Two issues are raised. (1) What is the nature of the drug effect Heyman thinks confers value to drugs? (2) What is the evidence that drug use decreases the value of drugs and of conventional incentives over the long-term? There is considerable evidence for the opposite; a persistent increase in the sensitivity of neural systems that mediate drug value.

Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a (...) complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings. (shrink)

Heyman explains useful ways to bring addictive drug use under environmental control. We doubt that relapse is explained by drug features such as immediate reinforcement, clouding of judgment, and so forth. Relapse may require explanation in terms of enduring sensitization of incentive neural substrates, but even if its causal assumptions are wrong, Heyman's model makes useful predictions for behavioral control.

Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease can lead to the development of neuropsychiatric symptoms. These can include harmful changes in mood and behaviour that alienate family members and raise ethical questions about personal responsibility for actions committed under stimulation-dependent mental states. Qualitative interviews were conducted with twenty participants following subthalamic DBS at a movement disorders centre, in order to explore the meaning and significance of stimulation-related neuropsychiatric symptoms amongst a purposive sample of persons (...) with PD and their spousal caregivers. Interview transcripts underwent inductive thematic analysis. Clinical and experiential aspects of post-DBS neuropsychiatric symptoms were identified. Caregivers were highly burdened by these symptoms and both patients and caregivers felt unprepared for their consequences, despite having received information prior to DBS, desiring greater family and peer engagement prior to neurosurgery. Participants held conflicting opinions as to whether emergent symptoms were attributable to neurostimulation. Many felt that they reflected aspects of the person’s “real” or “younger” personality. Those participants who perceived a close relationship between stimulation changes and changes in mental state were more likely to view these symptoms as inauthentic and uncontrollable. Unexpected and troublesome neuropsychiatric symptoms occurred despite a pre-operative education programme that was delivered to all participants. This suggests that such symptoms are difficult to predict and manage even if best practice guidelines are followed by experienced centres. Further research aimed at predicting these complications may improve the capacity of clinicians to tailor the consent process. (shrink)

Theorists at the interface of medicine and the humanities have recently suggested that interpretation as a literary activity can be applied to the practice of clinical medicine. This article reviews such theories and their literary metaphors and methods. In pushing these ideas further, it is proposed that a number of guidelines can be applied to interpretation as a practical activity for clinical medicine.

The COVID‐19 pandemic exposes underlying inequalities in our socio‐economic and health systems, such as gender‐based violence (GBV). In emergencies, particularly ones that involve quarantine, GBV often increases. Policymakers must utilize community expertise, technology and existing global guidelines to disrupt these trends in the early stages of the COVID‐19 epidemic. Gender norms and roles relegating women to the realm of care work puts them on the frontlines in an epidemic, while often excluding them from developing the response. It is critical to (...) value women’s roles in society and include their voices in the decision‐making process to avoid unintended consequences and ensure a comprehensive response that caters to the needs of the most vulnerable groups. (shrink)

Upon entering the examination room, Caitlyn encounters a woman sitting alone and in distress. Caitlyn introduces herself as the hospital ethicist and tells the woman, Mrs. Dennis, that her aim is to help her reach a decision about whether to perform an autopsy on her recently deceased husband. Mrs. Dennis begins the encounter by telling the ethicist that she has to decide quickly, but that she is very torn about what to do. Mrs. Dennis adds, “My sons disagree about the (...) autopsy.” As a standardized patient, a specialized actor, the woman playing Mrs. Dennis has already delivered the same opening lines several times to different learners practicing their clinical ethics consultation skills. An SP encounter is a simulated patient encounter used for educational purposes that requires the standardization of verbal and behavioral responses. In the encounter, the simulator, or “patient,” uses a scripted medical history to enable the learner to employ a certain skill, say, the ability to perform a neurological exam. The use of standardized patients in the evaluation of clinical skills has become a staple in medical education. To tackle the challenge of teaching clinical ethics consultation skills, we have incorporated SP encounters into the curriculum of the Bioethics Program of The Union Graduate College and the Icahn School of Medicine at Mount Sinai. SP encounters are incorporated into one of our onsite classes, the Onsite Clinical Ethics Practicum, and they are part of the capstone examination, which all of our graduates must complete successfully. The inclusion of simulated encounters into the curriculum is one way in which we equip our students with the core competencies specified by the American Society for Bioethics and Humanities Task Force for clinical ethicists. (shrink)

