The medical profession is not to blame for the limitations of the biomedical model with which it is often associated; the biology upon which that model is built is incomplete and bears some of the responsibility. Some of the more fundamental aspects of biological theory which are currently missing from the biomedical model need to be introduced in order to help provide a better description of the integrated biology involved. AIMS AND OBJECTIVES: By considering the biological nature (...) of the individual human being as an organism, this article introduces a brief sketch of a new biomedical model of the individual as a biological entity. Core to this model is the idea of individual survival in the 'struggle for existence' introduced 150 years ago by Charles Darwin in 'On the Origin of Species'. (shrink)

The ArgumentErnst Cassirer's fundamental conception of symbolism (symbolic pregnance) derives from what may be called a bio-medical model of semiotics, not a linguistic one. He employs both models in his philosophy of symbolic forms, but his notion of the “prototype and model of symbolism” was not derived from linguistics. The sources for his conception of symbolism include the ethnographic and anthropological literature he discovered in Aby Warburg's (1866–1929) Hamburg research library, findings of medical research on aphasia and related (...) conditions, particularly the work of Kurt Goldstein (1878–1965) and the theoretical biology of Jacob von Uexküll (1864–1944). The linguistic model of semiotics regards the bond between the signifier and the signified as purely arbitrary and conventional, but Cassirer traced meaning back to a “natural symbolism” of image-like configurations in bodily feeling and perception. In this way, his doctrine of symbolism assumed a form that undercut the distinction between philosophical Naturalism and Idealism. This helps to explain why in later years Cassirer developed his theory of Basic Phenomena. Cassirer's notion of the “prototype and model of symbolism” illustrates his method of thought, which eschews pure argument in favor of interaction with empirical research. (shrink)

ABSTRACT:Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each (...) framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward. (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive (...) theory applicable to the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (shrink)

This paper reconsiders some controversial aspects of Plato’s characterization of justice as psychic health. It rejects three prevailing interpretations of Plato’s ‘medicalization of justice’, while providing a new reading that exonerates Plato from the charges raised by his critics. I argue that Plato’s account articulates an unprecedented theory of mental health in the history of Western philosophy and medicine. This account is put forward as an alternative to the bio-medical model of mental health developed by Hippocratic doctors. Finally, I (...) discuss the practical implications of Plato’s account of justice for his ethical and political theory. (shrink)

Khalafzai, Rida Usman In this era, health has been redefined. The emphasis has shifted from the individual-focussed bio-medical model to a preventative model of collective health. This model of public health often challenges the concept of individual autonomy, the basis of human rights, in the name of the greater good. This article explores the relationship between public health and human rights, and the need for a public health ethic based on the principles of human rights.

Chaos, once considered antithetical to scientific law and order, is presently the subject of a vigorous and progressive scientific research program. "Chaos" as it is used in current scientific literature is a technical term: it refers to stochastic behavior generated by deterministic systems. This behavior has appeared in models of a wide range of phenomena including atmospheric patterns, population dynamics, celestial motion, heartbeat rhythms, turbulent fluids, chemical reactions and social structures. In general, chaos arises in the nonlinear dynamics of complex (...) systems. Grebogi, Ott and Yorke reflect the sentiment of the scientific community when they state that chaotic nonlinear dynamics has "fundamental implications." This dissertation explores these results in a philosophic context. ;The research is organized as follows: The Context of Science. Scientific results are achieved in and make sense in the practical context of research which includes both experiment and theory. Drawing on the work of Dyke, Galison, Garfinkel and Hacking, a philosophic context is described which more accurately reflects the significance of scientific results than do the contexts of discovery and justification. Models. Chaos theory is constituted by a family of numerical models. In this chapter, Giere's account of modeling is extended to both bio-medical and numerical models. Chaos in Scientific Models. This is a rather lengthy primer of chaos theory that is, although technically accurate, accessible to nonspecialists. It constitutes a road map for the primary literature on chaos. Chaos and Prediction. Chaos theory shows a limit of our science, namely, chaotic systems are deterministic yet unpredictable in the long run. The chapter includes a discussion of scientific determinism following Popper and, it concludes by providing evidence against the laplacian claim that deterministic systems are predictable. Chaos and Complexity. This shows what contribution chaos theory makes toward answering the challenge of organized complexity articulated by Weaver. It discusses attempts to characterize complexity and shows how the results of chaos theory can help. I draw on the work of Abraham, Arecchi, Atlan, Chaitin, Eckmann, Peacocke, Rosen, Ruelle, and others. Chaos theory provides a thoroughly nonvitalistic framework for understanding dynamical complexity in organic, as well as inorganic, systems. (shrink)

