Interactions between medicine and the pharmaceutical and device industries have become widespread in medicine. Despite their promise for improving patient care through innovation, there are ways in which these relationships may compromise patient care by creating conflicts of interest for physicians—both actual and perceived—that may result in delivery of poorly justified treatment, mistrust of doctors by the public, and an undermining of the integrity of the medical profession (IOM 2009). Conflicts of interest can arise in all arenas of medicine, due (...) to discord between the responsibility to patients and the opportunity for personal financial gain. But academic medicine presents an additional interest to protect: .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 53-55 [Access article in PDF] A Pragmatic Consideration of the Relation between Depression and Melancholia David H. Brendel THE MELANCHOLIA OF THE PAST and the major depression of the present are extraordinarily complex notions that represent different things to different people. With her compelling article "Is This Dame Melancholy? Equating Today's Depression and Past Melancholia," Jennifer Radden makes an important contribution (...) to the debate on whether these concepts are identical, overlapping, or distinct. Exploring both conditions from descriptive and causal points of view, Radden appropriately concludes that fully equating the two of them would constitute a "troubling oversimplification." Her line of reasoning runs as follows. Because past descriptions of melancholia and current descriptions of major depression are marked by dissimilarities (such as the genius and creativity associated with the former and the self-loathing and emphasis on loss associated with the latter), only an underlying causal base common to both conditions would justify our equating them. But the cause (or causes) of melancholia and depression remain mysterious. Thus, although Radden acknowledges that a causal explanation might yield substantial benefits ("research possibilities, further hypotheses, and even hope of prevention, or cure"), she suggests that we remain in a descriptive mode when comparing the two conditions and conclude that they are not one and the same.Radden's argument that past melancholia and contemporary depression are descriptively distinct is convincing and, I think, indisputable. But I would like to challenge and expand upon some of her ideas about considerations of causality and about the role of pragmatic reasoning in working out the relation between melancholia and depression. First of all, although Radden is correct that the cause of many (or perhaps most) depressive states is unknown, she underrates the extent of the empirical knowledge that we have acquired about the causation of depression and, in so doing, undervalues the relevance of causal reasoning to making the melancholia/depression distinction. Recent empirical research has revealed that major depressive episodes can result from brain lesions such as left-sided strokes or metabolic disorders such as hypothyroidism (Yudofsky and Hales 2002). Psychosocial research, moreover, has suggested that stressful life events also can be understood as causes of depression (Kendler, [End Page 53] Karkowski, and Prescott 1999). These findings provide some hope that the identification of causes of various clinical states is a real possibility. Identification of such causes, I believe, could empower us to make some plausible claims about the similarities or differences between past melancholia and current depression. A melancholic individual like van Gogh, for example, had a different illness than a contemporary stroke patient with major depression in a present-day hospital, not only on the basis of descriptive distinctions between their conditions, but also on the basis of the causes of their respective states. Although of course we cannot know the cause of van Gogh's melancholia, we can reasonably assume that it was not the result of a left-sided stroke due to the absence in his case of other clinical deficits that usually result from such a stroke (such as language and motor deficits). Plausible assertions about the causes of melancholic and depressive states would add to the robustness of any claims regarding the distinctness of the conditions.Conversely, careful consideration of the etiology of various clinical presentations might prompt us to hypothesize a shared pathophysiology and thereby lead us to believe that they are essentially identical conditions. It is difficult or impossible to discover a cause of melancholia in individuals who lived in past eras. But we might achieve our goal by comparing well-defined major depression to various forms of what Radden calls "masked depression," such as those seen in cross-cultural settings, where the subjective symptoms of sad mood are absent but numerous somatic signs of depression are observed. If it turned out that major depression and masked depression had the same cause, then differences in their clinical phenomenology would become merely surface differences that belie a shared etiological process. How might one discover the existence of such a process... (shrink)