Association between sister chromatids is essential for their attachment and segregation to opposite poles of the spindle in mitosis and meiosis II. Sister‐chromatid cohesion is also likely to be involved in linking homologous chromosomes together in meiosis I. Cytological observations provide evidence that attachment between sister chromatids is different in meiosis and mitosis and suggest that cohesion between the chromatid arms may differ mechanistically from that at the centromere. The physical nature of cohesion is addressed, and proteins that are candidates (...) for holding sister chromatids together are discussed. Dissolution of sister‐chromatid cohesion must be regulated precisely, and potential mechanisms to release cohesion are presented. (shrink)

This article presents evidence over which we stumbled while investigating a completely different part of the Platonic Corpus. While examining the ordinary working vocabulary of the doubtful dialogues and of those undisputed dialogues most readily compared with them, it seemed essential to have a representative sample of Plato's allegedly 'middle' and 'late' dialogues also. The real surprise came when the Critias was included, showing some frequencies not previously observed in Platonic dialogues. This prompted treatment of the Timaeus also, some of (...) which showed comparable peculiarities. The most distinctive feature was the increase in the rate of the definite article from around 8% of total vocabulary in dialogues assumed to be early, or around 10% in Laws, to some 14% in sizeable parts of the Timaeus-Critias, where Plato seemed no less interested in the literary credentials of his creations than elsewhere. Tests intended for application to our original set of problems were yielding results that appeared to bear on a number of problems central to the interpretation of the Timaeus-Critias. (shrink)

Accumulating evidence indicates that simulated natural settings can engage mechanisms that promote health. Simulations offer alternatives to actual natural settings for populations unable to travel outdoors safely; however, few studies have contrasted the effects of simulations of natural settings to their actual outdoor counterparts. We compared the impacts of simulated and actual natural settings on positive and negative affect (mood) levels using a pooled sample of participants enrolled in extant experimental studies. Relevant articles were identified from a review of research (...) published/in press by March 2020 and updated during the peer review of the current study. Of 16 articles identified, 6 met the inclusion criteria and administered a single cross-cutting, standardized instrument [the Positive and Negative Affect Schedule (PANAS)] before and after exposure. Random effects meta-analysis of pooled effects showed that positive affect increased in the actual settings but not in their simulated counterparts (Hedge's g = 0.87; 95% CI, 0.54, 1.20). We observed little difference in effects on negative affect change scores ( g = −0.28; 95% CI, −0.62, 0.06), with studies generally showing reductions in negative affect in both settings. Further research with additional populations, settings, antecedent conditions, and durations would provide a more robust understanding of differences in effects between these two ways to enhance mood by viewing nature. (shrink)

Discrete choice experiments—selecting the best and/or worst from a set of options—are increasingly used to provide more efficient and valid measurement of attitudes or preferences than conventional methods such as Likert scales. Discrete choice data have traditionally been analyzed with random utility models that have good measurement properties but provide limited insight into cognitive processes. We extend a well-established cognitive model, which has successfully explained both choices and response times for simple decision tasks, to complex, multi-attribute discrete choice data. The (...) fits, and parameters, of the extended model for two sets of choice data (involving patient preferences for dermatology appointments, and consumer attitudes toward mobile phones) agree with those of standard choice models. The extended model also accounts for choice and response time data in a perceptual judgment task designed in a manner analogous to best–worst discrete choice experiments. We conclude that several research fields might benefit from discrete choice experiments, and that the particular accumulator-based models of decision making used in response time research can also provide process-level instantiations for random utility models. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Bird kill rate and disruption of habitat has been reported when industrial wind turbines are introduced into migratory bird paths or other environments. While the literature could be more complete regarding the documentation of negative effects on birds and bird habitats during the planning, construction, and operation of wind power projects, there is sufficient evidence to raise concerns. Authoritative and mandatory vigilance monitoring and long-term surveillance over the life of the industrial wind facility are lacking. By the time the documentation (...) of the rate of bird kills, including that of endangered species is available in an environs of an industrial wind turbine facility, the damage may be irreversible. This article briefly explores the negative environmental impacts of the siting of industrial wind turbines and associated infrastructure, including transformer stations and transmission lines, in proximity to migratory bird corridors, wetlands, and nesting grounds. Research is required prior to proceeding with further industrial wind development in these environs. The authors propose that there is sufficient scientific evidence to require invoking the precautionary principle and halting further development until these risks are resolved. (shrink)

Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is usually expressed in terms of a person’s ability to make a decision about his or her health and treatment. Typically, this relates to the ability to refuse treatment. Exactly what “capacity” means, however, and how one determines when another individual lacks capacity, or lacks sufficient capacity, in this context is particularly controversial, with the United Nations Committee on the Rights of Persons with Disabilities insisting (...) that involuntary treatment be abandoned altogether and capacity tests avoided.Capacity is a concept that has multiple meanings and applications across different disciplines and... (shrink)

I raise skeptical doubts about the prospects of Bayesian formal epistemology for providing an adequate general normative model of epistemic rationality. The notion of credence, I argue, embodies a very dubious psychological myth, viz., that for virtually any proposition p that one can entertain and understand, one has some quantitatively precise, 0-to-1 ratio-scale, doxastic attitude toward p. The concept of credence faces further serious problems as well—different ones depending on whether credence 1 is construed as full belief (the limit case (...) of so-called partial belief) or instead is construed as absolute certainty. I argue that the notion of an “ideal Bayesian reasoner” cannot serve as a normative ideal that actual human agents should seek to emulate as closely as they can, because different such reasoners who all have the same evidence as oneself—no single one them being uniquely psychologically most similar to oneself—will differ from one another in their credences (e.g., because they commence from different prior credences). I argue that epistemic probability, properly understood, is quantitative degree of evidential support relative to one’s evidence, and that principled epistemic probabilities arise only under quite special evidential circumstances—which means that epistemic probability is ill suited to figure centrally within general norms of human epistemic rationality. (shrink)

Morphological content is information that is implicitly embodied in the standing structure of a cognitive system and is automatically accommodated during cognitive processing without first becoming explicit in consciousness. We maintain that much belief-formation in human cognition is essentially morphological : i.e., it draws heavily on large amounts of morphological content, and must do so in order to tractably accommodate the holistic evidential relevance of background information possessed by the cognitive agent. We also advocate a form of experiential evidentialism concerning (...) epistemic justification—roughly, the view that the justification-status of an agent’s beliefs is fully determined by the character of the agent’s conscious experience. We have previously defended both the thesis that much belief-formation is essentially morphological, and also a version of evidentialism. Here we explain how experiential evidentialism can be smoothly and plausibly combined with the thesis that much of the cognitive processing that generates justified beliefs is essentially morphological. The leading idea is this: even though epistemically relevant morphological content does not become explicit in consciousness during the process of belief-generation, nevertheless such content does affect the overall character of conscious experience in an epistemically significant way: it is implicit in conscious experience, and is implicitly appreciated by the experiencing agent. (shrink)

Causal compatibilism claims that even though physics is causally closed, and even though mental properties are multiply realizable and are not identical to physical causal properties, mental properties are causal properties nonetheless. This position asserts that there is genuine causation at multiple descriptive/ontological levels; physics-level causal claims are not really incompatible with mentalistic causal claims. I articulate and defend a version of causal compatibilism that incorporates three key contentions. First, causation crucially involves robust patterns of counterfactual dependence among properties.Second, often (...) several distinct such patterns, all subsuming a single phenomenon, exist at different descriptive/ontological levels (e.g., microphysical, neurobiological, macrobiological, and psychological). Third, the concept of causation is governed by an implicit contextual parameter that normally determines a specific descriptive/ontological level as the contextually relevant level, for the context-sensitive semantic evaluation of causal statements. (shrink)

Laws, codes, and rules are essential for any community, public or private, to operate in an orderly and productive fashion. Without laws and codes, anarchy and chaos abound and the purpose and role of the organization is lost. However, danger is significant, and damage serious and far-reaching when individuals or organizations become so focused on rules, laws, and specifications that basic principles are ignored. This paper discusses the purpose of laws, rules, and codes, to help understand basic principles. With such (...) an understanding an increase in the level of ethical and moral behavior can be obtained without imposing detailed rules. (shrink)

