An autobiographical account is offered of how the medical study of self (immunology) became a chapter in the philosophical study of human agency (from Nietzsche and Thoreau to Freud by way of Wittgenstein). Whether viewed scientifically or philosophically, several themes converge on the intractable instability of any notion of selfhood—epistemological or moral. How this problematic motivated an extended analysis of selfhood refracts the psychology of the author and his pursuit of philosophy as self‐knowledge.
Acknowledging the power of the id-drives, Freud held on to the authority of reason as the ego’s best tool to control instinctual desire. He thereby placed analytic reason at the foundation of his own ambivalent social theory, which, on the one hand, held utopian promise based upon psychoanalytic insight, and, on the other hand, despaired of reason’s capacity to control the self-destructive elements of the psyche. Moving beyond the recourse of sublimation, post-Freudians attacked reason’s hegemony in quelling disruptive psycho-dynamics and, (...) focusing upon the social domain, they sought strategies to counter the oppressive (repressive) social restrictions and conformist impositions impeding individual freedom that result from thwarted desire. Postmodern celebration of desire at the expense of reason and sublimation leaves the Enlightenment prospects altogether and moves psychoanalysis into a new terrain, where the very notion of rationality and an autonomous ego upon which much of Freudianism rests has been deconstructed. Thus the debate that begins with Freud’s social theories reflects the deeper divisions, which arose with postmodern ethics and discarded Cartesian–Kantian notions of personal identity. Here we consider the moral framework in which Freudian social theory sits and a contrasting understanding of agency that confronts his modernist conception. In that debate, we discern the larger humanist confrontation with postmodernity. Yet, all who engaged Freud shared some version of his utopian ethos, albeit radically restructuring the theory upon which social reform might occur. (shrink)
Author comments on the changes in the philosophy of immunology that have occurred since the publication of his book The Immune Self: Theory or Metaphor?, as well as on the dangers, misunderstandings and expectations in this area. Finally, he presents his account of moral agency in the context of his own works discussing this question.
By means of a series of autobiographical vignettes, plus personal reflection upon the medical and philosophico-political traditions, this paper criticizes how medical ethics and other applied ethics have been taught in American universities. Arguing against both paternalism and autonomism, the author provides a sketch of his philosophy of medicine and how it fits with several scientific and juridical models, within the background of a process of dehumanization of the health care relationship.
[Przekład] Autor komentuje zmiany w filozofii immunologii, które zaszły od czasu opublikowania jego książki The Immune Self: Theory or Metaphor?, a także istniejące w tej dziedzinie zagrożenia, nieporozumienia i oczekiwania. Wreszcie – przedstawia w tym kontekście własne ujęcie działania moralnego, odnosząc się do własnych prac.
Freud (and later commentators) have failed to explain how the origins of psychoanalytical theory began with a positivist investment without recognizing a dual epistemological commitment: simply, Freud engaged positivism because he believed it generally equated with empiricism, which he valued, and he rejected ‘philosophy’, and, more specifically, Kantianism, because of the associated transcendental qualities of its epistemology. But this simple dismissal belies a deep investment in Kant’s formulation of human reason, in which rationality escapes natural cause and thereby bestows humans (...) with cognitive and moral autonomy. Freud also segregated human rationality: he divided the mind between (1) an unconscious grounded in the biological and thus subject to its own laws, and (2) a faculty of autonomous reason, lodged in consciousness and free of natural forces to become the repository of interpretation and free will. Psychoanalysis thus rests upon a basic Kantian construction, whereby reason, through the aid of analytic techniques, provides a detached scrutiny of the natural world, i.e. the unconscious mental domain. Further, sovereign reason becomes the instrument of self-knowing in the pursuit of human perfection. Herein lies the philosophical foundation of psychoanalytic theory, a beguiling paradox in which natural cause and autonomous reason — determinism and freedom — are conjoined despite their apparent logical exclusion. (shrink)
Introduction: Concerning scientific reason -- General themes -- Narrative plan -- What is science? -- Reason in dispute -- Rebuttal to an unfair indictment -- Science and the quest for reality -- Science and its values -- Nineteenth-century positivism -- The argument -- Cultures -- The human sciences -- The fall of positivism -- Polany : personalizing knowledge -- Kuhn : raising the lid of pandora's box -- Quine and the dismantling of logical positivism -- The constructivist challenge -- The (...) science wars -- Battles in the night -- The character of reason -- Taking stock -- Science in its socio-political contexts -- Disentangling facts and values, again -- Science as politics -- Science and human nature -- Science and culture -- A case study : environmentalism -- Claims for a science-based ethics -- Teleology -- Environmentalism's religious origins -- Conclusion: The challenge of coherence -- Science as a world view -- Bridging the divide -- A moral epistemology -- The search for meaning. (shrink)