Van Rensselaer Potter (1911-2001), le biologiste à l’origine du terme « bioéthique » dans les écrits nord-américains, considère que « real bioethics falls in the context of the ideals of […] Aldo Leopold », un forestier, philosophe et poète ayant marqué le XXe siècle. Associer Leopold à Potter a pour effet de placer la bioéthique dans la famille des éthiques de l’environnement, ce qui la différencie du sens conventionnel retenu en médecine et en recherche depuis le Rapport Belmont (1979), une (...) déclaration ayant propulsé l’institutionnalisation de la bioéthique en Amérique du Nord. Cependant, diviser la bioéthique entre le médical et l’environnemental est réducteur. Potter propose au contraire une bioéthique globale s’intéressant aux enjeux situés à leur interface, dont ceux concernant la terre, la vie sauvage, la surpopulation, la consommation, etc. Cet article vise à amorcer un nouveau chantier d’analyse de la pensée de Potter en s’appuyant sur l’héritage de Leopold en biologie. Une synthèse de cette vision potterienne est proposée de manière à considérer son œuvre comme un tout cohérent s’intégrant aux grands débats qui transcendent les XXe et XXIe siècles. Sa vision apparaît comme une sagesse collective et prospective sous la forme d’une science de la survie et d’un code de bioéthique. Dépassant l’éthique de l’environnement, son association avec Leopold offre un modèle de la complexité s’imposant comme cas indissociable du contexte qui l’englobe, en améliorant nos façons d’intervenir en pratique dans un monde en constante transformation, à titre de gouvernance adaptative et de sagesse de la responsabilité. (shrink)

Managing Complexity in Healthcare introduces the ComEntEth (Complex Entropic Ethical) model as an integrated bio-medical and philosophical approach to understanding how people get things done in healthcare. Drawing on the complexity sciences, studies of entropy in living organisms, and the ethics of Emmanuel Levinas, healthcare is theorised as energetic relational exchanges between people as entropic and ethical entities that unfold around a central attractor: Reduction in elevated entropy or suffering in patients. Living entities are engaged in a continuous struggle (...) against the tendency to produce entropy. From the cellular to the collective of human endeavours, the tendency of complex systems is to disorder and decay. Yet in the micro-activity of healthcare enterprise, people resist this tendency by expending energy to create order and sustain life. Making sense of how this miraculous work is made possible is the foundation of this book. Through practical examples - from analysis of practitioner burnout, rural and remote healthcare, the functioning of emergency departments, to government, social and institutional responses to the COVID-19 pandemic -this new integral philosophy provides practitioners, managers, policy designers, and scholars an effective way to understand the dynamics of daily processes and practices that link the micro of everyday interactions with the macro-trends of healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to much feminist (...) bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