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for diagnostic and therapeutic paradigm (...) choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond EngelClinical Pragmatism as the Foundation of Psychiatric PracticeDavid H. Brendel (bio)Keywordsbiopsychosocial model, pluralism, pragmatism, psychiatryFor many years now, there has been growing recognition of the powerful role of pragmatic reasoning in numerous disciplines, including bioethics, medicine, law, political science, and philosophy (Dickstein 1998; Rosenthal, Hausman, and Anderson 1999). But until recently, philosophical pragmatism was neglected by scholars exploring the clinical challenges and theoretical underpinnings of psychiatry. In (...) his noteworthy article The Biopsychosocial Model and Philosophic Pragmatism: Is George Engel a Pragmatist?, Bradley Lewis offers a significant contribution to the small but gradually increasing literature in this area. Lewis appropriately presents Engel as a major figure in twentieth-century American medicine and psychiatry, a critic and a visionary who dared to question the dominant paradigm of biomedical reductionism (Engel 1977)—a paradigm that led to important scientific advances, but also restricted the physician’s understanding of the patient as a complex individual with an inner world and interpersonal relationships. Lewis argues that medicine and psychiatry a generation after Engel’s seminal 1977 paper can be revitalized by reinterpreting Engel in the intellectual tradition of classical American pragmatism and neo-pragmatism. Placing Engel in the pragmatic tradition, Lewis suggests, could enhance the biopsychosocial model and have substantial benefits for both individual patients and society as a whole.There is no disputing Lewis’s argument that a pragmatic philosophy of medicine and psychiatry is a noble goal. In fact, in my book Healing Psychiatry: Bridging the Science/Humanism Divide (Brendel 2006), I present philosophical pragmatism as the most compelling theoretical approach to clinical psychiatry in the twenty-first century—the approach that is most likely to empower the clinician and the patient to collaboratively develop a treatment plan that heeds the multidimensional complexity of the patient’s life, recognizes the confusion and uncertainty that grows out of this complexity, and aims for a favorable therapeutic outcome. Drawing on work of the classical American pragmatists and contemporary pragmatic bioethicists, I identify four dimensions of philosophical pragmatism that provide a sound foundation for clinical work, which I call the “four ps”: (1) diagnostic formulations and treatment plans in psychiatry are practical insofar as they focus on results rather than a commitment to any particular theory; (2) they are pluralistic [End Page 311] insofar as they incorporate explanatory concepts that span the biopsychosocial spectrum; (3) they are participatory and collaborative, not imposed authoritatively by the clinician; and (4) they are provisional, open-ended, and malleable to newly acquired information and evolution of the patient’s condition.Lewis casts Engel as a philosophical pragmatist who battled the Goliath of biomedical reductionism that had come to dominate American medicine and psychiatry in the latter half of the twentieth century. Unfortunately, however, regardless of how elegantly Lewis reinterprets Engel, he cannot render him a full-blown pragmatist for the medicine and psychiatry of the twenty-first century. Lewis provides quotations to suggest that Engel valued a results-oriented clinical sensibility, for example “the value of a scientific model is measured not by whether it is right or wrong but by how useful it is” (Engel 1980). But Engel was not fully committed to clinical outcome as the supreme judge of theory in medicine and psychiatry. Lewis notes that Engel understood the biopsychosocial model as less “a matter of compassion and humanity” and more a matter of “rigorous application of the principles and practices of science”; he was a man of his time who could not fully escape the scientism of the day. Working within this scientistic world, he distinguished himself by reintroducing psychological, sociological, and humanistic concepts into clinical medicine, which had become obsessed with the power and robustness of the natural sciences but had neglected the suffering human subject and the social context of illness. Engel undoubtedly hoped the biopsychosocial model would lead to better clinical results but, unlike the classical American pragmatists and contemporary pragmatic bioethicists, he did not make a systematic case for privileging clinical outcome above strict adherence to scientific theory.In fact, Engel’s biopsychosocial model runs the risk of becoming a reified end in itself; those who unquestioningly espouse its basic tenets are in danger of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychophysical Causation and a Pragmatist Approach to Human BehaviorDavid H. Brendel (bio)Keywordsmind-body problem, philosophy, pragmatism, psychology, psychophysical causationJochen Fahrenberg and Marcus Cheetham have performed a valuable service by conducting and presenting an empirical study of some basic philosophical assumptions of psychologists, philosophers, and scientists. Well-designed, large-scale empirical studies of this kind are all too rare in the literature. Those of us interested in the human sciences are rather (...) in the dark about the assumptions of others working in our own and related fields. For the most part, we are privy only to the philosophical assumptions of friends and colleagues we know intimately and of those relative few who publish their views. We can only speculate about the views of the countless others with whom we have not had the opportunity to establish direct philosophical discourse. The findings presented by Fahrenberg and Cheetham give us an intriguing glimpse at some of the key philosophical assumptions of a variety of clinicians and academics who are interested in human nature and the human sciences.My aim in this commentary is to present an interpretation of a central finding of this questionnaire study: that psychologists were more likely than philosophers and scientists to embrace “psychophysical causation” as a part of their philosophical worldview. It is not, I think, too much of an oversimplification to define psychophysical causation as the presumption that mental events and physical events can cause other mental events and physical events. Psychophysical causation can be distinguished from other positions on the mind–body relation, some of which Fahrenberg and Cheetham mention in their article. Among these alternative positions is epiphenomenalism, the position that physical events cause other physical events and can cause mental events, but that mental events themselves have no causal power. Another philosophical position distinct from psychophysical causation is monism, which holds that all events in the world in general (and in human beings in particular) are physical and are best described in physical terms. Fahrenberg and Cheetham do not describe the multiple forms of monism in detail, but it is worth noting that reductive materialism (Wilson 1998) and eliminative materialism (Churchland 1981) are two highly developed forms of the kind of monism to which they allude. It is beyond the scope of this commentary to explore the differences between the two, but suffice it to say that both these forms of materialism reject the legitimacy of mental [End Page 205] events or the mental vocabulary that refers to such events.It is also beyond the scope of this commentary to advance arguments either for or against psychophysical causation in the philosophy of mind. The concept of psychophysical causation certainly has multiple proponents among philosophers, including those who are ontological monists. The compelling nonreductive materialism of a philosopher such as Terence Horgan, for example, suggests the viability of combining ontological monism with methodological pluralism. In a book chapter entitled “Nonreductive Materialism and the Explanatory Autonomy of Psychology,” Horgan (1993) developed the position that the world is entirely physical (i.e., there are no disembodied minds, persons, or other entities) but is so complex that it can only be understood and explained by employing many vocabularies and methodologies, spanning “the microphysical, neurobiological, macrobiological, and psychological.” This kind of methodological pluralism in the philosophy of mind can be disputed on conceptual grounds, but it seems to be at least as justifiable (and perhaps more justifiable) when compared with other well-defined positions on the mind–body relation.The appeal of nonreductive materialism and psychophysical causation comes into particularly clear focus in contexts where our philosophical concerns are pragmatic in nature. In other words, when we need to achieve practical goals in our everyday lives, we usually benefit from a philosophy that provides us with the flexibility to use a broad range of ideas, conceptual tools, and causal hypotheses that can be adapted to specific needs and challenges. Nonreductive materialism regards the world as a purely physical place, but ensures this kind of conceptual and methodological flexibility when it comes to explaining and predicting complex human experience and behavior. “Typically, certain context-relative features of discourse,” Horgan wrote (1993, 298), “will determine, in a given... (shrink)