In biology, the ‘ecological orientation' rests on a commitment to examining systems, and the conceptual challenge of defining that system now employs techniques and concepts adapted from diverse disciplines (i.e., systems philosophy, cybernetics, information theory, computer science) that are applied to biological simulations and model building. Immunology has joined these efforts, and the question posed here is whether the discipline will remain committed to its theoretical concerns framed by the notions of protecting an insular self, an entity demarcated from its (...) environment, or will shift its focus of interest to a wider context. An ecological perspective emphasizes the interchange between the organism and its environment, the processing of information, and the regulation arising from responses to this larger context. Moving from the first attempts at modeling the immune system as a closed network, immunologists have joined the general interest in systems analysis, and that move might portend a significant shift to an open, more holistic consideration of immune regulation. *Received December 2006; revised August 2007. †To contact the author, please write to: Center for Philosophy and History of Science, Boston University, 745 Commonwealth Ave., Boston, MA 02215; e-mail: email@example.com. (shrink)
The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies a complex array of choices influenced by individual and cultural values, themselves reflecting religious beliefs, personal histories, psychologies, and social mores. (...) But the typical medical chart, which records clinical descriptions, analyses, and rationales for treatment, rarely identifies or accounts for this value-laden dimension of care and thus both over-simplifies and distorts the depiction of a patient's illness and its treatment. To better reflect the complex moral domain of clinical care, and assist in organizing its complex structure, a systematic procedure is proposed here to evaluate the ethical status of every patient: As a routine part of the clinical evaluation, in a designated Ethical Concerns section of the medical record, an ?ethics work-uP? is designed to serve as a moral ?diagnostic? analogous to its scientific counterpart. Adapted to the needs of individual patients, such evaluations should identify ethical problems, coordinate related data, resources, and opinion, and define the rationale for choices made and actions pursued. In establishing improved integration of the ?epistemologies? of care and the ?ethics? of care, the goals of a more humane, patient-centered medicine may be better met. (shrink)
In the 17th century, ‘reflexivity’ was coined as a new term for introspection and self-awareness. It thus was poised to serve the instrumental function of combating skepticism by asserting a knowing self. In this Cartesian paradigm, introspection ends in an entity of self-identity. An alternate interpretation recognized how an infinite regress of reflexivity would render ‘the self’ elusive, if not unknowable. Reflexivity in this latter mode was rediscovered by post-Kantian philosophers, most notably Hegel, who defined the self in its self-reflective (...) encounter with an other, and whose full articulation would occur at the final culmination of Reason's evolution. In the rising tide of 19th-century individualism, Emerson and Kierkegaard formulated constructions both in debt to, and in opposition against, Hegelian metaphysics. For each, although employing distinct strategies of self-consciousness, ‘the self’ reached its apogee through divine encounter. Characterized by personal responsibility and individual choice, their philosophies would later be subsumed by secular existentialists committed to defining moral individualism and asserting the possibilities for human freedom and selfauthentication. (shrink)
Medicine’s fundamental moral philosophy is the responsibility of caring for the ill, yet beneficence is not under the province of the law.Indeed, fiduciary responsibilities of doctors are limited. Instead, American law is preoccupied with protecting patient rights under the precept of patient autonomy, and contemporary medical ethics is dominated by these concerns. The extrapolation of autonomy rights from the political and judicial culture to medicine is, under ordinary circumstance, non-problematic. However, in instances of conflict, the dominance of autonomy reveals a (...) hierarchy of values determining patient care. To illustrate the moral calculus of balancing competing principles, the ethical issues of involuntary treatment of psychotic patients are considered, and alternatives to the moral reasoning currently guiding the care of these individuals are offered to better solve the dilemma of respecting patient autonomy while still fulfilling the claims of physician responsibility. (shrink)
Emerson articulated his metaphysics of selfhood within a theistic framework; Thoreau reconfigured his ideas as a mystical pantheism. In this latter form, Transcendentalism offered twentieth century Americans a new religious sensibility based on an intimacy with nature, which became a spiritual and aesthetic resource for personal fulfillment.