BackgroundAs suggested by Shook and Giordano, understanding and therefore addressing the urgent international governance issues around globalizing bio-medical/technology research and applications is limited by the perception of the underlying science.MethodsA philosophical methodology is used, based on novel and classical philosophical reflection upon existent literature, clinical wisdoms and narrative theory to discover a meta-science and telos of humankind for the development of a relevant and defendable global biomedical bioethics.ResultsIn this article, through pondering an integrative systems approach, I propose a biomedical (...) class='Hi'>model that may provide Western biomedicine with leadership and interesting insight into the unity beyond the artificial boundaries of its traditional divisions and the limit between physiological and pathological situations. A unified biomedicine, as scientific foundation, might then provide the basis for dissolution of similar reflected boundaries within bioethics. A principled and communitarian cosmopolitan bioethics may then be synonymous with a recently proposed principled and communitarian cosmopolitan neuroethics based on a novel objective meta-ethics. In an attempt to help facilitate equal and inclusive participation in inter-, multi-, and transdisciplinary intercultural discourse regarding the aforementioned international governance issues, I offer: a meta-science derived through considering the general behaviour of activity, plasticity and balance in biology and; a novel thought framework to encourage and enhance the ability for self-evaluation, self-criticism, and self-revision aimed at broadening perspective, as well as acknowledging and responding to the strengths and limitations of extant knowledge.ConclusionsThrough classical philosophical reflection, I evolve a theory of medicine to discover a telos of humankind which in turn provides an ‘internal’ moral grounding for a proposed global biomedical bioethics. (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should (...) spend hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice and Naturalistic OntologyChristopher R. Williams (bio)Keywordscausality, criminality, determinism, medical model, positivismThese questions have been posed: Is vice (encompassing criminal and other wrongful conduct) best regarded as “sick” behavior, “immoral” behavior, or some other type altogether? Are we to understand vice in natural-medical terms, or are we better served by utilizing a moral framework? Is criminality reducible to and best categorized as a metaphysical type the essential features (...) of which are neurological or otherwise biological in nature? Or, perhaps, is criminality closer to a (non-natural) sociological type, the essential features of which can be understood only through reference to social norms and cultural conventions? These are torturously involved philosophical and theoretical questions that have given rise to an equally torturous volume of literature. Without pretending to do justice to these questions or their corresponding literature, several key considerations that must be inserted into and accounted for within the discursive pursuit of these inquiries are worth noting.Where a naturalistic ontology is employed within the study of vice, we reduce the intricacies of deviant behavioral phenomena to what we presume to be their underlying medical/biological properties. It is worth remembering that behavior itself cannot rightfully be said to be “sick”; rather, what we mean to say is that the behavior in question—in our case, various forms of “vice”—is symptomatic of some underlying illness or medical/biological condition. The presumed underlying sickness and the behavior itself are distinct, ontologically linked only through their theorized relationship to one another. This, then, is a key assumption of the medical approach to vice and its ontological classification as a natural-medical kind: that there exists a relationship between the behavior (a symptom) and the underlying illness or medical condition, and that the relationship is of the causal kind. Vice, it is suggested, is a change in state that is caused by (or, at the very least, is a direct consequence of) sickness or illness. Second, to legitimate such attributions, the illness supplying the requisite causal force must be identifiable and its causal connection to the behavior must be or be capable of being sufficiently explicated. In other words, once we have identified the relevant medical/biological properties and the behavior to which they stand in causal relatedness, we must be prepared to characterize this dynamic—we must be able to show exactly how and why such and such a condition gives rise to such and such a behavior.Problematically, causation itself is and has always been a contentious metaphysical specimen. Hume (1955) reminded us of the troubling reality [End Page 39] that we cannot ever “see” one thing cause or necessitate another. We are left, rather, to merely presume the existence of causal relationships between things. How is it, exactly, that disorder in neurodevelopment can necessitate certain behavioral outcomes? Even if we can “see” (in the empirical sense) the disorder and equally “see” the behavior, we cannot of course witness the precise causal action of the former upon the latter. Even if we are content inferring causal action in such cases, we still need to demonstrate the basic conditions of causality. To show that Condition X is causally related Behavior Y, we need to show that they are regularly associated with one another, that Condition X temporally preceded Behavior Y and, most challengingly, that no other conditions or factors have an intervening (e.g., additive, synergistic) influence. Hypothetically, if we were to posit a causal relationship between schizotypal personality traits and violent behavior, we would need to establish: (1) that schizotypal traits and violent behavior regularly coexist; (2) that those traits presented before the manifestation of the violent behavior; and (3) that no other factors (biological, psychological, and/or sociological) contributed in any meaningful way to those manifestations. We would thus need to systematically rule out family dynamics, income, education, intelligence, substance use, and so forth, as contributing factors. If, in turn, we were to determine that the presence of schizotypal traits alone is not sufficient—even if a necessary condition—to produce violent behavior but, rather, that those traits act in concert with other variables to produce the behavior, then we would not truly be... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Finding PartnershipThe Benefit of Sharing and the Capacity for ComplexityMichaela Amering (bio)Keywordsrecovery, empowerment, trialog, user involvement, schizophreniaIs There Ignorance and Arrogance? In Psychiatry? In Medicine?Adding insight to injury' is the paraphrase psychiatrist Pat McGorry (1992) coined for his reproach of 'pushing for "insight" or "acceptance of diagnosis"' without carefully taking into account the complexities of the individual situation, context, and needs. That must be about the kind of behavior (...) Marga Reimer has in mind in her paper on treatment adherence in the absence of insight, which depicts mental health professionals characterized by arrogance against the common sense of motivating compliance by perceived or anticipated benefits on different everyday life levels, but instead trying to get people to believe in a mental illness such as schizophrenia and wishing them to want treatment for that in the form of medication.In addition, Reimer presents examples from general medicine to make her point that adherence follows perceived or anticipated benefits instead of being a result of insight into a medical model of illness and McGorry (1992) also suggests that disregard for the active role that patients may play as reflected in psychiatry in terms such as 'case management' and 'compliance' "is a failing which extends to mainstream medicine and probably to most systems of human service delivery." On the other hand, Bill Anthony (2006), one of the most eminent experts on psychiatric rehabilitation and recovery in a personal report on his own medical illness, multiple sclerosis—MS, and the assistance he has been receiving in connection with it, describes the 'MS-Community' as exemplary with respect to instilling courage and hope, continually providing information and opportunities for exchange, and for never questioning a person's ultimate freedom of choice. In contrary, in mental health care he does not experience the medical profession as acting with full respect and support for its patients and suggests a great deal more work and transformation—especially concerning coercive treatments—ahead to follow this example. Similarly, it has been suggested that psychiatry should be better integrated into medicine to overcome stigma and discrimination of psychiatric health problems and interventions. A pertinent example of an initiative in this direction is the proposal of a fusion of mental health and incapacity legislation to arrive at ethically consistent legal situations with regard to involuntary [End Page 77] treatment across medicine (Dawson and Szmukler 2006).Is There Something Called Schizophrenia? and How Much Longer?Reimer's main example—schizophrenia—is the diagnosis that poses some of the greatest problems to the field and to the recognition of psychiatry as a scientific medical discipline. The current concept as well as the term 'schizophrenia' will probably not be around much longer; 'a century of schizophrenia is enough' (Kelly and Murray 2002). Suggested solutions for the problems of the diagnosis of schizophrenia concern the urgent complement of the categorical with a dimensional approach (Allardyce et al. 2007), a change also put forward as one of the essential remedies to undermine the stigma of mental illness that is often exacerbated by clinical diagnosis (Corrigan 2007). Such a move would also clearly help against the still prevalent experiences of users of services and their families and friends, whose hopes and dreams have been crushed and whose resilience has been undermined by clinical situations, which in times of psychotic crises, not only forced diagnoses but also prognoses—often scientifically unfounded—on them (Amering and Schmolke 2009).Is There a Solution? Can We Use Our Talents? And Those of People With a Lived Experience of Mental Health Problems and Care?Clinicians as well as scientists know that health, illness, and recovery occur in complex ways and contexts. People faced with mental health problems clearly realize the complexities of their situation and are especially motivated to appreciate the variety of factors and interactions that need to be integrated to arrive at a valid assessment. Ideally, the therapeutic relationship—essentially a partnership—holds a formidable chance of sharing efforts and creating the wisdom for finding and facing the truths necessary to develop solutions that can uphold and work in line with the complexities of human life.I would argue that psychiatric professionals are certainly part... (shrink)