Moral judgments are typically experienced as being categorically authoritative – i.e. as having a prescriptive force that is motivationally gripping independently of both conventional norms and one's pre-existing desires, and justificationally trumps both conventional norms and one's pre-existing desires. We argue that this key feature is best accommodated by the meta-ethical position we call ‘cognitivist expressivism’, which construes moral judgments as sui generis psychological states whose distinctive phenomenological character includes categorical authoritativeness. Traditional versions of expressivism cannot easily accommodate the justificationally (...) trumping aspect of categorical authoritativeness, because they construe moral judgments as fundamentally desire-like. Moral realism cannot easily accommodate the aspect of inherent motivational grip, because realism construes moral judgments as a species of factual belief. (shrink)

What is real? Less than you might think. We advocate austere metaphysical realism---a form of metaphysical realism claiming that a correct ontological theory will repudiate numerous putative entities and properties that are posited in everyday thought and discourse, and also will even repudiate numerous putative objects and properties that are posited by well confirmed scientific theories. We have lately defended a specific version of austere metaphysical realism which asserts that there is really only one concrete particular, viz., the entire cosmos (...) (see Horgan and Potr (2000, 2002), Potr (2003)). But there are various potential versions of the generic position we are here calling austere metaphysical realism; and it is the generic view that constitutes the ontological part of the overall approach to realism and truth that we will describe here. What is true? More than you might think, given our austere metaphysical realism. We maintain that truth is semantically correct affirmability, under contextually operative semantic standards. We also maintain that most of the time, the contextually operative semantic standards work in such a way that semantic correctness (i.e., truth) is a matter of indirect correspondence rather than direct correspondence between thought or language on the one hand, and the world on the other.1 When correspondence is indirect rather than direct, a given statement (or thought) can be true even if the correct ontology does not include items answering to all the referential commitments (as we will here call them) of the statement. 2 This means that even if a putative object is repudiated by a correct ontological theory, ordinary statements that are putatively about that object may still be true. For instance, the statement “The University of St. Andrews is in Scotland” can be semantically correct (i.e., true) even if the right ontology does not include any entity answering to the referring term ‘The University of St. Andrews’, or any entity... (shrink)

Metaethics, understood as a distinct branch of ethics, is often traced to G. E. Moore's 1903 classic, Principia Ethica. Whereas normative ethics is concerned to answer first order moral questions about what is good and bad, right and wrong, metaethics is concerned to answer second order non-moral questions about the semantics, metaphysics, and epistemology of moral thought and discourse. Moore has continued to exert a powerful influence, and the sixteen essays here represent the most up-to-date work in metaethics after, and (...) in some cases directly inspired by, the work of Moore. (shrink)

I explore the prospects for overcoming the prima facie tension in the following four claims, all of which I accept: the phenomenal character of experience is narrow; virtually all aspects of the phenomenal character of experience are intentional; the most fundamental kind of mental intentionality is fully constituted by phenomenal character; and yet introspection does not by itself reliably generate answers to certain philosophically important questions about the phenomenally constituted intentional content of experience. The apparent tension results from the following (...) initially plausible thought: if indeed the answers to such questions are entirely fixed by phenomenal character by itself, then presumably these answers should be directly available introspectively. I focus the discussion specifically on certain questions about the phenomenal intentional content of agentive experience—e.g., the question whether the content of agentive experience is compatible with causal determinism. I consider three alternative possibilities for explaining why the answers to such questions are not directly available introspectively—two of which I argue against and the third of which I embrace. (shrink)