Relationships between patients and psychiatrists are shaped by a complex array of factors. The clinical experience centers on diagnostic and treatment decisions occurring in the context of a structured relationship that is regulated by principles of professional ethics and personal boundaries. At the same, however, patients and psychiatrists are unique and autonomous agents with emotional responses to one another that may evoke a wish for a personal friendship or other sorts of personal relationships that are outside the bounds of the (...) usual professionally defined structures. Negotiating the tension between the need for professional regulation and the desire for developing a friendship with certain patients can present clinical and ethical challenges in psychiatric practice. Pragmatist reasoning can help the psychiatrist and patient to successfully negotiate the dilemma that may arise when either or both of them wishes to develop a personal friendship but still adhere to the ethical tenets of the patient/psychiatrist professional dyad. (shrink)

Richard Dawkins has a dilemma when it comes to design arguments. On the one hand, he maintains that it was Darwin who killed off design and so implies that his rejection of design depends upon the findings of modern science. On the other hand, he follows Hume when he claims that appealing to a designer does not explain anything and so implies that rejection of design need not be based on the findings of modern science. These contrasting approaches lead to (...) the following dilemma: if he claims that Darwinism is necessary for rejecting design, he has no satisfactory response to design arguments based on the order in the laws of physics or the fine-tuning of the physical constants; alternatively, if Humean arguments are doing most of the work, this would undermine one of his main contentions, that atheism is justified by science and especially by evolution. In any case, his Humean arguments do not provide a more secure basis for his atheism because they are seriously flawed. A particular problem is that his argument for the improbability of theism rests on a highly questionable application of probability theory since, even if it were sound, it would only establish that the prior probability of God’s existence is low, a conclusion which is compatible with the posterior probability of God’s existence being high. (shrink)

At least since Descartes, philosophers have been interested in the special knowledge or authority that we exhibit when we speak about our own thoughts, attitudes, and feelings. This book contends that even the best work in contemporary philosophy of mind fails to account for this sort of knowledge or authority because it does not pay the right sort of attention to the notion of expression. What's at stake is not only how to understand self-knowledge and first-person authority, but also what (...) it is that distinguishes conscious from unconscious psychological states, what the mental life of a nonlinguistic animal has in common with our sort of mental life, and how to think about Wittgenstein's legacy to the philosophy of mind. (shrink)

This is the first sustained, whole-Bible treatment on the theme of meeting God face to face. Starting with Genesis and ending with Revelation, the author systematically covers the major events in salvation history, all of which reveal the beauty of encountering God's grace in abundance.