In the monograph Philosophy and Psychedelics: Frameworks for Exceptional Experience, Hauskeller raises the important subject of individualization and alienation in psychedelic psychotherapy. Under the prevailing conditions of neoliberalism, Hauskeller contends that psychedelic-assisted psychotherapy appropriates Indigenous knowledges in an oppressive fashion, may be instrumentalised to the ends of productivity gain and symptom suppression, and may be utilised to mask societal systems of alienation. Whilst offering a valuable socio-political critique of psychedelics' clinical uptake, we suggest that Hauskeller's view does not adequately acknowledge (...) the ways in which psychedelics offer a challenge to the Western reductive bio-medical understanding of healing and wellbeing. It is contended herein that Indigenous knowledges, in alliance with a range of emerging sciences, offer both an engagement with ethnomedicines in a less harmfully appropriative fashion, and a renewed understanding of the means by which psychedelics achieve therapeutic change. With this understanding, what becomes apparent are the potential ways in which psychedelic medical usage may produce positive feedback upon the oppressive systems in which we are embedded. That is, transpersonal experience through encounters with the ineffable may offer a revisioning of Western psychology and cognitive science. Indeed, if psychedelics are approached with an understanding of the actual means by which they produce therapeutic outcomes—changing mental representations of the self, or self-insight derived through non-ordinary states of consciousness—then psychedelic psychotherapy offers a reimagining of psychiatric nosology, challenging conventional understandings of both pathology and wellbeing through an overturning of specified and discrete deficit models of psychopathology. This may provide both a critique of the prevailing categories used to describe madness and an expansion of our understanding of the mind-body relation, as well as an increased recognition of positive psychology grounded in cross-cultural contemplative traditions. This provides an implicit challenge to the pharmaceutical industrial-complex and its profit motives; and the corresponding neoliberalist, globalising tendencies which Hauskeller seeks to address. -/- . (shrink)

