In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of (...) different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of reference in (...) the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines. (shrink)

In a recent paper, I argued that an externalist understanding of mental disorder from the philosophy of psychiatry presents an ethical challenge to the practice of medical assistance in dying (MAiD) for psychiatric illness, because it highlights the ways in which the suffering associated with psychiatric illness is sustained by features of the external environment wherein the person is embedded, including social barriers and injustices. In a response to my paper, Harry Hudson argues that addressing social inequality lacks relevance to (...) the immediate permissibility of psychiatric MAiD and that the issue of psychiatric MAiD should be informed by ‘pragmatic politics’ rather than by ‘obfuscatory philosophy’. Herein, I contend that Hudson’s response misconstrues my position and ascribes to me views I neither express nor endorse. My paper does not claim that psychiatric MAiD should be denied to people who are presently in intolerable distress. Rather, it suggests that the provision of psychiatric MAiD comes along with social responsibilities of the state to attend to the barriers and injustices that sustain and exacerbate psychiatric illness, as well as ethical responsibilities of clinicians to consider a wider range of presently available psychological and social interventions which may have been neglected under a traditional internalist approach. (shrink)

We give an exponential lower bound on the number of proof-lines in intuitionistic propositional logic, IL, axiomatised in the usual Frege-style fashion; i.e., we give an example of IL-tautologies A1,A2,… s.t. every IL-proof of Ai must have a number of proof-lines exponential in terms of the size of Ai. We show that the results do not apply to the system of classical logic and we obtain an exponential speed-up between classical and intuitionistic logic.

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular cases. (...) While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates. (shrink)

Chapter One: Constructions. Entities, constructions, and functions When one travels from Los Angeles to New York, going, say, by way of St. Louis, Chicago, ...

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state-funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its claim to medical treatment by (...) claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state-funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine, which avoids the problems associated with the concepts of health and disease. (shrink)

In contemporary philosophy of mind, the conceivability argument against physicalism is often used to support a form of dualism, which takes consciousness to be ontologically fundamental and distinct from physical matter. Recently, some proponents of the conceivability argument have also shown interest in panpsychism, which is the view that mentality is ubiquitous in the natural world. This paper examines the extent to which panpsychism can be sustained if the conceivability argument is taken seriously. I argue that panpsychism’s ubiquity claim permits (...) a strong reading or a weak reading. This presents a dilemma. On the one hand, the strong reading, which is typically characterised as a form of monism, is undermined by the conceivability argument. On the other hand, the weak reading, while compatible with the conceivability argument, turns out just to be a special case of dualism. I also show that the related position of panprotopsychism cannot provide a tenable monist position because it too cannot withstand the challenge of the conceivability argument. Therefore, if the conceivability argument is taken seriously, then we are committed to a dualist metaphysics, regardless of whether or not we accept the ubiquity claim. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment (...) for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (shrink)

It is often claimed in parts of the psychiatric literature that neuroscientific research into the biological basis of mental disorder undermines dualism in the philosophy of mind. This paper shows that such a claim does not apply to all forms of dualism. Focusing on Kenneth Kendler’s discussion of the mind–body problem in biological psychiatry, I argue that such criticism of dualism often conflates the psychological and phenomenal concepts of the mental. Moreover, it fails to acknowledge that there are different varieties (...) of dualism, and so overlooks the important metaphysical insights of contemporary dualist philosophers. I argue that while the neuroscientific research underpinning biological psychiatry challenges the traditional dualism of René Descartes, it does not pose any problem for the more modern dualism of David Chalmers. It is possible to take seriously the scientific claims of biological psychiatry while holding that this latter form of dualism is true. This has implications for the positioning of the mind–body problem in psychiatry. While the “easy” problem of explaining psychological processes is relevant to the aims of biological psychiatry, psychiatrists need not worry about the “hard” problem of consciousness. (shrink)

