We understand the concept of thought in Arendt as part of the activities which for her constitute the human condition, even when she classifies it as vita contemplativa. Thought as an activity cannot be separated from the faculty of judging, which is crucial to the state of human reality in the wo..

Arthur Caplan has argued that the presumptive naturalness, universality, and inevitability of aging are no obstacles to conceptualizing aging as a disease since those traits are themselves merely contingent. Moreover, aging lends itself to discussion in terms of diagnostic symptomatology and etiology. Is aging therefore a disease? I argue that aging need not be shown to be unnatural or a disease in order to make it the subject of biomedical interest. I suggest that rather than ask "Is aging a disease?", (...) the better point of philosophical departure would be to ask "Is aging objectionable such that its prevention and cure ought to be sought?". In this way, the moral issues at stake emerge more clearly. Chief among these issues are the potential results of curing aging and the implications for the prospect of meaningful human life without the de facto limitations that aging (and perhaps death) put upon it. A convincing argument that aging should be cured, therefore, would need to show that human significance warrants and possibly seeks such a cure and that the social costs of curing aging are morally acceptable. Keywords: aging, disease, cure, immortality CiteULike Connotea Del.icio.us What's this? (shrink)

Psychotherapy is commonly described as a “talking cure,” a treatment method that operates through linguistic action and interaction. The operative specifics of therapeutic language use, however, are insufficiently understood, mainly due to a multitude of disparate approaches that advance different notions of what “talking” means and what “cure” implies in the respective context. Accordingly, a clarification of the basic theoretical structure of “talking cure models,” i.e., models that describe therapeutic processes with a focus on language use, is (...) a desideratum of language-oriented psychotherapy research. Against this background the present paper suggests a theoretical framework of analysis which distinguishes four basic components of “talking cure models”: (1) a foundational theory (which suggests how linguistic activity can affect and transform human experience), (2) an experiential problem state (which defines the problem or pathology of the patient), (3) a curative linguistic activity (which defines linguistic activities that are supposed to effectuate a curative transformation of the experiential problem state), and (4) a change mechanism (which defines the processes and effects involved in such transformations). The purpose of the framework is to establish a terminological foundation that allows for systematically reconstructing basic properties and operative mechanisms of “talking cure models.” To demonstrate the applicability and utility of the framework, five distinct “talking cure models” which spell out the details of curative “talking” processes in terms of (1) catharsis, (2) symbolization, (3) narrative, (4) metaphor, and (5) neurocognitive inhibition are introduced and discussed in terms of the framework components. In summary, we hope that our framework will prove useful for the objective of clarifying the theoretical underpinnings of language-oriented psychotherapy research and help to establish a more comprehensive understanding of how curative language use contributes to the process of ther-apeutic change. (shrink)

Baruch Spinoza’s (1632–77)Tractatus theologico-politicus (1669 or 1670) caused outrage across the Dutch Republic, for it obliterated the carefully installed separation between philosophy and theology. The posthumous publication of Spinoza’s Ethica, which is contained in his Opera posthuma (1677), caused similar consternation. It was especially the mathematical order in which the Ethica was composed that caused fierce opposition, for its mathematical appearance gave the impression that Spinoza’s heretical teachings were established demonstratively. In this essay, I document how the Dutch physician, local (...) politician, and amateur mathematician and experimenter Bernard Nieuwentijt (1654–1718) attempted to physico-mathematically and methodologically counter the threats posed by Spinoza’s program. Nieuwentijt tried to defend the authority of the scriptures in times at which they came under attack by the new philosophy and by the emerging sciences that were gradually winning terrain. The crux of his defense consisted in delineating a modest epistemology, a “learned ignorance,” that would cure Spinoza’s followers of their pansophical aspirations, on the one hand, and remove the conflict between the Bible and reason, on the other. The specific way in which he sought to accomplish this distinguished him from Dutch Reformed thought, or so I will argue. (shrink)

