Depression is often diagnosed in patients nearing the end of their lives and medication or psychotherapy is prescribed. In many cases this is appropriate. However, it is widely agreed that a health care professional should treat sick persons so as to improve their condition as they define improvement. This raises questions about the contexts in which treatment of depression in late life is appropriate. This article reviews a problematic case concerning the appropriateness of treatment in light of the literature in (...) bioethics. Specific attention is paid to the concept of authenticity and the role of suffering. Suffering is often the result of a situation in which one's self is damaged. In some circumstances, this suffering should not be seen as a symptom of illness but as a reflection, in a difficult life context, of the individual's authentic nature. Assessment of depression in the elderly must go beyond a symptom list and must consider both the context of the individual's situation and his or her authentic self. When the symptoms reflect the individual's assessment of the situation in the context of the authentic self, they may be "appropriate." However, even when the symptoms are appropriate, if they interfere with life assessment and adjustment, treatment should be considered. (shrink)

Max Weber is noted for his analysis of the `specific and peculiar rationalism' of western culture. However, his diagnosis of a life disenchanted by reason draws attention to his lesser known formulations of the problem of theodicy - the problem of reconciling pain and misfortune with moral expectations of the world. Weber suggests that cultural responses to this problem change with the increasingly secular rationalization of life. The present paper traces this development from the cultural representation of pain as the (...) embodiment of moral strife in the early modern novel to contemporary images of pain and suffering in medicine, the mass media and film. The comparison suggests that late modernity is confronted by an `inverse' problem of theodicy, in which representations of pain and suffering are disassociated from ethical and political contexts and the quest for meaning within a human frame. (shrink)

Recent work on signaling has mostly focused on communication between organisms. The Lewis–Skyrms framework should be equally applicable to intra-organismic signaling. We present a Lewis–Skyrms signaling-game model of painful signaling, and use it to argue that the content of pain is predominantly imperative. We address several objections to the account, concluding that our model gives a productive framework within which to consider internal signaling.

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

Background: Although the term “mental pain” is often the subject of expert opinions regarding claims for damages, there is still no standardized questionnaire in the German-speaking area to operationalize this concept. Therefore, the aim of this work is the development and validation of a self-assessment measurement for psychological pain after traumatic events.Methods:A first version of the questionnaire was applied on a sample of the German speaking general population. After performing an item analysis and exploratory factor analysis, the questionnaire was shortened (...) and tested on a second German speaking general population sample. Finally, the newly developed questionnaire was related to the extent of traumatization and already established instruments for the assessment of psychiatric symptom burden, which included the Brief Symptom Inventory-18 and the Post-traumatic-Stress-Scale.Results: The final version of the FESSTE consists of a total of 30 items and covers the subscales “Somatization,” “Depression,” “Intrusive Memories,” “Dissociation” and “Anxiety,” and a total scale “Mental Pain.” Based on the confirmatory factor analysis, it is assumed that the latent factor structure of the FESSTE can be best described as a bifactor-model. The final version shows a satisfactory model fit, high internal consistencies, and strong positive correlations with the BSI-18 and PTSS-10, as well as the extent of traumatic experiences.Discussion: The FESSTE enables an operationalization of mental pain comprising five subscales and one total scale. What is more, the trauma checklist attached to the FESSTE allows for the standardized assessment of potentially traumatic experiences and the corresponding extent of these experiences. The results indicate that the FESSTE is a reliable and valid self-assessment procedure for mental pain, which is suitable for use in research and in expert practice. (shrink)

This paper uses Schrag's framework to analyze an episode of pain and to discuss the phenomenological perspective of pain. The experience of pain is explicated through the metaphor of co-present, interwoven fields of consciousness, embodiment, attitudinal posture and custom, time, and space. Interventions based on the metaphor are discussed.