We have been studying cognition and learning in research laboratories in the field of biomedical engineering. Through our combining of ethnography and cognitive-historical analysis in studying these settings we have been led to understand these labs as comprising evolving distributed cognitive systems and as furnishing agentive learning environments. For this paper we develop the theme of 'models-in-action,' a variant of what Knorr Cetina has called 'knowledge-in-action.' Among the epistemically most salient objects in these labs are so called "model systems," (...) which are designs that blend engineering with the study and use of biological systems for purposes of simulative model-based reasoning. We portray the prevalent design-orientation in this engineering specialty and how the prevailing activity of cell-culturing in these labs transitions into a design activity for the bio-medical engineers, leading them to work with 'wet' devices. We discuss how devices, 'wet' and 'dry,' situate model-based understandings and how they participate in model systems in these labs. Models tend to come in clusters or configurations, and the model systems in these labs are epistemically salient junctures of interlocking models. Model systems in these labs evolve thereby consolidating what we want to call a 'fabric of interlocking models,' which functions as point of stability and departure in these labs. We convey a taste of such a 'fabric' for a tissue-engineering lab. We conjecture that through this 'fabric' extended developments in technology and methodology have a 'situated' presence in the workings of these labs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hildegard: Medieval Holism and ‘Presentism’—Or, Did Sigewiza Have Health Insurance?Jerome L. Kroll (bio)Keywordsholistic healing, presentism, Hildegard of Bingen, medieval medicineSuzanne Phillips and Monique Boivin have published an article examining Hildegard of Bingen’s (1098–179) treatment and cure of Sigewiza, a possessed woman. The purpose of their article is to demonstrate Hildegard’s holistic, or biopsychosocial, approach to healing as a model that we in the twenty-first century have lost but (...) would do well to recover. Several questions come to mind:What is Hildegard’s model?Have we lost it?Is it something we wish to emulate?The basics of the case history is that a noblewoman, Sigewiza, is ill or possessed of an evil spirit. Attempts by her local abbot and community to send her on pilgrimages or otherwise to cure or exorcise her, even with Hildegard’s recommendation, have only short-lived success, after which Sigewiza’s illness or demon returns. Finally, the abbot asks Hildegard to take the noblewoman into her Benedictine monastery, and after a suitable time and various interventions, Sigewiza is permanently (presumably) cured. The arduous process of effecting this cure has left Hildegard weak and ill herself, a pattern of poor physical health from which Hildegard suffered all her life.Phillips and Boivin claim that this is an early example of conceptualizing and utilizing a bio-psychosocial model to treat a complex illness. Hildegard, well known for her medical and pharmaceutical knowledge, applies the proper dietary changes to correct Sigewiza’s humoral (biological) imbalance. She treats the psyche and its partner, the soul, by long hours of discussion with Sigewiza and verbal duels with her demon, as well as by exorcising the demon, and she includes the social aspects of treatment by bringing Sigewiza into the Benedictine community of sisters as a participating member. Which of these three modalities may be sufficient for a cure depends upon the medieval literary genre in which the case appears. If in a medical text, then the proper dietary treatment and application of compounds to neutralize and correct the offending humoral imbalances would be the therapeutic agents. In medieval hagiography, [End Page 369] the biological modality is never sufficient and often ridiculed, because the entire thrust of the text is to demonstrate the futility of medical (secular) ministrations and the effectiveness of saintly intervention in producing a cure, whether or not exorcism is technically part of the process. In Sigewiza’s case, perhaps because of the stubbornness of the possessing demon or because of other factors attached to Sigewiza’s condition, the three (biopsychosocial) modalities are utilized. It seems that Sigewiza has a treatment-resistant illness.The narrative follows a familiar topos in saint’s lives (Kroll and Bachrach 2005). Attempts to cure a demoniac by prayers, pilgrimages, intercessions of other local saints or reputedly holy persons, and sometimes by physicians (when available) are to no avail. The sufferer is brought, amidst great fanfare and public attention (a media event), to the holy woman who is the central figure of the particular Vita, and the sufferer is promptly, or protractedly, cured. In such an account, the holiness of the holy woman is further demonstrated and her reputation, shrine, and influence are duly extended and enhanced. The holy person, with humility, attributes the intercession and cure to the power of God, or Jesus or Mary or a particular patron saint, but the crowd of onlookers and the audience of the Vita understand that God (or Jesus or Mary) has in fact granted the miracle cure as a way of demonstrating the holiness of this holy person in contrast to those who previously tried to cure the ill person. The abbot who ‘referred’ Sigewiza to Hildegard, and the previous saints’ shrine to whom Sigewiza was brought, although generally acknowledged as being of fine character or respectability, had to suffer the ignominy of their petitions being rejected to dramatize the special regard in which Hildegard is held.Although we can say that the “purposes” for which Hildegard’s hagiographer includes such anecdotes is to demonstrate her holiness and her importance in God’s eyes, this does not stop us, nine centuries later, from using such... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflections on InsightDilemmas, Paradoxes, and PuzzlesMarga Reimer (bio)Keywordsinsight, psychosis, treatment adherence, medical model, autonomy, open placebos, rationalityThe Practitioner's DilemmaThe psychiatrist aware of the potential intractability of what Jennifer Radden calls "insightlessness," faces a dilemma. Should she encourage her patient to embrace a medical model of his "troubles," a model whose adoption is likely to motivate treatment adherence? She might then be trying to do the impossible; (...) she might also alienate her patient in the process. Should she instead encourage her insightless patient to embrace his own non-medical model, according to which treatment adherence makes no medical sense whatsoever? She might then see herself as encouraging a kind of uninformed consent: Her insightless patient might be taking powerful, potentially harmful, medication for reasons (such as sound sleep and "peace of mind") that would never medically justify adherence.In my original paper, I suggested that the way out of this dilemma might be to embrace the latter option, while characterizing the very real (and medically based) benefits of treatment adherence in non-medical terms. I now realize that my proposed resolution reflects an oversimplified understanding of what might be called the "practitioner's dilemma." As Michaela Amering (2010) makes clear, the situation for those with mental illness is improving dramatically. With "recovery orientation" as the "guiding principle of mental health policy," the emphasis is on "health promotion, individual strengths, and resilience." The question becomes: Can the practitioner encourage her insightless patient to partake in this "recovery" movement if she does not simultaneously encourage him to embrace a medicalized understanding of his "troubles"?Not obviously. For although a "recovery" model might eschew notions like illness1 and disease, pathology and dysfunction, and even schizophrenia, it will inevitably involve some medical notions. The patient who partakes in the "recovery movement" described by Amering, would seem to have no choice but to accept a model that is essentially medical. Consider the language used by Amering in characterizing that movement. She talks of mental health problems, therapeutic relations, patient self-determination, diagnosis and, of course, recovery. The concepts underlying such language are intrinsic to the patient-oriented movement Amering describes. The question becomes:How can the insightless patient rationally partake in such a movement without embracing some version of the medical model of mental illness? [End Page 85]This question suggests the importance of promoting some kind of insight, even if not insight "into psychosis." At the close of these comments, I consider briefly what such "revisionary" insight might involve.Paradoxes of Conditional and Relinquished AutonomyAutonomy among patients with psychosis presupposes the sort of clear-headedness that arguably comes only with treatment adherence. This may provide some justification for the "coercive treatments" that Anthony (2006) finds so offensive. For patients with psychosis, genuine autonomy is conditional, requiring some degree of insight: Recognition that their "troubles" are at least amenable to medical treatment. Once the patient recognizes this, he can choose freely to decline such treatment (regardless of whether that choice is ultimately respected). Call this the "paradox of conditional autonomy." The conditional nature of autonomy is a familiar point in philosophical discussions regarding free will. There is no genuine freedom without the sort of knowledge required for informed choices. What distinguishes the patient with psychosis from persons more generally is that his autonomy is further conditioned: The knowledge required for autonomous decision making arguably requires some degree of treatment adherence.However, the mentally ill patient has the right, as do all patients, to relinquish autonomy. He may opt for deference to, and dependency on, the relevant experts: Mental health care professionals (Campbell 1994). We are led once again to paradox. To respect the patient's autonomy, the mental health care professional must respect his right to forego autonomy in favor of deference and dependency. This paradoxical situation, involving a kind of deferred autonomy, is not unique to psychiatry but applies to medicine across the board. Indeed, it applies to the human service industry more generally where, as McGorry (1992) suggests, there is an implicit assumption that the service user is to defer to the expertise of the service provider.This assumption is rightly challenged. Suppose Justin and... (shrink)