This chapter briefly discusses the history of the notion of "cure" in relation to serious mental illnesses from Pinel to the present day, including both theories on the nature of the illnesses and the nature of presumed therapeutic agents and mechanisms. The chapter then gives a brief overview of the notion of "recovery" in relation to serious mental illnesses, also from Pinel to the present day, and describes various definitions and forms of recovery as they have emerged over time. (...) With this historical and conceptual background in place, the chapter then takes up the present state-of-the-art in psychiatry in relation to both concepts of cure and recovery, considers the empirical and neuroscientific evidence available relative to each concept, and then suggests several directions for research and philosophical reflection as the field continues to evolve. Two guiding principles that shape this discussion are that mental illnesses are not one-dimensional phenomena, but may be made up of several loosely related components which each have their own natural course, and that mental illnesses do not typically take over the entirety of a person's functioning, but also leave other aspects of functioning relatively intact. The combination of these principles suggests that cure and recovery are not likely to be binary functions in relation to serious mental illnesses, but will more likely be more a matter of degree across multiple domains. (shrink)

In examining Hegel's and Kierkegaard's theories of language, I argue that both entail conceptions of the therapeutic power of language to heal us from madness and despair. I show that whereas Hegel quite straightforwardly celebrates the emancipatory power of language, Kierkegaard is more ambivalent; on the one hand, he devotes his life to a maieutic authorship in service of aiding the reader, but on the other, he believes that ultimately it is only faith in God that can cure us, (...) and that faith requires silence. I use Lacan's psychoanalytic account of the role of language to explore Hegel's view that language constitutes the self and Kierkegaard's experimentation with an indirect form of communication that he hopes will enable him to fulfill each of his apparently conflicting goals, to write and yet to remain silent. (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

An invigorating exploration of the pleasures and social benefits of conversation Talking Cure is a timely and enticing excursion into the art of good conversation. Paula Marantz Cohen reveals how conversation connects us in ways that social media never can and explains why simply talking to each other freely and without guile may be the cure to what ails our troubled society. Drawing on her lifelong immersion in literature and culture and her decades of experience as a teacher (...) and critic, Cohen argues that we learn to converse in our families and then carry that knowledge into a broader world where we encounter diverse opinions and sensibilities. She discusses the role of food in encouraging conversation, the challenges of writing dialogue in fiction, the pros and cons of Zoom, the relationship of conversation to vaudeville acts, and the educational value of a good college seminar where students learn to talk about ideas. Cohen looks at some of the famous groups of writers and artists in history whose conversation fed their creativity, and details some of the habits that can result in bad conversation. Blending the immediacy of a beautifully crafted memoir with the conviviality of an intimate gathering with friends, Talking Cure makes a persuasive case for the civilizing value of conversation and is essential reading for anyone interested in the chatter that fuels culture. (shrink)

It is argued that philosophers can contribute indirectly to the cure of psychopathology by helping to resolve problems that impede the development of effective treatments. Two such problems are discussed. The first arises because different schools of therapy use conflicting criteria in evaluating therapeutic outcomes. A theory of Defective Desires is developed to deal with this problem. The second issue, which divides the field of psychotherapy, concerns the need for experiments, especially in validating claims of therapeutic efficacy. An epistemological (...) foundation is developed to support the need for experiments. (shrink)

Nationalism can be closely associated with powerful feelings about the relationship among cultural heritage, identity and embodied experience. Almost by definition this relationship is expressed in terms of continuity, distinctiveness and the purity of tradition, to an extent that nationalistic sentiments can be said to be ‘visceral.’ Contrasting the way in which the body is implicated in nature cure and Ayurveda, two forms of medicine closely linked to nationalism in India, this article presents an analytical perspective on the embodiment (...) of viscerality to provide a more nuanced understanding of how these experiences blur distinctions of cultural continuity and how an ecology of the body shapes the cultural politics of tradition in India. (shrink)

