One of the fundamental problems in the philosophy of psychology is to determine the relation between personal and subpersonal explanations of human behavior. The problem of determining the relation between the personal and subpersonal levels is called the “interface problem”. This paper has two goals. The first is to introduce the domestic reader to the interface problem from the perspective of the philosophy of psychology. The second goal is to show that insufficient focus on the interface problem and (...) its potential solutions can lead to uncritical and fallacious reasoning that can have significant consequences for particular debates in philosophy of medicine and philosophy of law. (shrink)

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. (...) RCOPE is an instrument designed to categorize religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control. (shrink)

This paper suggests that the paradigm of the lived-body developed by Straus, Merleau-Ponty and others has important implications for medical practice and theory. Certain recognized flaws in modern medicine, such as its reductionist tendencies and lack of emphasis on preventive measures are shown to be related to the exclusive use of a Cartesian notion of embodiment. Increased attention to the paradigm of the lived-body emphasizing its unity, purposiveness and "enworldment" could help to beneficially reorient practice. Moreover, this portrayal of (...) the body as an intentional entity may provide a better tool than the traditional view for conceptualizing the psychological and psychosocial components of disease etiology, as well as some newly developed modes of treatment. CiteULike Connotea Del.icio.us What's this? (shrink)

Can there be scientific theories in psychology, medicine or psychiatry? I approach this question through an in-depth analysis of a typical experiment for clinical depression involving the monoamine hypothesis, drug action, and placebos. I begin my discussion with a reconstruction of Adolph Grünbaum's conceptual analysis of 'placebo,' and then use his notion of "intentional placebo" to discuss a typical experiment using the monoamine hypothesis, two drugs and a placebo. I focus on the theoretical aspects of the experiment, especially (...) on the notion of causal explanation. I then raise five conceptual and methodological problems for theory construction. These problems focus on questions of the causal efficacy of placebos and drugs; ad hoc versus ceteris paribus explanations in biomedicine and psychology; and the falsifiability of the monoamine hypothesis. I conclude by pointing out the need for further, rigorous philosophical analysis concerning the possibility of theory construction in psychology, medicine, or psychiatry. (shrink)

Philosophy of psychiatry is a philosophical discipline focused on fundamental theoretical and conceptual issues in contemporary psychiatry. One of such issues is the so-called demarcation problem, which can be understood as the question about the difference between mental illness and psychological functioning which is normal, or healthy. After a brief account of the standard criteria for such differentiation the dominant naturalistic understanding of psychiatry as well as the notion of mental illness proper to the latter are subjected to scrutiny. Then, (...) in turn, critical currents are investigated with their concept of psychiatry as a discipline of humanistic and normative character. Some of these currents, such as the antipsychiatry of Szasz, are of historical importance today. Still, however, many threads are discussed, especially in the context of the notion of mental disorder developed by the American Psychiatric Association. One may expect that such discussions will be fruitfully carried on, especially in those cases when particular disorders are philosophically investigated. (shrink)

This collection explores the subject of conflicts of interest. It investigates how to manage conflicts of interest, how they can affect well-meaning professionals, and how they can limit the effectiveness of corporate boards, undermine professional ethics, and corrupt expert opinion. Legal and policy responses are considered, some of which (e.g., disclosure) are shown to backfire and even fail. The results offer a sobering prognosis for professional ethics and for anyone who relies on professionals who have conflicts of interest. The contributors (...) are leading authorities on the subject in the fields of law, medicine, management, public policy, and psychology. The nuances of the problems posedby conflicts of interest will be highlighted for readers in an effort to demonstrate the manyways that structuring incentives can affect decision making and organizations' financial well-being. (shrink)

There is a need to bring ethics and medical practice closer together, despite the risk and problems this may involve. Deontological ethics may promote sanctity of life considerations against the quality of life considerations favoured by consequentialists or utilitarians; while talk of respect for life and the value of life may point to more qualified ethical positions. This paper argues for a respect-for-life position, dismissing a utilitarian cost-benefit outlook as too simplistic; but an unqualified fixed principles approach is also ruled (...) out, both because of its unacceptable consequences in individual cases and also because of its reliance on the slippery slope argument which, it is argued, is logically and psychologically deficient. The case of genetic engineering provides an example in which the notion of respect may operate, but in which broad general principles also apply. A cautious conservatism towards accepted principles is recommended in the development of medical technologies. (shrink)