Contemporary American medical ethics was born during a period of social ferment, a key theme of which was the espousal of individual rights. Driven by complex cultural forces united in the effort to protect individuality and self-determined choices, an extrapolation from case law to rights of patients was accomplished under the philosophical auspices of âautonomyâ. Autonomy has a complex history; arising in the modern period as the idea of self-governance, it received its most ambitious philosophical elaboration in Kant's moral philosophy. (...) In examining the Kantian construction, it is evident that neither his universal moral imperative nor his rigorous application of self-legislated ethical action can sustain our own notions of moral agency in a pragmatic, pluralistic society. But the Kantian position is useful in highlighting that self-governance is not equivalent to âautonomyâ, and this distinction defines the limits of autonomy in the clinical setting. A critique of Engelhardt's idea of âprinciple of permissionâ is used to illustrate autonomy's eclipse as a governing principle for medical ethics. (shrink)
The language of self and nonself has had a prominent place inimmunology. This paper examines Frank Macfarlane Burnet's introductionof the language of selfhood into the science. The distinction betweenself and nonself was an integral part of Burnet's biological outlook– of his interest in the living organism in its totality, itsactivities, and interactions. We show the empirical and conceptualwork of the language of selfhood in the science. The relation betweenself and nonself tied into Burnet's ecological vision of host-parasiteinteraction. The idiom of (...) selfhood also enabled Burnet to organizeand unify a diversity of immune phenomena. Rather than approach thelanguage of self and nonself as a bluntly imposed metaphor, we focuson its endogenous origins and immanent uses in immunology. (shrink)
Since Galileo, critics have waged a relentless assault against science, attacking it as dehumanizing, reductionist, relativistic, dominating, and imperialistic. Supporters meanwhile view science as synonymous with modernity and progress. The current debates over the role of science-- described by such headlines as Scientists are Urged to Fight Back Against `Politically Correct' Critics in The Chronicle of Higher Education--testify to how deeply divided we remain about the values and responsibilities of science in the modern age. Acknowledging the validity of a deep (...) skepticism about science but eager to preserve its strengths and values, Alfred I. Tauber's anthology seeks to avoid an either/or configuration. Science, Tauber argues, is fundamentally pluralistic and must accept detracting criticism as part of its very code in the hope that, in its defense, the scientific enterprise is strengthened and reaffirmed. Featuring essays by a wide range of interdisciplinary, classical, and contemporary thinkers such as Martin Heidegger, Thomas Kuhn, Hilary Putnam, Evelyn Fox Keller, and Max Weber, the work is divided into five parts: science and its worldview; the problem of scientific realism; the nature of scientific change; the boundaries of science; and science and values. (shrink)
Friedrich Nietzsche''s will to power, and the philosophical ediface built on this foundation, is formulated on a biologicism that is indebted to a particular post-Darwinian vision of the organism. Of the various models that attempt to formulate a comprehensive organismal biology, Nietzsche unknowingly grasped that of Elie Metchnikoff, who authored the theoretical foundation of modern immunology. Metchnikoff regarded the organism as a disharmonious entity, in constant inner strife between competing cellular activities. Immune functions were responsible for mediating harmonization, which however (...) remains an elusive ideal. This view of the organism posited an ever-changing, self-defining entity striving for self-actualization while in ceaseless inner struggle as well as in competition with the environment. The theory is no less than an epistemological response of how to establish the subject-object relation in a construct where the subject''s boundaries are dialectical and evolving. The similarity of the philosophical positions of Nietzsche and Metchnikoff regarding the Self offers rich resonance in current attempts to formulate a biomedical language appropriate to address the issues raised by these problems. (shrink)