Les sages-femmes en France incarnent une subtile synthèse du cure et du care, entretenant une ambiguïté qui fonde une partie de leur identité professionnelle et qui brouille les pistes des stéréotypes de genre. En fonction du contexte social et politique qui conditionne leur mode d’exercice, ces professionnel.le.s développent spontanément des stratégies pour équilibrer les tensions qui existent entre ces deux pôles. Elles/ils vont ainsi promouvoir tantôt leurs compétences dans le care comme valeur ajoutée par rapport aux autres acteurs médicaux, (...) tantôt leur expertise médico-technique et leur autonomie de pratique, affirmant ainsi leur appartenance au monde médical et scientifique. Cet article s’inscrit dans une double approche d’analyse en sciences sociales et d’expérience professionnelle de trente années en tant que sage-femme. (shrink)

Written with a rare combination of multidisciplinary expertise and personal passion, "The Cure of Souls" is a sociocultural investigation into the role and impact of the practice of psychotherapy in the modern world. The author argues against the "medicalization" of the field in favor of a values-oriented understanding of psychotherapy's role in our culture.

This thesis shows what we may learn about ancient Pyrrhonian scepticism, Indian Madhyamaka Buddhism, and their potential as philosophical therapy, by examining the two traditions in conjunction. It aims to accomplish three goals: present a robust comparison of Pyrrhonism and Madhyamaka; demonstrate that significant insights may be gained from this juxtaposition; and show that these two traditions challenge current ways of doing philosophy. -/- The thesis starts by examining the preconditions of fruitful cross-cultural research; it is shown that ascribing too (...) much or too little importance to context (radical relativism and universalism, respectively) is problematic. Previous comparisons of Pyrrhonism and Madhyamaka have paid little attention to such methodological considerations, which has led to crucial shortcomings. This is unfortunate, because their remarkable parallels demand a representative, accessible overview. Having laid the necessary foundations, the thesis presents such an overview. A therapeutic framework is employed to systematically compare the two traditions, including their diagnoses of disturbance, their proposed cures, and their promised cured conditions. Such themes allow for systematically outlining their similarities and differences and to limit arbitrariness and bias. -/- Despite their striking similarities, very few attempts have been made to learn about Pyrrhonism and Madhyamaka by studying them in conjunction. This thesis corrects this oversight by demonstrating that such cross-cultural research enables us to shed new light on persistent ambiguities and allows us to bolster and defend both traditions. For example, it is demonstrated that Madhyamaka can shine a new light on one of the, if not the most vexed question regarding Pyrrhonism: what is the scope of suspension of judgment? -/- Finally, this thesis shows that Pyrrhonism and Madhyamaka challenge the practice of philosophy itself. It is demonstrated that contemporary schools of thought akin to Pyrrhonism and Madhyamaka may share their therapeutic potential. If so, then certain contemporary philosophies are able to alleviate distress and instil a sense of tranquillity. This means we must expand our understanding of what philosophy can do. After all, if contemporary philosophy can change our experience of the world for the better, it has a much greater potential than is currently believed—both in terms of audience and impact. (shrink)

This paper sheds light on the shift that is taking place from the practice of ‘coding’, namely developing programs as conventional in the software community, to the practice of ‘curing’, an activity that has emerged in the last few years in Deep Learning (DL) and that amounts to curing the data regime to which a DL model is exposed during training. Initially, the curing paradigm is illustrated by means of a study-case on autonomous vehicles. Subsequently, the shift from coding to (...) curing is analysed taking into consideration the epistemological notions, central in the philosophy of computer science, of function, implementation, and correctness. First, it is illustrated how, in the curing paradigm, the functions performed by the trained model depend much more on dataset curation rather than on the model algorithms which, in contrast with the coding paradigm, do not comply with requested specifications. Second, it is highlighted how DL models cannot be considered implementations according to any of the available definitions of implementation that follow an intentional theory of functions. Finally, it is argued that DL models cannot be evaluated in terms of their correctness but rather in their experimental computational validity. (shrink)