Coercive medico-legal interventions are often employed to prevent people deemed to be unable to make competent decisions about their health, such as minors, people with mental illness, disability or problematic alcohol or other drug use, from harming themselves or others. These interventions can entail major curtailments of individuals' liberty and bodily integrity, and may cause significant harm and distress. The use of coercive medico-legal interventions can also serve competing social interests that raise profound ethical, legal and clinical questions. Examining the (...) ethical, social and legal issues involved in coerced care, this book brings together the views and insights of leading researchers from a range of disciplines, including criminology, law, ethics, psychology and public health, as well as legal and medical practitioners, social-service 'consumers' and government officials. Topics addressed in this volume include: compulsory treatment and involuntary detention orders in civil mental health and disability law; mandatory alcohol and drug treatment programs and drug courts; community treatment orders; the use of welfare cards with Indigenous populations; mandated treatment of seriously ill minors; as well as adult guardianship and substituted decision-making regimes. These contributions attempt to shed light on why we use coercive interventions, whether we should, whether they are effective in achieving the benefits that are offered to justify their use, and the impact that they have on some of society's most vulnerable citizens in the names of 'justice' and 'treatment'. This book is essential reading for clinicians, researchers and legal practitioners involved in the study and application of coerced care, as well as students and scholars in the fields of law, medicine, ethics and criminology. The collection asks important questions about the increasing use of coercive care that demand to be answered, and offers critical insights, guidance and recommendations for those working in the field. (shrink)

Archetypal medicine and past life therapy have received only scant attention in mainstream medical and psychological literature. Nonetheless, the epistemological and practice assumptions underlying Alfred Ziegler's model of archetypal medicine are highly congruent with those of past life therapy and both proffer salient alternatives to traditional reductionistic practice in psychotherapy and medicine. This paper explores the manner in which both seek to understand the meanings embedded in "health" and "illness" through a metaphorical interpretation of symptoms. Dualistic thinking (...) gives way to unitary consciousness as we begin to understand symptomatology in the larger scheme of a human being's entire lived experience. The transcendent, psychospiritual work of past life therapy is viewed in integrated partnership with archetypal medicine in healing the whole person rather than merely assessing symptoms in isolation and remediating them through mechanistic techniques and external applications of treatments. (shrink)

Thomas, Bracken, and Timimi (2012) make an important contribution in critiquing the extent to which the profession of psychiatry can be so bureaucratic that patients are treated as problems to be solved in an ‘efficient’ assembly line fashion rather than as individual persons. The trouble with bureaucracies is that they promote a cold and impersonal accounting approach in which critical reflection on purposes is circumvented by decision-making algorithms (Zachar and Bartlett 2009). Psychotherapy treatment manuals definitely satisfy the bureaucratic instinct, and (...) the fifteen-minute medication management session even more so (Harris 2011). Ideally, evidence-based medicine (EBM) should be used to promote the goals of .. (shrink)

In Timothie Bright and the Origins of Early Modern Shorthand, J. D. Fleming brings together two areas of sixteenth-century intellectual history. One is the period emergence of artificial systems for verbatim shorthand notation-a crucial episode in the history of information. The other is the ancient medical discourse of melancholy humour, or black bile. Timothie Bright (1550-1615), physician and priest, prompts the juxtaposition. For he was the author, not only of the period's original shorthand manual-Characterie (1588)-but also of the first book (...) in English on the dark humour: The Treatise of Melancholy (1586). Bright's account of melancholy involves a cybernetic phenomenology of the human. Essentially, we are psyches (souls or minds). We are sealed off from our bodies, operating them as automata across an interface. Psychological presence, for Bright, is illusion and pathology. Engrossing performances or representations therefore bring great danger, and so does the doctrine of predestination-less for its content than its typical delivery. Painful preaching was indispensable in sixteenth-century English Protestantism. But it falls foul of Bright's proscriptions. This is followed by his publication of the first known system for verbatim shorthand notation since antiquity, its technique heavily inflected toward a vocabulary of the pulpit. The passionate, oral performance of the inspired preacher receives an unprecedented textual preservative-and prophylactic. Bright's technology of information serves his phenomenology of alienation. This book will be of interest to students and scholars of the early modern period, the tradition of melancholy, and the history of information-as theory, and technology. (shrink)