The overarching guiding principle of Alan Turing’s work was directed towards modelling the human mind as a machine. It is extraordinary that Turing introduced, in his early papers, ideas that are only now beginning to be investigated. Throughout his life, he considered conjectures to be of great importance because they suggest useful lines of research. In my own conjecture, I am asking the question: what is the brain’s geometry? Can it ever be unravelled, or does its complexity defy any form (...) of visual representation? Recent research reveals that the detailed workings of the brain take place in a ‘global workspace’, where conscious contents appear to be disseminated globally to a great multitude of networks throughout the brain that are unconscious. During conscious tasks, neurons contributing to the global workspace enter into a coherent activation pattern by being tightly connected through long axons. Is it possible, therefore, that my proposed geometric pattern (an Islamic latticework) can be envisaged as a useful means of interconnecting multiple long axons in a unified global workspace dedicated to conscious thought? I share and communicate my idea through a process that combines visual imagery with musical performance (i.e. visual music). It is a method that can assist in clarifying concepts that might otherwise remain elusive or esoteric. (shrink)

For the last 20 years or so, philosophers of mind have been using the term ‘qualia’, which is frequently glossed as standing for the “what-it-is-like” of experience. The examples of what-it-is-like that are typically given are feelings of pain or itches, and color and sound sensations. This suggests an identification of the experiential what-it-islike with such states. More recently, philosophers have begun speaking of the “phenomenology“ of experience, which they have also glossed as “what-it-is-like”. Many say, for example, that any (...) acceptable materialism—or any acceptable account of the relation of mind and body—must “respect the phenomenology.”1 Typically, no examples beyond those mentioned in the first paragraph are offered. This suggests that the picture of the phenomenology that ”must be respected” is the what-it-is-like of bodily sensations, of sensations that occur in perception, and perhaps of certain analogous nonperceptual states, such as imaginings and image-like rememberings. According to the suggested picture, all there is to phenomenology is such states; intentional mental states—as such— have no phenomenology; there is nothing that it is like to undergo them. Although beliefs and desires are intentionally directed—i.e., they have aboutness—these mental states allegedly are not inherently phenomenal. On this view, there is nothing that it is like to be.. (shrink)

I advocate a two part view concerning vagueness. On one hand I claim that vagueness is logically incoherent; but on the other hand I claim that vagueness is also a benign, beneficial, and indeed essential feature of human language and thought. I will call this view transvaluationism, a name which seems to me appropriate for several reasons. First, the term suggests that we should move beyond the idea that the successive statements in a sorites sequence can be assigned differing truth (...) values in some logically coherent way that fully respects the nature of vagueness -a way that [1] fully eschews any arbitrarily precise semantic transitions. We should transcend this impossible goal by accepting that vagueness harbors logical incoherence. Second, just as Nietzsche held that one can overcome nihilism by embracing what he called the transvaluation of all values, my position affirms vagueness, rather than despairing in the face of the logical absurdity residing at its very core. This affirmation amounts to a transvaluation of truth values, as far as sorites sequences are concerned. Third, the term ’transvaluationism’ has a nice ring to it, especially since one of the principal philosophical approaches to vagueness is called supervaluationism. I will call the first claim of transvaluationism, that vagueness is logically incoherent, the incoherence thesis . I will call the second claim, that vagueness is benign, beneficial, and essential, the legitimacy thesis . The legitimacy thesis, taken by itself, seems overwhelmingly plausible; anyone who denies it assumes a heavy burden of proof. But prima facie, it seems dubious that the legitimacy thesis can be maintained in conjunction with the incoherence thesis. For, there is reason to doubt whether there is any cogent way to embrace the incoherence thesis without thereby becoming mired in what Williamson (1994) calls global nihilism about vagueness -the view that vague terms are empty (i.e., they do not, and cannot, apply to anything). Global nihilism, Williamson argues, has such destructively negative consequences that it does not deserve to be taken seriously -for instance, the consequence that vastly many of our common sense beliefs are false, and the consequence that these beliefs are not even useful (since the constituent terms in ’Common sense beliefs are useful’ are vague and hence this statement turns out, given the [2] incoherence thesis, to be false itself). In short, the idea that one can adopt the incoherence thesis and then somehow transcend nihilism might initially seem hopelessly optimistic; transvaluationism would then be an unattainable, chimerical, goal rather than an intelligible and conceptually stable position concerning vagueness. Given certain widely held philosophical views about how language and thought must map onto the world in order for statements and the beliefs they express to be true -views that fall appropriately under the label ’referential semantics’ -transvaluationism probably is a chimerical goal. (shrink)

