary encounters. Most examinations of the ethical issues raised by genetics are concerned in a broad sense (...) with the application of new technology to human reproduction. This volume focuses on genetic counselling and screening as such, providing valuable insights for the health professional, social scientist, philosopher, lawyer, and bioethicist. (shrink)

This chapter describes the relation between humanism and counselling. It explores this relation by proceeding in two directions, departing from different starting points. The chapter discusses some important approaches to counselling which are rooted in the humanist worldview. It reflects the diversity of traditions and heritage on which humanism draws. The chapter deals with a further exploration of the question of how to understand humanist counselling nowadays: which counselling practices may be called humanist and which not, (...) and what are essential features of humanist counselling practices. It focuses on some central ideas and principles of humanism instead of on the diversity of humanist thought. The chapter uses the work of the Dutch philosopher and humanist Peter Derkx to identify this shared humanist inspiration in terms of more specific key aspects of humanist counselling. Derkx presents four principles as central characteristics of humanism as a worldview. (shrink)

This article investigates National Defense Education Act and National Defense Education Act-related calls in the late 1950s for the training of guidance counselors, an emergent profession that was to play an instrumental role in both the measuring and placement of students in schools by “intelligence” or academic “ability”. In analyzing this mid-century push for more guidance counseling in schools, this article will first explore a foundational argument for the fairness of intelligence testing made by Educational Testing Service psychometrician William Turnbull (...) in 1951, and then later taken up and employed by other National Defense Education Act-era advocates of testing and grouping. Secondly, this analysis will proceed to National Defense Education Act expert testimony, examining here assertions of the necessity of guidance counseling in schools, and an emergent and shared vision articulating the role guidance counseling was supposed to play in school life. A pattern or structure to this vision emerges here. According to its advocates, guidance counseling would not only inform the self-understanding of the measured individual, but it would also work to condition the ideology of individual intelligence across numerous layers of social life around the student: through peer group, through teachers and school administrators, and finally through home, family, and the wider community. (shrink)

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV‐status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV‐positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions (...) about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice. (shrink)

This commentary shows how philosophical counseling offers an alternative way for consultants to facilitate "closure" in bioethical disputes.

Purpose: A cursory look at the lives of most people living in the rural areas of Ghana suggests that they are poor as compared to their counterparts living in the urban areas. The study aimed at investigating into the culture, philosophy, lifestyles and factors that have impacted negatively on the socio-economic situation that make the people living in the rural areas poor. Methodology: In order to obtain data on the causes of poverty among the rural people, the qualitative research approach (...) was used for the study in which the observation method was employed to collect information from the elderly, youth, farmers, women, men, workers, illegal miners, traders, market women, etc. in some villages on their social lifestyles and economic activities. For effective and reliable outcome, unstructured interviews, surveys and investigations were used as tools to gather data. The use of unstructured interviews and conversations enabled majority of the sampled population who could not read nor write offer useful information. Findings: The study revealed that rural poverty is on the ascendency because most of the youth who serve as the work force migrate to the urban areas in search of jobs and better living conditions while a fraction of those who remained engage in illegal mining. The effect of this illegal activities has led to the degradation of arable lands, destruction of millions of acreages of cash/food crops and river bodies making agriculture, which is the backbone of the economy, very unsustainable. The attitude of majority of Ghanaians to time and work, especially in the public sector, leaves much to be desired. As a result, a lot of man-hours is rendered unproductive due to unpunctuality, religious and cultural activities. Unique contribution to theory and Practice and Policy: The outcome re-echoes the need for a policy direction on education that focuses on skill development and hands on experience to enable school leavers enter into entrepreneurship and be self-reliant so they will not be dependent on the limited government work. It will also make people come to the realization that only few people benefit from illegal mining but the harmful effects are universal and back government effort in fighting/curbing it. Government, Municipal/District Assemblies will see the need to provide amenities that rural communities lack, initiate intervention programmes for youth employment especially, in the rural areas to curtail rural-urban migration. (shrink)

This paper approaches philosophical counseling practice from the idea that philosophy itself is primarily a way of living and only secondarily a subject matter to be grasped and comprehended. Three things are shown to follow from this view: first, charging a fee for access to this practice is inimical to the practice itself; secondly, contrary to scientific ‘objectivity’ as the means to truthspeaking, this view of philosophy calls for a consciously articulated autobiographical expression or personal admission on the part of (...) the philosophical practitioner; and, finally, an understanding of philosophical counseling practice emerges from this view of philosophy that is depicted as naturally occurring therapeutic interacting. (shrink)