ABSTRACT This article explores the history of the bedwetting alarm, invented in 1938 by two psychologists to cure enuresis, or bedwetting, using the principles of classical conditioning. Infused with the optimism of behaviorism, the bedwetting alarm unexpectedly proved difficult to implement in practice, bearing a multitude of unanticipated complications that hindered its widespread acceptance. Introduced as a medical and psychological technology, in practice the alarm was also a child‐rearing device, encouraging the kind of behavioristic attitudes that had prompted its initial (...) development, while simultaneously promoting the child‐centered approach that would become dominant in the early 1950s. The life story of the bedwetting alarm muddies the traditional account of how child‐rearing theories progressed in tidy succession, suggesting both that behavioristic approaches did not die out in the 1930s and that elements of permissive child‐rearing were being considered earlier than we traditionally assume. (shrink)

This essay focuses on the meaning that the term “experimental” acquires within spiritualism during the second half of the nineteenth century. It builds upon Paul Janet’s notions of “experience” and “experimentation” in psychology, by stressing the role of physiology and pathology in his reflection. Regardless of the role the concept of “experimentalism” took on in Victor Cousin’s psychology, which arguably indicated more an “internal affection” than actual experimentation, in Janet’s spiritualism the term regains its original meaning of empirical (...) verification. Janet highlights the importance of madness to the development of a new psychological paradigm that could reconcile philosophy and medicine, reason and experience, by taking up pathology as a form of natural and indirect experimentation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Evidence-Based Medicine and EvaluativismTim Thornton (bio)KeywordsPhilosophy, psychiatry, values, causalThe rise of evidence-based medicine (EBM) in psychiatry has brought, in its train, a concentration on the validity of psychiatric taxonomy to augment the previous focus on reliability (in the medical sense of inter-subject agreement). This is not surprising. If EBM is to be a trustworthy guide to future events, such as patient recovery, it must be based on (...) projectible predicates (Goodman 1983). Not all the predicates that apparently fit past observations would produce true predictions for the future. Furthermore, there is reason to think that employing projectible predicates goes a long way to satisfy the (widespread if contested) aim of being based on a nomological science (Papineau 1986). Thus, the successful implementation of EBM within psychiatry requires the successful articulation of a valid psychiatric taxonomy.This connection helps to explain why fears about the application of EBM to psychiatry often turn on fears about the application of the criteriological model of diagnosis to individuals. In her commentary in this issue, Gloria Ayob has examined some of the arguments concerning the application of EBM to individuals. In this brief commentary, I examine a different potential source of disquiet focused on the underlying nature of psychiatric taxonomy.Dimensions for Psychiatric TaxonomyIn their recent paper, Peter Zachar and Kenneth Kendler suggest a number of different dimensions according to which rival conceptions of psychiatric taxonomy can be mapped. These include (1) causalism–descriptivism, (2) essentialism– nominalism, (3) objectivism–evaluativism, (4) internalism–externalism, (5) entities–agents, and (6) categories–continua (2007, 557). At the heart of the objectivism-evaluativism dimension is the question:Is deciding whether or not something is a psychiatric disorder a simple factual matterY (objectivism), or does it inevitably involve a value-laden judgment (evaluativism)?(Zachar and Kendler 2007, 558)Objectivists argue that the concept of disorder is a simple or plain factual matter by contrast with an evaluation. The apparently evaluative connotations of disorder, they argue, can either be reduced to, or explained away in, more basic terms, which are not themselves essentially evaluative. Thus, for example, the attempt to explain disorder in statistical terms is a form of objectivism. The more plausible attempt to explain disorder through the idea of a biological or proper function is also usually presented as a form of objectivism. (The most famous proponent of a biological approach, however, Jerome Wakefield, adds to an objectivist-aspiring core an explicit value in the form of harm [End Page 175] [Wakefield 1999].) Whether or not it can be successful as a form of objectivism, in addition to whether an analysis in biological terms is possible, depends on whether the account of function can fully discharge any initial evaluative or normative assumptions.There seems to be good evidence that current psychiatric taxonomy, at least, contains values. John Sadler, for example, makes a powerful case for this in his substantial work Values and Psychiatric Diagnosis (2005). Sadler, furthermore, addresses in some detail a further set of questions concerning the kinds and nature of the values involved. I outline just one further question about the nature of values involved.Zachar and Kendler contrast the presence of values with objectivism. Objectivity has at least two relevant senses reflecting contrasts with two senses of subjectivity. It—objectivity—might mean requiring no special subject for the conception