Care theory's efforts to valorize care have depended upon the development of a minimally coherent conception of “care.” Despite many disagreements, there is a shared assumption that care is the Other to concepts and activities that are male-dominated and so better paid, more powerful, and included in instead of excluded from politics. However, such an assumption ignores the other, noncaring forms of labor women do, which are likewise underpaid, exploited, and excluded from politics. This becomes a problem when care theorists (...) propose greater inclusion for care workers, for example Joan Tronto's argument to extend citizenship on the basis of care work, because it does not consider the hierarchies it may reproduce between care and its Others, especially feminized commodity production. Using Dorothy Roberts's distinction between spiritual and menial housework, I argue that care theory is susceptible to perpetuating hierarchies among women. Extending Roberts's argument, I argue that the care/noncare division of feminized labor reproduces hierarchies among women in the Global South, and between consumers and producers. Although we do not need to abandon the category of care altogether, we do need to address care's exclusions and its relationship to other forms of feminized labor. (shrink)

This paper addresses a philosophical problem concerning the ontological status of age classification. For various purposes, people are commonly classified into categories such as “young adulthood”, “middle adulthood”, and “older adulthood”, which are defined chronologically. These age categories prima facie seem to qualify as natural kinds under a homeostatic property cluster account of natural kindhood, insofar as they capture certain biological, psychological, and social properties of people that tend to cluster together due to causal processes. However, this is challenged by (...) the observation that age categories are historically unstable. The properties that age categories are supposed to capture are affected by healthcare and cultural developments, such that people are staying biologically, psychologically, and socially young for longer. Furthermore, the act of classifying people into age categories can bring about changes in their behaviors, which in turn alter the biological, psychological, and social properties that the categories are supposed to capture. Accordingly, I propose that age categories are best understood as interactive kinds that are influenced in dynamic ways by looping effects. I consider some implications of these looping effects for our classificatory practices concerning age, including how different disciplines may need to review the ways they define and use age categories in their inductive inferences. (shrink)

In this paper, I would like to present Aristotle’s attitude to sense-perception. I will refer to this attitude as “perceptual optimism”. Perceptual optimism is, very briefly, the position that the senses give us full access to reality as it is. Perceptual optimism entails perceptual realism, the view that there is a reality out there which is accessible to our senses in some way or other, and the belief that our senses are veridical at least to some extent, but it is (...) more comprehensive than that. For instance, a perceptual optimist does not admit such things as qualities which are perceptible in principle but not by us or bodies too small to be perceptible. In this paper I argue that Aristotle is a perceptual optimist, since he believes that reality, at least in the sublunary sphere, is indeed fully accessible to our senses. In the first and largest part of this paper, I will show, in seven distinct theses, what Aristotle’s perceptual optimism entails. In the second and shorter part, I will put Aristotle’s position in a wider context of his epistemology and show why it was important for him to be a perceptual optimist. (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person (...) and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

The necessity of origin suggests that a person’s identity is determined by the particular pair of gametes from which the person originated. An implication is that speculative scenarios concerning how we might otherwise have been had our gametic origins been different are dismissed as being metaphysically impossible. Given, however, that many of these speculations are intelligible and commonplace in the discourses of competent speakers, it is overhasty to dismiss them as mistakes. This paper offers a way of understanding these speculations (...) that does not commit them to incoherence but aims to make the best sense of what they are expressing. Using the philosophical framework of two‐dimensional semantics, it proposes that the speculative scenarios are best analysed as epistemic possibilities, rather than as metaphysical possibilities. It then explores some implications of this analysis for the ethical challenges associated with the non‐identity problem. (shrink)

The article offers a rigorous explication of the intuitive notion of verisimilitude, I.E., Of the distance of a theory from the truth. The proposal is defended against charges of material inadequacy made by popper, Niniluoto, And miller.

The authors' review of alternative models for reading is of great value in identifying issues and progress in the field. More emphasis should be given to distinguishing between models that offer an explanation for behavior and those that merely simulate experimental data. An analysis of a model's discrete structure can allow for comparisons of models based upon their inherent dimensionality and explanatory power.