연명치료에 대해 보통의 사람들이 가진 가장 일반적인 견해는 ‘연명의료의 중단은 환자를 죽이는 것이라기보다는 죽도록 내버려두는 것이다‘라는 주장으로 표현될 수 있을 것이다. 이러한 일반적인 신념은 소위 웰다잉법으로 알려진 연명의료결정법이 근본전제로서 가정하고 있는 사실이기도 하다. 즉, 이러한 (표준)견해에서 보면, 연명치료의 중단은 반윤리적이라고 보기 어렵고, 따라서 연명의료의 중단은 일정한 조건 하에서 법으로 허용된다는 것이다. 그러나 이러한 연명의료에 대한 표준견해나 주장에는 여러 비판이 있을 수 있다. 즉 연명치료의 중단은 살인일 수 있다는 견해가 가능하다.BR 본 논문은 연명치료중단 행위가 지닌 함의를 생명의료윤리의 측면에서 분석함으로써 연명치료중단이 살인이 (...) 아니라 죽게 내버려 두는 것이라는 표준견해를 이론적으로 옹호하였다.BR 이를 위해 우리는 ‘차이를 만듦’ 그리고 ‘행함’과 ‘허용함’이란 개념 틀을 사용하여 인과관계에서의 ‘원인으로서 야기함(causing)’이란 개념을 검토하였다. 그렇게 함으로써 우리는 표준견해에 포함된 ‘죽음을 (원인으로서) 야기함’이란 개념은 ‘행함’보다는 ‘허용함’에 해당한다고 보는 것이 보다 합리적이고 타당하다는 사실을 주장했다. 끝으로 우리는 표준견해에 대한 이런 방식의 이해를 통해 표준견해에 대해 제기되는 전형적이고 대표적인 몇몇 비판을 논박함으로써 표준견해가 참이거나 혹은 최소한 참일 가능성이 크다는 사실을 보여주고자 하였다. (shrink)

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of (...) the “atheoretical” approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry’s over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry. As a result, the field has suffered a loss of knowledge that may be difficult to recover. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sigewiza’s CureJennifer H. Radden (bio)Keywordsbiopsychosocial model, Hildegard of Bingen, associationist presuppositions, causation, power of suggestionSuzanne Phillips and Monique Boivin provide us with a sympathetic and compelling account of how the various elements of Hildegard’s sophisticated amalgam of ritual, magic, religion, dietary and other medical remedies, caring, and community, formed a seamless cure for Sigewiza’s affliction. Whether Hildgard’s approach reflects an early instance of the biopsychosocial “model” is (...) a separate claim, and may be challenged. But that her ministrations somehow effected a cure in this case seems—if not without a doubt, then very likely.Descriptions of Sigewiza’s condition, with its “clumping together of blackness and steam” caused by a “constellation of humors,” echo those of other medieval writers speaking of the humoral disorder of melancholia—at that time an encompassing category for a range of symptoms and syndromes that would today be assigned as different mental disorders. In these descriptions a variety of explanations for mental illness are quite typically introduced, including biological, social, supernatural, dietary and astrological ones. Phillips and Boivin take care to point out that Hildegard was not offering her remedies as alternatives, but rather proposing them as at work jointly and in a range of causal directions, exhibiting mutual influence, and feedback loops. As these authors say, multiple explanations “were often held simultaneously... in reference to a specific case” (Phillips and Boivin 2007, XX). And the factors that might cause the system to move out of balance are many: food, emotions, the soul, the mind, actions, and spiritual forces. So although deeds may cause bodily changes and their psychological accompaniments, “problems in the diet might affect the humors which would then have psychological effects, which demons might... use as opportunities to cause further trouble in the spirit, mind, and body” (Phillips and Boivin 2007, 365).What first struck me about Hildegard’s description of these many distinct causes interacting in complex ways is its compatibility with the multi-causal accounts of depression (and other mental disorder) frequently proffered in our own time. Daily habits (e.g., diet, sleep and exercise regimes), genetic predispositions, including biological states of fragility, external events, experiences of loss, social roles, and cultural beliefs—not to mention spontaneous recovery, and placebo effects—are all regularly implicated in the onset and course of conditions such as depression.Still, the similarity to these modern causal accounts may be somewhat misleading and we must beware of overstating it. In favoring and pressing on Hildegard’s holistic understanding, moreover, Phillips and Boivin perhaps insufficiently emphasize significant dissimilarities between Hildegard’s and our contemporary accounts.It is the interaction between the various elements making up Sigewiza’s cure that is most noteworthy [End Page 373] in this account, as Phillips and Boivin recognize. Yet that relationship itself seems in some ways surprisingly problematic: difficult for us to make sense of, and profoundly unmodern. Granted, we think we see the way these approaches probably influenced how Sigewiza felt and responded; but it is not so clear how Hildegard saw things. Like a lot of thinking in medieval times, Hildegard’s account provides us with glimpses of an understanding of the world that today looks prescientific and in that respect, almost precausal. (So, to the extent that the biopsychosocial model is understood as a causal one, the case of Sigewiza may exemplify it only inexactly.)It is not merely the range and type of causes, including supernatural and astrological ones, in accounts such as Hildegard’s that distinguish it from today’s analyses. It is also the reliance of such accounts on what seems to be a different metaphysics, one of associations or qualities.Associationist presuppositions can be found in accounts of health and illness from before, during, and long after, Hildegard’s time. Three examples of this pervasive, but puzzling thinking serve to illustrate. The melancholiac’s perceived swarthiness and darkened skin color—regularly noted from the time of the Greek physicians and an established part of the medieval iconography in images of melancholy—were not, or not primarily, thought to be a causal result of the darkness of his bile, as one might suppose. Instead, this coloring seems... (shrink)