The development of gene therapy has always come with the expectation that it will offer a cure for various disorders, of which hemophilia is a paradigm example. However, although the term is used regularly, it is unclear what exactly is meant with “cure”. Therefore, the aim of this paper is to analyse how the concept of cure is used in practice and evaluate which of the interpretations is most suitable in discussions surrounding gene therapy. We analysed how (...) cure is used in four different medical fields where the concept raises discussion. We show that cure can be used in three different ways: cure as normalization of the body, cure as obtaining a normal life, or cure as a change in identity. We argue that since cure is a practical term, its interpretation should be context-specific and the various uses can exist simultaneously, as long as their use is suitable to the function the notion of cure plays in each of the settings. We end by highlighting three different settings in the domain of hemophilia gene therapy in which the term cure is used and explore the function(s) it serves in each setting. We conclude that in the clinical application of gene therapy, it could be better to abandon the term cure, whereas more modest and specified definitions of cure are required in the context of health resource allocation decisions and decisions on research funding. (shrink)

Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, (...) deserve attention; as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely. (shrink)

This book is a philosophical examination of the mysteries surrounding the foundations of science, philosophy, and religion. Much of Western philosophy and science is discussed in order to see our epistemological and metaphysical situation. The love/hate relation philosophers have with mystery is explored and the importance of mystery is reaffirmed.

Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; (...) and third, participants’ understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as (...) a biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

The article argues that Dewey's _Art as Experience_ is one of just four foundational texts in Western aesthetics, which break down into two oppositions: Plato's _Republic_ versus Aristotle's _Poetics_ and Kant's _Critique of Judgment_ versus _Art as Experience_. It points out that Dewey's book, after decades of neglect, has helped give rise to a number of rich aesthetic subdisciplines, including everyday aesthetics, environmental aesthetics, somaesthetics, and political aesthetics.

SEXUALITY IN THE ANALYTICAL CURE TALK LOVE TO ME Given the freedom of tone that is the rule, we might well imagine that the analytical session moves on to talk about sexuality. In fact, it is not so much sexuality that is addressed as sex, and sex in the sense of identity, to describe what assigns the subject within a gender or in the other. The article shows that sex, indeed, is not just a partial object, of the phallic (...) type, or a genital organ, but also an object of the ideal type embodying the potentialities specific to each of the two sexes. This explains why, in analysis, the ideal sexuality, based on that idealisation of sex, prevails outright over the two other forms. In “transfer love”, the analyst or the analysis firstly embody the ideals in question and it becomes problematic if the analysand does not manage to detach them from their person or from the situation, so as to invest them in full knowledge – a necessary evolution too in married life. (shrink)

It’s well known that one way to cure a hangover is by a “hair of the dog” — another alcoholic drink. The drawback of this method is that, so it would appear, it cannot be used to completely cure a hangover, since the cure simply induces a further hangover at a later time, which must in turn either be cured or suffered through.

In this paper, I shall argue that during the period from the end of World War II until just before the Islamic revolution of 1979, a body of literature emerged critiquing the petro-colonialism of the United States and select European countries, which infected Iran with a severe case of “occidentosis.” This set the stage for the revolution, and a presentation of the principle author of occidentosis, Jalal Al-e Ahmad, will facilitate understanding of the Iranian intellectual tradition.

About a week after Maran Wolston was prescribed Copaxone, a drug for multiple sclerosis, she got a phone call from a nurse at an organization called Shared Solutions. The organization was familiar to Wolston; when her neurologist had asked permission to share her health information with Shared Solutions, Wolston had agreed, assuming it was connected to her health insurance.The nurse who called Wolston was checking in to see how the treatment was going. It was not going well. While Copaxone is (...) not typically associated with some of the unpleasant side effects of other MS drugs, it does have at least one serious drawback: the drug must be injected every day. The injections can be brutally painful. “No matter where I injected the drug each day, the injection site swelled up into a huge welt and felt like a gigantic bee sting,” Wolston writes. (shrink)

Volume 19, Issue 12, December 2019, Page 66-68.