Jaegwon Kim argues that one should distinguish naturalism from materialism, and that both should be construed as ontological rather than epistemological. I agree, on both counts. Although I have sometimes tended to slur together materialism and naturalism in of my writings (as is done in much recent philosophy), I do think that it is important to distinguish them. It is a serious philosophical task to get clearer about how each position is best articulated, and about ways that one could embrace (...) naturalism without embracing materialism. British emergentism, for example, seems reasonably classified as a position that is naturalist but not materialist (and evidently the British emergentists themselves construed their view this way). Here are two key tenets of British emergentism, both of which seem to disqualify the view from being a form of materialism without thereby disqualifying it as a form of naturalism: (E.1) There are emergent properties in nature, in the following sense: although (i) these properties are supervenient on certain other properties, the relevant supervenience facts are ontologically sui generis (and hence are unexplainable). (E.2) Emergent properties are fundamental force generating properties , in this sense: they produce additional fundamental forces that affect the distribution of matter, above and beyond the fundamental forces posited in physics. A position worth of the label “materialism,” it seems to me, should preclude both of these emergentist theses. My notion of superdupervenience is intended as a condition that any version of materialism should satisfy, and is supposed to be incompatible with theses (E.1) and (E.2). Although sometimes, as in Horgan and Timmons (1992) and Horgan (1994), the condition is articulated in terms of the need for supervenience to be explainable “in a naturalistically acceptable way” (thereby slurring the naturalism/materialism distinction), what I had in mind was that supervenience relations must be explainable in a materialistically acceptable way.. (shrink)

Within cognitive science, mental processing is often construed as computation over mental representations—i.e., as the manipulation and transformation of mental representations in accordance with rules of the kind expressible in the form of a computer program. This foundational approach has encountered a long-standing, persistently recalcitrant, problem often called the frame problem; it is sometimes called the relevance problem. In this paper we describe the frame problem and certain of its apparent morals concerning human cognition, and we argue that these morals (...) have significant import regarding both the nature of moral normativity and the human capacity for mastering moral normativity. The morals of the frame problem bode well, we argue, for the claim that moral normativity is not fully systematizable by exceptionless general principles, and for the correlative claim that such systematizability is not required in order for humans to master moral normativity. (shrink)

OBJECTIVE: This paper addresses the question of the circumstances which lead clinicians to use legal coercion in the management of patients with severe anorexia nervosa, and explores similarities and differences between such formal coercion and other forms of 'strong persuasion' in patient management. METHOD: Logistic regression and other statistical analysis was undertaken on 75 first admissions for anorexia nervosa from a sample of 117 successive admissions to an eating disorder facility in New South Wales, Australia, where an eating disorder was (...) the primary diagnosis. Admissions with other primary diagnoses, such as bulimia nervosa (25 episodes), and entries with a co morbid diagnosis (e.g. depression or opiate overdose), were discarded, leaving 96 admissions by 75 individuals. RESULTS: Resort to measures of legal coercion into treatment was found to be associated with three main indicators: the patient's past history (number of previous admissions); the complexity of their condition (the number of other psychiatric co morbidities); and their current health risk (measured either by Body Mass Index or the risk of re-feeding syndrome). CONCLUSIONS: Our study is consistent with the few earlier studies about indicators for legal coercion in anorexia nervosa management, and suggests that clinicians use legal coercion very sparingly, distinguishing legal coercion from other forms of close clinical management of patients. (shrink)

My researches into 'architecture as music' have led me to investigate how a synchronicity of sound and space, acting together, can enable buildings to become not only smart but also sentient. It was one particular building in the City of London that prompted me to join the patterns of architecture with the rhythms of music in an experimental audio-visual performance called Citirama. Each of the piece's three movements throws some new light on what makes a building 'musical' ‐ i.e. capable (...) of exerting some power over our emotional response. I take a journey back in time to find that architecture is a world of relationships very close to that of the performing musician but, if we are to apply the lessons of music more widely, it will be necessary that we obtain some understanding of how our brains' pathways and neural mechanisms enable us to see and hear through a process of pattern recognition. Only then will the indelible links between architecture and music enable architects to act more as composers in rebalancing the challenges that underpin the future of our cities. I illustrate what I mean by 'musicality' with reference to a specific urban community that is close to home ‐ the Barbican. (shrink)