Assumptions about obesity—e.g., its connection to ill health, its causes, etc.—are still prevalent today, and they make up what I call the medical model of fatness. In this paper, I argue that the medical model was established on the basis of insufficient evidence and has nevertheless continued to be relied upon to justify methodological choices that further entrench the assumptions of the medical model. These choices are illegitimate in so far as they conflict with both the epistemic (...) and social aims of obesity research. I conclude the paper with a partial solution to these epistemic and social shortcomings. (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)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant (...) model, which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

This chapter sketches an account of psychiatric explanation with roots in contemporary philosophy of science and suggests that it is a natural fit with what it will call the strong interpretation of the medical model in psychiatry. The chapter starts by distinguishing between strong and minimal ways to understand the medical model before it moves on to talk about explanation. The basic idea of the chapter is that the logic of the medical model, together with recent developments (...) in the sciences of the brain, suggests that psychiatry should be seen as a kind of cognitive neuroscience. The second part of the chapter discusses some issues in applying mechanistic explanatory models to mental disorders. Recent philosophical work on explanation in the cognitive neurosciences has seen it as mechanistic explanation. A mechanistic explanation shows how components of a system interact to give rise to the phenomenon to be explained. (shrink)

This chapter contains sections titled: Introduction Investing in Science: Child Health and U.S. Medicine in the Twentieth Century The Impact of Specific Medical Interventions The Changing Definition of ID The “Flynn Effect” and the Impact of Improved Public Health Conclusion References.

Biomedical science has been remarkably successful in explaining illness by categorizing diseases and then by identifying localizable lesions such as a virus and neoplasm in the body that cause those diseases. Not surprisingly, researchers have aspired to apply this powerful paradigm to addiction. So, for example, in a review of the neuroscience of addiction literature, Hyman and Malenka (2001, p. 695) acknowledge a general consensus among addiction researchers that “[a]ddiction can appropriately be considered as a chronic medical illness.” Like other (...) diseases, “Once addiction has taken hold, it tends to follow a chronic course.” (Koob and La Moal 2006, p. ?). Working from this perspective, much effort has gone into characterizing the symptomology of addiction and the brain changes that underlie them. Evidence for involvement of dopamine transmission changes in the ventral tegmental area (VTA) and nucleus accumbens (NAc) have received the greatest attention. Kauer and Malenka (2007, p. 844) put it well: “drugs of abuse can co-opt synaptic plasticity mechanisms in brain circuits involved in reinforcement and reward processing”. Our goal in this chapter to provide an explicit description of the assumptions of medical models, the different forms they may take, and the challenges they face in providing explanations with solid evidence of addiction. <br>. (shrink)

Scholarship in neuroethics and related disciplines has long reflected on the value of different conceptual models of disability and impairment. While this theoretical work is valuable, centering the voices of people with mental health conditions in neuroethics research can help us better understand how such models apply in everyday people’s lives. Drawing on qualitative data from a study on mental health peer providers’ lived experiences of recovery, this paper will demonstrate that peers borrow from both a neurodiversity framework and the (...) medical model of disability, though their feelings toward the two models were often complex and ambivalent. These findings advance neuroethics by indicating that future research and clinical practice should take a nuanced approach to responding to the needs of people with mental health conditions and turn to peers as experts, honoring their values and recognizing both the promise and pitfalls of living with a mental health condition. (shrink)

This chapter contains sections titled: Introduction Investing in Science: Child Health and U.S. Medicine in the Twentieth Century The Impact of Specific Medical Interventions The Changing Definition of ID The “Flynn Effect” and the Impact of Improved Public Health Conclusion References.

Chronic pain patients often miss receiving acknowledgement for the multidimensional struggles they face with their specific conditions. People suffering from chronic pain experience a type ofinvisibilitythat is also borne by other chronically ill people and their respective medical conditions. However, chronic pain patients face both passive and active exclusion from social participation in activities like family interactions or workplace inclusion. Although such aspects are discussed in the debates lead by the bio-psycho-social model of pain, there seems to be a (...) lack of a distinct interest in assessing more specifically the social aspects regarding chronic pain. As a result, the social aspects have yet to be taken into a more thorough theoretical consideration of chronic pain and to be practically implemented to help affected patients. By addressing chronic pain patients’ struggle for recognition, this paper attempts to shed light on some of these social aspects. We base this attempt on a theoretical framework that combines patients’ statements with an adaptation of Axel Honneth’s social-philosophical work onrecognition. Thus, this paper tries to make a suggestion on how the bio-psycho-social model of pain can live up to its name by helping to address more adequately some of the more neglected aspects in chronic pain patients’ suffering than has been possible to date. (shrink)