In “Prediction, Understanding, and Medicine,” Alex Broadbent rejects the curative thesis, the view that the core medical competence is to cure, in favor of his predictive thesis that the main intellectual medical competence is to explain and the main practical medical competence is to predict. Broadbent thinks his account explains the phenomenon of multiple consultation, which is the fact that people persist in consulting alternative medical traditions despite having access to mainstream medicine. I argue that Broadbent’s explanation of multiple (...) consultation makes sense only from the perspective of patients who migrate from mainstream to alternative consultation. His explanation is not as convincing when we consider alternative-to-mainstream migration. I also provide an argument against Broadbent’s view that prediction is medicine’s main practical competence and argue that, when it comes to explaining most cases of multiple consultation, the curative thesis provides a more convincing explanation than the predictive thesis. (shrink)

Curing Mad Truths, a short collection of essays and lectures, is Rémi Brague's plea for ‘some sort of return to the Middle Ages’ (p. 5) in the teeth of the ideology of Modernity which, he posits, t...

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)

Substance addiction has been historically conceived and widely researched as a brain disease. There have been ample criticisms of brain-centred approaches to addiction, and this paper aims to align with one such criticism by applying insights from phenomenology of psychiatry. More precisely, this work will apply Merleau-Ponty’s insightful distinction between the biological and lived body. In this light, the disease model emerges as an incomplete account of substance addiction because it captures only its biological aspects. When considering addiction as a (...) brain disorder, it will be shown that research fails to account for the contextual, functional, and emotional aspects inherent to subjective health. It is concluded that, while the disease model is fundamental to our understanding of what happens in the brain, its brain-centred approach is cure-oriented. Instead, we suggest a care-orientated approach, which understands and treats the psychological feel as bodily experience situated in an environment, allowing for a more encompassing therapeutic perspective. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Talking Cures, the Clinic, and the Value of the IneffableDaniel Berthold (bio)KeywordsMadness, disease, the normal, the abnormal, the ineffable, Hegel, Kierkegaard, LacanI am most grateful to my readers, James Phillips and Louis Sass, who have led me to several new insights by suggesting ways of complicating my reading of a Lacanian approach to Hegel's and Kierkegaard's conceptions of madness. I am a Kierkegaard and Hegel scholar, with very little (...) pretense to expertise about Lacan and regrettably even less about the theory and practice of psychiatry. In submitting my essay to Philosophy, Psychiatry, & Philosophy, I was hoping to entice a community of practitioners and theoreticians I have great respect for to consider the musings of a philosopher on topics which engage them as thinkers and actors in their professions. I could not possibly have hoped for more intelligent and provocative replies than I have been given by my two respondents.Phillips' framing of his response in terms of the distinction between the "madness of the philosophers" and the "madness of the clinic" is very helpful. It is a distinction that is indeed central to the question of the possibility of dialogue between philosophers and clinicians—so central, in fact, that it is generous of Phillips not to reproach me for failing to mention it. On the one hand, the challenge for philosophers is to show that their descriptions are not merely metaphoric and that their preoccupation with the dark side of human experience connects in some way with the reality of disease, so that there is some way for clinicians to translate their language into the language of psychiatry. Otherwise, philosophers will have only poetic or literary interest for the psychiatrist or psychologist.On the other hand, the challenge for clinicians is the extent to which they are open to moving beyond a reduction of "mental illness" to a purely biological conception of disease. One needn't go so far—nor should we—as Thomas Szasz or Michel Foucault in seeing "mental disease" as itself merely a metaphor. But granting the evidence of underlying organic disorder, symptoms nevertheless display themselves as mental and behavioral states (what Hegel calls "shapes of consciousness") that, as Hegel argued, are paralleled in "normal" experience, so that the distinction between disease and normality (and hence illness and metaphor) is often elusive. Madness "has the healthy consciousness for its presupposition," Hegel writes, because the healthy mind is still grappling with the same sorts of contradictions and feelings of alienation, the same "infinite pain" which characterizes insanity. Madness is not the absolute "other" of rationality, but an echo of it (1978, 3:382, 408).Hegel himself accepted the medicalization of madness that began to occur in the late eighteenth [End Page 325] century, and rejected the metaphysical and theological categories of what was called "romantic medicine." But he also cautioned against the narrowness of the "somatic" school which he felt lacked sufficient explanatory value if not connected to a "speculative" (i.e., philosophic) framework (see Berthold-Bond 1995, ch. 2).It might even be argued that every person seeking therapy is first of all suffering from "philosophic" madness, at least in the sense that initially she does not understand her own suffering as "disease," but experiences her torment in the vocabulary of the philosopher. Thus the philosopher's descriptions are the closest to the subject's own self-understanding, and while the therapist must seek to rephrase these descriptions into the vocabulary of the clinic (just as Hegel, for example, translated his own philosophic description of the madness of his friend Hölderlin in the Phenomenology as the "lost soul" whose "light dies away within it" into the medical category of Wahnsinn—mania or frenzy, which today we would call schizophrenia—in the classificatory scheme of mental disorder he gives in the Encyclopaedia; 1977, 400; 1978, 408)—there is a real question about which vocabulary is a metaphor for the other.The second main point Phillips addresses, which is taken up in different ways by Sass as well, has to do with the relation between speech and silence in madness. Phillips finds that Kierkegaard offers a more complex and subtle view than... (shrink)