and framing of relevant judgments. (This mirrors primary, by contrast with secondary qualities, and Williams' idea of an absolute conception [Williams 1978]). Or, it might mean disciplining and providing a contrast between correctness and incorrectness, or truth and falsity, for the relevant judgments. This contrasts with subjective whimsy.Although it seems relatively straight forward that the conception and framing of value judgments requires that subjects have a particular kind of mind, that still leaves open the other issue. Are value judgments disciplined by anything or does the "truth" of a value judgment collapse back into its being sincerely made?Evaluativism in Psychiatric Taxonomy and EBMThis question relates to the application of EBM to psychiatry in this way. On a disciplined account, psychiatric taxonomy can aim to get right the mixture or, better, the compound of simple facts and values... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Evidence-Based Medicine and EvaluativismTim Thornton (bio)KeywordsPhilosophy, psychiatry, values, causalThe rise of evidence-based medicine (EBM) in psychiatry has brought, in its train, a concentration on the validity of psychiatric taxonomy to augment the previous focus on reliability (in the medical sense of inter-subject agreement). This is not surprising. If EBM is to be a trustworthy guide to future events, such as patient recovery, it must be based on (...) projectible predicates (Goodman 1983). Not all the predicates that apparently fit past observations would produce true predictions for the future. Furthermore, there is reason to think that employing projectible predicates goes a long way to satisfy the (widespread if contested) aim of being based on a nomological science (Papineau 1986). Thus, the successful implementation of EBM within psychiatry requires the successful articulation of a valid psychiatric taxonomy.This connection helps to explain why fears about the application of EBM to psychiatry often turn on fears about the application of the criteriological model of diagnosis to individuals. In her commentary in this issue, Gloria Ayob has examined some of the arguments concerning the application of EBM to individuals. In this brief commentary, I examine a different potential source of disquiet focused on the underlying nature of psychiatric taxonomy.Dimensions for Psychiatric TaxonomyIn their recent paper, Peter Zachar and Kenneth Kendler suggest a number of different dimensions according to which rival conceptions of psychiatric taxonomy can be mapped. These include (1) causalism–descriptivism, (2) essentialism– nominalism, (3) objectivism–evaluativism, (4) internalism–externalism, (5) entities–agents, and (6) categories–continua (2007, 557). At the heart of the objectivism-evaluativism dimension is the question:Is deciding whether or not something is a psychiatric disorder a simple factual matterY (objectivism), or does it inevitably involve a value-laden judgment (evaluativism)?(Zachar and Kendler 2007, 558)Objectivists argue that the concept of disorder is a simple or plain factual matter by contrast with an evaluation. The apparently evaluative connotations of disorder, they argue, can either be reduced to, or explained away in, more basic terms, which are not themselves essentially evaluative. Thus, for example, the attempt to explain disorder in statistical terms is a form of objectivism. The more plausible attempt to explain disorder through the idea of a biological or proper function is also usually presented as a form of objectivism. (The most famous proponent of a biological approach, however, Jerome Wakefield, adds to an objectivist-aspiring core an explicit value in the form of harm [End Page 175] [Wakefield 1999].) Whether or not it can be successful as a form of objectivism, in addition to whether an analysis in biological terms is possible, depends on whether the account of function can fully discharge any initial evaluative or normative assumptions.There seems to be good evidence that current psychiatric taxonomy, at least, contains values. John Sadler, for example, makes a powerful case for this in his substantial work Values and Psychiatric Diagnosis (2005). Sadler, furthermore, addresses in some detail a further set of questions concerning the kinds and nature of the values involved. I outline just one further question about the nature of values involved.Zachar and Kendler contrast the presence of values with objectivism. Objectivity has at least two relevant senses reflecting contrasts with two senses of subjectivity. It—objectivity—might mean requiring no special subject for the conception and framing of relevant judgments. (This mirrors primary, by contrast with secondary qualities, and Williams' idea of an absolute conception [Williams 1978]). Or, it might mean disciplining and providing a contrast between correctness and incorrectness, or truth and falsity, for the relevant judgments. This contrasts with subjective whimsy.Although it seems relatively straight forward that the conception and framing of value judgments requires that subjects have a particular kind of mind, that still leaves open the other issue. Are value judgments disciplined by anything or does the "truth" of a value judgment collapse back into its being sincerely made?Evaluativism in Psychiatric Taxonomy and EBMThis question relates to the application of EBM to psychiatry in this way. On a disciplined account, psychiatric taxonomy can aim to get right the mixture or, better, the compound of simple facts and values... (shrink)