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

This article presents a model for regulating cognitive enhancement devices. Recently, it has become very easy for individuals to purchase devices which directly modulate brain function. For example, transcranial direct current stimulators are increasingly being produced and marketed online as devices for cognitive enhancement. Despite posing risks in a similar way to medical devices, devices that do not make any therapeutic claims do not have to meet anything more than basic product safety standards. We present the case for extending (...) existing medical device legislation to cover CEDs. Medical devices and CEDs operate by the same or similar mechanisms and pose the same or similar risks. This fact coupled with the arbitrariness of the line between treatment and enhancement count in favour of regulating these devices in the same way. In arguing for this regulatory model, the paper highlights potential challenges to its implementation, and suggests solutions. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life (QoL) measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale (KPS, 1948), and the classification of functional capacity as a diagnostic criterion for heart diseases (Bainton, 1928) and as a supplementary aid to therapeutic criteria in rheumatoid arthritis ( (...) Steinbrocker, Traeger, and Batterman, 1949 ) – I discuss how medicine, throughout the emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ (2007) and Wahlberg’s idea of ‘knowledge of living’ (2018), I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

Translational research is a buzzword which dominates discussions about the quality, the utilization, and the benefits of medical research. Yet, although translational research has become a prominent topic, no commonly agreed definition of this terminology exists. Instead, experts from different contexts such as biomedical research, clinical practice or nursing discuss translational research in multiple ways depending on how they define the problem that translational research is supposed to be the solution to. In this paper, we do not seek to find (...) a ‘correct’ definition of translational research, but instead ask how actors using this terminology for describing their own research make sense of it. To do so, we asked three questions: Which actors are engaged in the debate about translational research? What kind of different meanings of translational research exist? And, which actors refer to which meaning of translational research when using the term? In answering these questions, we highlight the role this terminology plays in defining what medical science is about today. (shrink)

There is a conceptual crisis in the biomedical sciences that is particularly salient in psychopathology research. Underlying the crisis is a controversy that pertains to the current medical model of disease that largely draws from causal-mechanistic explanations. The bedrock of this model is the analysis of biological part-dysfunctions that aims at unequivocally defining a pathological condition and demarcating it from its neighboring entities. This endeavor has led to a quest for physiological, biochemical, and genetic signatures. Yet, so far (...) there is little evidence for reliable biomarkers for any mental disorder. The contemporary biomedical paradigm largely ignores historical, dynamic, and system-level aspects—a view that has contributed much to the conceptual disjunction of the patient as a person from his/her disease. Notwithstanding the impressive progress in the biomedical sciences, increasingly more critics question whether the constituting framework is sufficient to convey a comprehensive understanding of illnesses, especially mental illnesses. Thus, the medical model urgently requires an update. But rather than revamping it by methodological advancements, it will be necessary to critically review its philosophical roots. The most problematic issues that require reworking are: the preponderance of the biostatistical theory; the undue decoupling of physiological from evolutionary explanations of function; the clinging to the Modern Synthesis ; and the neglect of dynamic and system-level properties. The proposed overhaul requires the heeding of historical explanations that draw from the Extended Evolutionary Synthesis as well as systems biology approaches for tackling multilevel and dynamic phenomena of complex systems. (shrink)

I defend an empirically-oriented approach to the analysis and remediation of social injustice. My springboard for this argument is a debate—principally represented here between Tommie Shelby and Elizabeth Anderson, but with much deeper historical roots and many flowering branches—about whether racial-justice advocacy should prioritize integration (bringing different groups together) or community development (building wealth and political power within the black community). Although I incline toward something closer to Shelby’s “egalitarian pluralist” approach over Anderson’s single-minded emphasis on integration, many of Shelby’s (...) criticisms of integrationism are misguided, and his handling of the empirical literature is profoundly unbalanced. In fact, while both Shelby and Anderson defend the importance of social science to their projects, I’ll argue that each takes a decidedly unempirical approach, which ultimately obscures the full extent of our ignorance about what we can and ought to do going forward. A more authentically empirical tack would be more epistemically humble, more holistic, and less organized around what I’ll call prematurely formulated “Grand Unified Theories of Social Change.” I defend a more “diversified experimentalist” approach, which rigorously tests an array of smaller-scale interventions before trying to replicate and scale up the most promising results. (shrink)

I argue that Plato holds a medical model of virtue as health which does not have themorally unacceptable implications which have led some to describe it as authoritarian.This model, which draws on the educational virtues of the elenchos, lacks anyimplication that all criminals are mad or all mad people criminals – this implication beingat the source of many criticisms of Plato’s analogy of virtue and health. After setting upthe analogy and the model, I defend my argument against (...) two objections. The firstclaims that Plato's picture of virtue as health is unacceptable because it entails that vice isa defect and therefore that criminals are all mad. The second resists Kenny'sinterpretation but does so by attacking its first premise, i.e. that Plato believes virtue issome kind of health. I reply that both objections are misguided. (shrink)

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity (...) in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models. (shrink)