Through expanded access protocols, the Food and Drug Administration (FDA) allows patients with serious or immediately life-threatening diseases access to experimental drugs outside the clinical trial setting when no satisfactory alternative treatment is available. While the FDA has established a mechanism for providing patients with unapproved drug access, the regulations do not require the pharmaceutical company to provide the drug. The drug company’s permission to use its experimental drug is a necessary prerequisite to using the FDA’s expanded access mechanism. Increasingly, (...) drug companies are coming under scrutiny regarding the programs governing that decision-making power. Historically, disclosing whether a company has an expanded access program, and whether or how it would respond to an expanded access request, has been left to discretion of the drug companies themselves. Few manufacturers publish adequate expanded access protocols. As a result, patients were provided with little insight into how companies evaluate expanded access requests and are naturally skeptical as to the ethical integrity of the process. The recently passed 21st Century Cures Act changes that practice by requiring drug companies to have, and make publically available, their expanded access procedures including criteria for evaluating and responding to patient requests. In this article, we contend that complying with the new transparency provisions will require drug companies to respond to several unresolved expanded access issues. Namely, how to reconcile a patient’s desire to access lifesaving experimental therapies alongside the company and society’s interest in the efficient development of new drugs. Even more challenging, how can companies devise practices for evaluating and processing expanded access requests that also fairly and equitably acknowledge those concerns? In addressing these questions, this article explores the legal, regulatory, business, and societal influences that have shaped expanded access policies and practices. From there, we provide companies a framework that balances appropriately the desires of individuals and gaining the requisite approvals ensure access not just for one person but for society. (shrink)

Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV (...) treatment and research to inform consent processes for cure research. In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions. Thematic analysis of transcribed IDIs and FGDs was conducted. The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research. (shrink)

Two cases of carcinoma of the stomach presenting during the same month and dying within four weeks of one another less than one year later are presented. One was treated symptomatically and the other received radical surgery. The care they received depended on decisions about diagnosis and treatment; the outcomes of these and the difficulties involved in evaluating monetary costs and quality of care are discussed in the light of recent interest in medical audit.