… and all the rhythmic crises that punctuate the stream of living.1Through the course of the twentieth century, John Dewey built a reputation as a pragmatic philosopher who influenced notions of education, democracy, and the arts. Dewey has long been known for his emphasis on the power of reflection, and much scholarship on the role of reflection has been generated for classroom learning and pedagogy. Dewey’s definition of democracy emphasized individual freedoms balanced with social responsibility. He identified the instructive value (...) of artistic expression as a worthy human endeavor supported by scientific rationalism. While Dewey did not necessarily weave together the threads of educational experience, aesthetic... (shrink)

This article provides an introductory overview of the theories of Paul Virilio, particularly regarding how technologically-enhanced speed impacts human reality. It positions Virilio as part modernist, part postmodernist and discusses how his ethico-political views color his more aesthetic metaphysics, creating a tension in his final position on the merits of technological speed's blurring of the real and the imaginary. It concludes by contrasting Virilio's position with some comments on aesthetics by Ludwig Wittgenstein.

In the framework of quantitative possibility theory, two representation modes were developed: logical-based representation in terms of quantitative possibilistic bases and graphical-based representation in terms of product-based possibilistic networks. This paper deals with logical and graphical representations of uncertain information using a quantitative possibility theory framework. We first provide a deep analysis of the relationships between these two forms of representational frameworks. Then, in the logical setting, we develop syntactic relations between penalty logic and quantitative possibilistic logic. These translations are (...) useful for different applications and are interesting for taking advantage of each format at the inferential level. We also provide an algorithm for reasoning with quantitative possibilistic logic. The algorithm takes inspiration from the syntactic relations between quantitative possibilistic logic bases and penalty logic. Finally, we provide experimental results that compar.. (shrink)

In an article in a previous issue of this journal, I argue against the falsity criterion in the definition of delusion by presenting cases of delusions that are not false. I thank José Eduardo Porcher for his thought-provoking reply to my article. Although Porcher agrees that the falsity criterion is incorrect, he argues that my method of showing this is unsatisfactory on the grounds that it relies on a pre-defined conception of delusion.

This essay sheds additional light on the biographies and fates of Ayn Rand’s closest relatives in the Soviet Union and abroad after young Alissa Rosenbaum left the “country of workers and peasants” in 1926 for the pursuit of a new life in the United States. Previously unknown facets of her relatives’ lives were intertwined with the complex and often tragic historical events of the first half of the twentieth century. Among these relatives are victims of the German blockade of Leningrad, (...) a music teacher, a European bacteriologist, a doctor who was twice a refugee, and a Soviet Medical Service Corps officer. (shrink)

It is well known that the manner in which a definitely descriptive term contributes to the meaning of a sentence depends on the place the term occupies in the sentence. A distinction is accordingly drawn between ordinary contexts and contexts variously termed non-referential, intensional, oblique, or opaque. The aim of the present article is to offer a general account of the phenomenon, based on transparent intensional logic. It turns out that on this approach there is no need to say (as (...) Frege does) that descriptive terms are referentially ambiguous or to deny (as Russell does) that descriptive terms represent self-contained units of meaning. There is also no need to tolerate (as Montague does) exceptions to the Principle of Functionality. The notion of an ordinary (i.e., non-intensional) context is explicated exclusively in terms of logical structure and it is argued that two aspects of ordinariness (termed hospitality and exposure) must be distinguished. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions (...) of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

Illusionism is the view that conscious experience is some sort of introspective illusion. According to illusionism, there is no conscious experience, but it merely seems like there is conscious experience. This would suggest that much phenomenological enquiry, including work on phenomenological psychopathology, rests on a mistake. Some philosophers have argued that illusionism is obviously false, because seeming is itself an experiential state, and so necessarily presupposes the reality of conscious experience. In response, the illusionist could suggest that the relevant sort (...) of seeming here is not an experiential state, but is a cognitive state, such as a judgement or a belief, which is fully amenable to a physical or functionalist analysis. Herein, I argue that this response is unsuccessful and fails to undermine the reality of conscious experience. Nonetheless, the response does raise the problem of how a judgement or belief about the character of a conscious experience, even if it is true, can be justified if the conscious experience has no causal role in the formation of the judgement or belief. This is not a new problem, but is a reiteration of an old problem that is known in the philosophy of mind literature as the paradox of phenomenal judgement. I consider how the paradox of phenomenal judgement can be resolved and how the judgement or belief about conscious experience can be justified with appeal to the notion of acquaintance. (shrink)