This article demonstrates that Ibn Sīnā’s theory of experience (taǧriba) requires a cross-reference between logic and psychology. Following the Basran linguistic tradition, he paraphrases derived names (ism muštaqq) into the li-x y formula: for example, ʿālim (“knowing”) is paraphrased into lahu ʿilm (“an act of knowing belongs to him”). His theory of experience employs this formula for arranging observed phenomena into a certain form of a syllogism and describing functions of the brain’s inner senses. Ibn Sīnā arranges observed phenomenon (...) into the li-x y formula or the proposition of which a predicate is a derived name of y. Meanwhile, he holds that the sense of recollection is involved in the process of experience. Recollection is an inner sense of the brain, which preserves maʿnā perceived by the sense of estimation. Estimation means to perceive maʿnā (y) that inheres in a subject (x), and to make a judgment about x based on y. Thus, in this process, the analysis of derived names arranges observed phenomena into a rational order, and the inner sense establishes the causation between apprehension and logical assertion. The article concludes by discussing the relation of this philosophy to medicine. (shrink)

Medicine and families, two venerable institutions crucial to human well-being, are in crisis. The medical profession, struggling to control and equitably distribute care, finds itself compromised by its own success; families are shattered by divorce, violence and confusion about their own nature. What has gone unnoticed is the way these two powerful and pervasive spheres contribute to each other's loss of direction. The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each (...) other. The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality . This book takes an unprecedented perspective on both institutions. Innovative and vivid, their stories tell the tales of families interacting with the medical establishment. (shrink)

James Lorimer Halliday (1897–1983) pioneered the development of the concept of psychosocial medicine in Britain in the 1930s and 1940s. He worked in Glasgow, first as a public health doctor, and then as part of the corporatist National Health Insurance scheme. Here he learned about links between poverty, the social environment, emotional stress and psychological and physical ill-health, and about statistical tools for making such problems scientifically visible. The intellectual development of his methodologically and epistemologically integrated medicine – (...) a hybrid of biomedical and psychological approaches – was embedded in the context of this practice with its particular medical culture and socio-economic circumstances. Halliday’s ideas are part of the wider, heterogeneous turn towards medical modernism and holism within mainstream medicine in Britain, western Europe and the United States in the inter-war period, and their evolution underlines the varied nature of contemporary anti-reductionist thinking in medicine. It also points to the diversity of the sources of holism and the many routes by which psychological and especially psychosocial discourses about health and illness entered professional and public arenas in Britain in this period. (shrink)