I revise J L Mackie's first account of casual direction by replacing his notion of "fixity" by a newly defined notion of "sufficing" that is designed to accommodate indeterminism. Keeping Mackie's distinction between casual order and casual direction, I then consider another revision that replaces "fixity" with "one-way conditionship". In response to the charge that all such accounts of casual priority beg the question by making an unjustified appeal to temporal priority, i maintain that one-way conditionship explains rather that assumes (...) objective temporal dependence as well as objective casual dependence. (shrink)

Freud is often assumed to have given an explanation of how human beings acquire a morality, especially as it is manifested in the phenomenon of moral conscience. Freud himself certainly lends credence to such an interpretation of his theory, as the following passage testifies.

Critics of the conventional theory of biological evolution have asserted that while natural processes might result in some limited diversity, nothing fundamentally new can arise from “random” evolution. In response, biologists like Richard Dawkins have demonstrated that a computer program can generate a specific short phrase via evolution-like iterations starting with random gibberish. While such demonstrations are intriguing, they are flawed in that they have a fixed, prespecified future target, whereas in real biological evolution there is no fixed future target, (...) but only a complicated “fitness landscape.” In this study, a significantly more sophisticated evolutionary scheme is employed to produce text segments reminiscent of a Charles Dickens novel. The aggregate size of these segments is larger than the computer program and the input Dickens text, even when comparing compressed data. (shrink)

Hume, in "An Enquiry Concerning Human Understanding", holds (1) that all causal reasoning is based on experience and (2) that causal reasoning is based on nothing but experience. (1) does not imply (2), and Hume's good reasons for (1) are not good reasons for (2). This essay accepts (1) and argues against (2). A priori reasoning plays a role in causal inference. Familiar examples from Hume and from classroom examples of sudden disappearances and radical changes do not show otherwise. A (...) priori causal reasoning is closely related to understanding causal mechanisms. One uncovers the intelligibility of a causal process by understanding its mechanism. (shrink)

In "Causes and "If P, Even If X, still Q," Philosophy 57 (July 1982), Ted Honderich cites my "The Direction of Causation and the Direction of Conditionship," journal of Philosophy 73 (April 22, 1976) as an example of an account of causal priority that lacks the proper character. After emending Honderich's description of the proper character, I argue that my attempt to account for one-way causation in terms of one-way causal conditionship does not totally lack it. Rather than emphasize the (...) singularity of an effect, as Honderich does, I emphasize the multiplicity of independent factors in a causal circumstance. (shrink)

McTaggart argues that the A series, which orders events with reference to past, present, and future, involves an inescapable contradiction. The significant difference between the earlier version of his argument (Mind, 1908) and the version in The Nature of Existence, Volume II, Chapter 33 (1927), has often gone unnoticed. His arguments are all invalid; the conclusion can be rejected without rejecting any premiss. It is therefore unnecessary to adopt any philosophical thesis about time (e.g., that some token-reflexive analysis of tensed (...) statements is adequate) to avoid McTaggart's final conclusion that time is unreal. (shrink)

In this paper I discuss what triage is and how it might be applied to the preservation of endangered species. I compare the suggested application oftriage to endangered species with its application to wartime military practice, distribution of food aid, and human population control to show that the situation of endangered species is not analogous to these other suggested uses. I argue that, as far as species preservation is concemed, triage starts with the wrong norms and values: it is “human (...) chauvinistic,” giving primacy to economic, political, and sociocultural aspects that emphasize human interests without recognizing the connection between the survival of other species and the survival of humans. (shrink)

This new edition includes three new chapters, updating the book to take into account developments in the field over the past fifteen years.

For a stable visual world, the colours of objects should appear the same under different lights. This property of colour constancy has been assumed to be fundamental to vision, and many experimental attempts have been made to quantify it. I contend here, however, that the usual methods of measurement are either too coarse or concentrate not on colour constancy itself, but on other, complementary aspects of scene perception. Whether colour constancy exists other than in nominal terms remains unclear.

