Online research in philosophy

Hillel Braude offers a thoughtful paper that explores the nature of suffering, with particular relation to—and distinction from—pain, as regards the work of Eric Cassell, and in reflection of the perspectives of Karl Jaspers and Emmanuel Levinas. To be sure, establishing distinction(s) between pain and suffering is not an easy task. As Yuri Maricich and I have noted, pain and suffering are often used synonymously, even in medical conversation(s). Yet, we have urged that such colloquialisms should be rectified, particularly in (...) clinical contexts, because they can, and often do, foster ambiguities regarding the nature of these experiences, meanings to patient and clinician, and attendant trajectories and .. (shrink)

Using a metaphorical reminiscence upon holiday toys - and the hopes, challenges and possibilities they presented - this essay addresses the ways that the heuristics, outcomes and products of neuroscience have effected change in the human condition, predicament, and being. A note of caution is offered to pragmatically assess what can be done with neurotechnology, what can't, and what should and shouldn't - based upon the capacities and limitations of both the science, and our collective ability to handle knowledge, power (...) and the unknown. This is not an appeal to impede brain research. To the contrary, it is a call to engage neuroethics as a discipline and set of practices 1) to allow a deeper, more finely-grained understanding of brains and their functions in ecological dynamics (that we define as morality and ethics), and 2) to intuit how to engage neuroscientific research and its applications in the social sphere (inclusive of medicine, public life and national agenda), to more accurately perceive how neuroscience is changing human society and the human being, and to instantiate more relevant ethics and laws that are in step with advancing epistemological capital and technological capability. (shrink)

This Editorial introduces the thematic series on 'Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care' http://www.biomedcentral.com/series/newpsychiatry.

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature (...) and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. (shrink)

Neuroscience, together with a broadened concept of “mind” has instigated pragmatic and ethical concerns about the experience and treatment of pain. If pain medicine is to be authentic, it requires knowledge of the brain-mind, pain, and the relative and appropriate “goodness” of potential interventions that can and/or should be provided. This speaks to the need for an ethics that reflects and is relevant to the contemporary neuroscience of pain, acknowledgment and appreciation of the sentient being in pain, effects of environment (...) and value(s), and the nature of healing. It may be that neuroethics provides this viable meta-ethic for pain care. This essay describes how an integrative neuroethics of pain care allows, if not obligates, alignment of facts, values, and moral attitudes as a continuing process of re-investigation, analysis, and revision of what we know (and don’t know) about brains, minds, selves, and how we regard and treat the painient. (shrink)

It examines three core questions. First, what is the scope and direction of neuroscientific inquiry?

A common theme in the contemporary medical model of psychiatry is that pathophysiological processes are centrally involved in the explanation, evaluation, and treatment of mental illnesses. Implied in this perspective is that clinical descriptors of these pathophysiological processes are sufficient to distinguish underlying etiologies. Psychiatric classification requires differentiation between what counts as normality (i.e.- order), and what counts as abnormality (i.e.- disorder). The distinction(s) between normality and pathology entail assumptions that are often deeply presupposed, manifesting themselves in statements about what (...) mental disorders are . In this paper, we explicate that realism, naturalism, reductionism, and essentialism are core ontological assumptions of the medical model of psychiatry. We argue that while naturalism, realism, and reductionism can be reconciled with advances in contemporary neuroscience, essentialism - as defined to date - may be conceptually problematic, and we pose an eidetic construct of bio-psychosocial order and disorder based upon complex systems' dynamics. However we also caution against the overuse of any theory, and claim that practical distinctions are important to the establishment of clinical thresholds. We opine that as we move ahead toward both a new edition of the Diagnostic and Statistical Manual, and a proposed Decade of the Mind, the task at hand is to re-visit nosologic and ontologic assumptions pursuant to a re-formulation of diagnostic criteria and practice. (shrink)

With the rise of modern medicine, spiritual approaches to cop- ing with pain and understanding distress have been largely aban- doned. However, there is sufficient empirical evidence available that shows the importance of spiritual experiences, beliefs and practices for self- and pain perception as well as coping. Hence, this paper ar- gues that the assessment of patients' spirituality, acknowledgment of the effects of and e_ects upon pain, and utilization of pluralist resources to accommodate patients' spiritual needs reflect our most current (...) understanding of the physiological, psychological and socio- cultural aspects of spirituality and spiritual experiences (regardless of religious or secular expression). (shrink)