Evolutionary psychiatry suggests that mental disorders can be explained in evolutionary terms (a) as failures of psychological mechanisms to produce the adaptive effects for which they were naturally selected, (b) as mismatches between naturally selected psychological mechanisms and contemporary environmental pressures, or (c) as naturally selected psychological mechanisms whose effects continue to be adaptive. In this paper, I present a philosophical critique of evolutionary psychiatry that draws on Subrena Smith’s matching problem for evolutionary psychology. For evolutionary psychiatry hypotheses to be (...) empirically supported, proponents of evolutionary psychiatry must demonstrate (1) that the contemporary psychological mechanisms involved in mental disorders resemble the psychological mechanisms of our evolutionary ancestors, (2) that the contemporary psychological mechanisms are phylogenetically descended from the ancestral psychological mechanisms, and (3) that the ancestral psychological mechanisms were naturally selected because their effects had adaptive benefits. However, for many mental disorders, evolutionary psychiatry lacks the methodological resources to demonstrate these conditions. Therefore, many evolutionary psychiatry hypotheses are empirically untestable and remain indefinitely underdetermined by data. (shrink)

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that these claims are (...) unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model. (shrink)

Assisted reproduction using donor gametes is a procedure that allows those who are unable to produce their own gametes to achieve gestational parenthood. Where conception is achieved using donor sperm, the child lacks a genetic link to the intended father. Where it is achieved using a donor egg, the child lacks a genetic link to the intended mother. To address this lack of genetic kinship, some fertility clinics engage in the practice of matching the ethnicity of the gamete donor to (...) that of the recipient parent. The intended result is for the child to have the phenotypic characteristics of the recipient parents. This paper examines the philosophical and ethical problems raised by the policy of ethnic matching in gamete donation. I consider arguments for the provision of ethnic matching based on maximising physical resemblance and fostering ethnic identity development. I then consider an argument against ethnic matching based on the charge of racialism. I conclude that while the practice of ethnic matching in gamete donation could promote positive ethnic identity development in donor-conceived children from historically subjugated ethnic minorities, it also risks endorsing the problematic societal attitudes and assumptions regarding ethnicity that enabled such subjugation in the first place. (shrink)

The article offers a rigorous truth condition for subjunctively conditional statements. The theory is framed in the system of transparent intensional logic and takes connections (especially the cause-Effect relation) as basic. Counterexamples are given to rival theories based on the notion of world similarity.

Traxler, Pickering, and Clifton found that ambiguous sentences are read faster than their unambiguous counterparts. This so-called ambiguity advantage has presented a major challenge to classical theories of human sentence comprehension because its most prominent explanation, in the form of the unrestricted race model, assumes that parsing is non-deterministic. Recently, Swets, Desmet, Clifton, and Ferreira have challenged the URM. They argue that readers strategically underspecify the representation of ambiguous sentences to save time, unless disambiguation is required by task demands. When (...) disambiguation is required, however, readers assign sentences full structure—and Swets et al. provide experimental evidence to this end. On the basis of their findings, they argue against the URM and in favor of a model of task-dependent sentence comprehension. We show through simulations that the Swets et al. data do not constitute evidence for task-dependent parsing because they can be explained by the URM. However, we provide decisive evidence from a German self-paced reading study consistent with Swets et al.'s general claim about task-dependent parsing. Specifically, we show that under certain conditions, ambiguous sentences can be read more slowly than their unambiguous counterparts, suggesting that the parser may create several parses, when required. Finally, we present the first quantitative model of task-driven disambiguation that subsumes the URM, and we show that it can explain both Swets et al.'s results and our findings. (shrink)

Of two false theories, One can be, Intuitively, Closer to the truth than the other. The purpose of the article is to propose a rigorous explication of this intuitive notion.

Aristotle's notion of experience plays an important role in his epistemology as the link between perception and memory on the one side, and higher cognitive capacities on the other side. However, Aristotle does not say much about it, and what he does say seems inconsistent. Notably, some passages suggest that it is a non-rational capacity, others that it is a rational capacity and that it provides the principles of science. This paper presents a unitary account of experience. It explains how (...) experience grows from perception and memory into a rational capacity, and in what way it provides the principles. (shrink)