We present a set of algorithms for automated simplification of symbolic constants of the form ∑iαixi with αi rational and xi complex. The included algorithms, called SimplifySum2 and implemented in Mathematica, remove redundant terms, attempt to make terms and the full expression real, and remove terms using repeated application of the multipair PSLQ integer relation detection algorithm. Also included are facilities for making substitutions according to user-specified identities. We illustrate this toolset by giving some real-world examples of its usage, including (...) one, for instance, where the tool reduced a symbolic expression of approximately 100 000 characters in size enough to enable manual manipulation to one with just four simple terms.2Available from https://github.com/alexkaiser/SimplifySum. (shrink)

Erdelyi's dialectical repression theory attempts to reconcile what appear to be incompatible perspectives in the contentious area of memory for trauma. He partially succeeds and makes a strong case that repression is “an empirical fact,” but makes a weaker case that distortions and omissions are due to the same mechanism and that recovered memories are necessarily unreliable. Available data do not suggest that the return of the repressed is any less accurate than the return of the non-repressed.

Ex nihilo nihil fit: PHILOSOPHY'S "STARTING POINT" Periodically, philosophers have had the feeling that somehow the entire weight of the traditional ...

Naive mereology studies ordinary, common-sense beliefs about part and whole. Some of the speculations in this article on naive mereology do not bear directly on Peter van Inwagen's "Material Beings". The other topics, (1) and (2), both do. (1) Here is an example of Peter Unger's "Problem of the Many". How can a table be a collection of atoms when many collections of atoms have equally strong claims to be that table? Van Inwagen invokes fuzzy sets to solve this problem. (...) I claim that an alternative treatment of vagueness, supervaluations over many-value valuations, provides a better solution. (2) The Special Composition Question asks how parts compose a whole. One who rejects van Inwagen's answer in terms of constituting a life need not provide some alternative answer. Even if all answers to the Special Question fail, there are a multitude of less general composition questions that are not so difficult. (shrink)

A primary purpose of argument is to increase the degree of reasonable confidence that one has in the truth of the conclusion. A question begging argument fails this purpose because it violates what W. E. Johnson called an epistemic condition of inference. Although an argument of the sort characterized by Robert Hoffman in his response (Analysis 32.2, Dec 71) to Richard Robinson (Analysis 31.4, March 71) begs the question in all circumstances, we usually understand the charge that an argument is (...) question begging with reference to the beliefs of the person, or the sort of person, to whom the argument is directed. (shrink)

In the form of inference known as inference to the best explanation there are various ways to characterise what is meant by the best explanation. This paper considers a number of such characterisations including several based on confirmation measures and several based on coherence measures. The goal is to find a measure which adequately captures what is meant by 'best' and which also yields the truth with a high degree of probability. Computer simulations are used to show that the overlap (...) coherence measure achieves this goal, enabling the true explanation to be identified almost as often as an approach which simply selects the most probable explanation. Further advantages to this approach are also considered in the case where there is uncertainty in the prior probability distribution. (shrink)

We present a conceptual framework on the experience of time and provide a coherent basis on which to base further inquiries into qualitative approaches concerning time experience. We propose two Time-Layers and two Time-Formats forming four Time-Domains. Micro-Flow and Micro-Structure represent the implicit phenomenal basis, from which the explicit experiences of Macro-Flow and Macro-Structure emerge. Complementary to this theoretical proposal, we present empirical results from qualitative content analysis obtained from 25 healthy participants. The data essentially corroborate the theoretical proposal. With (...) respect to Flow, the phenomenally accessible time experience appeared as a continuous passage reaching from the past through the present into the future. With respect to Structure, the individual present was embedded in the individual biography, emerging from past experiences and comprising individual plans and goals. New or changing plans and goals were being integrated into the existing present, thus forming a new present. The future appeared as changeable within the present, by means from the past, and therefore as a space of potential opportunities. Exemplarily, we discuss these results in relation to previous empirical findings on deviant experiences of time in Autism Spectrum Disorder that is presumably characterized by a breakdown of Flow and concomitant compensatory repetition resulting in an overly structured time. Finally, we speculate about possible implications of these findings both for psychopathological and neuroscientific research. (shrink)

This paper considers an application of work on probabilistic measures of coherence to inference to the best explanation. Rather than considering information reported from different sources, as is usually the case when discussing coherence measures, the approach adopted here is to use a coherence measure to rank competing explanations in terms of their coherence with a piece of evidence. By adopting such an approach IBE can be made more precise and so a major objection to this mode of reasoning can (...) be addressed. Advantages of the coherence - based approach are pointed out by comparing it with several other ways to characterize ‘ best explanation ’ and showing that it takes into account their insights while overcoming some of their problems. The consequences of adopting this approach for IBE are discussed in the context of recent discussions about the relationship between IBE and Bayesianism. (shrink)