James Lorimer Halliday pioneered the development of the concept of psychosocial medicine in Britain in the 1930s and 1940s. He worked in Glasgow, first as a public health doctor, and then as part of the corporatist National Health Insurance scheme. Here he learned about links between poverty, the social environment, emotional stress and psychological and physical ill-health, and about statistical tools for making such problems scientifically visible. The intellectual development of his methodologically and epistemologically integrated medicine – a (...) hybrid of biomedical and psychological approaches – was embedded in the context of this practice with its particular medical culture and socio-economic circumstances. Halliday’s ideas are part of the wider, heterogeneous turn towards medical modernism and holism within mainstream medicine in Britain, western Europe and the United States in the inter-war period, and their evolution underlines the varied nature of contemporary anti-reductionist thinking in medicine. It also points to the diversity of the sources of holism and the many routes by which psychological and especially psychosocial discourses about health and illness entered professional and public arenas in Britain in this period. (shrink)

Why do physicians who've taken the Hippocratic Oath willingly cut into seemingly healthy patients? How do you measure the success of surgery aimed at making someone happier by altering his or her body? Sander L. Gilman explores such questions in Creating Beauty to Cure the Soul, a cultural history of the connections between beauty of body and happiness of mind. Following these themes through an impressive range of historical moments and players, Gilman traces how aesthetic alterations of the body have (...) been used to "cure" dissatisfied states of mind. In his exploration of the striking parallels between the development of cosmetic surgery and the field of psychiatry, Gilman entertains an array of philosophical and psychological questions that underlie the more practical decisions rountinely made by doctors and potential patients considering these types of surgery. While surveying and incorporating the relevant theories of Sigmund Freud, Alfred Adler, Karl Menninger, Paul Schilder, contemporary feminist critics, and others, Gilman considers the highly unstable nature of cultural notions of health, happiness, and beauty. He reveals how ideas of race and gender structured early understandings of aesthetic surgery in discussions of both the "abnormality" of the Jewish nose and the historical requirement that healthy and virtuous females look "normal," thereby enabling them to achieve invisibility. Reflecting upon historically widespread prejudices, Gilman describes the persecutions, harrassment, attacks, and even murders that continue to result from bodily difference and he encourages readers to question the cultural assumptions that underlie the increasing acceptability of this surgical form of psychotherapy. Synthesizing a vast body of related literature and containing a comprehensive bibliography, Creating Beauty to Cure the Soul will appeal to a broad audience, including those interested in the histories of medicine and psychiatry, and in philosophy, cultural studies, Jewish cultural studies, and race and ethnicity. (shrink)

As an eminent practical theologian, Don S. Browning watched religious belief and practice interact with the larger culture for a long time, especially in regard to issues of personal and family well-being. As Alexander Campbell Professor Emeritus of Ethics and the Social Sciences at the Divinity School of the University of Chicago, he also lived in the midst of currents and controversies in academic philosophy, theology, and other disciplines. As a result, his work is distinguished by its alertness to a (...) variety of endeavors including medicine and the sciences.From the vantage point of his years of work and thought, Browning perceived that certain critical interactions, social and intellectual, are currently .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:George Engel’s Legacy for the Philosophy of Medicine and PsychiatryBradley Lewis (bio)KeywordsBiopsychosocial model, George Engel, pragmatism, philosophy of medicine, philosophy of psychiatryEach of the respondents to this paper raises critical and important concerns. I am grateful for the quality of their insights. David Brendel’s response, along with his recent book, Healing Psychiatry: Bridging the Science/Humanism Divide, resembles my efforts in several ways. Like Brendel, I too believe (...) that the American pragmatic philosophy can be helpful in healing the splits and divisions within psychiatry. And, like Brendel, I believe that psychiatry would benefit from what he calls the “four ps” of pragmatism. Where we differ with regard to George Engel and his biopsychosocial model seems to be less about philosophy and more about strategy. Brendel argues that Engel was too scientistic in his manifest reasoning to be considered a pragmatist. I agree with this description of Engel. But, strategically, we can go beyond Engel’s manifest reasoning to draw out the implications of Engel’s writings in a pragmatic fashion. I am not saying that Engel did this himself; I am only saying that it is very possible to reinterpret Engel along these lines.Brendel also argues that the biopsychosocial model itself needs improvement. But, just as it is possible to update Engel’s theoretical scaffold, we can also update Engel’s biopsychosocial model. Along the lines of Brendel’s concerns, we can easily revise the model so that we remember that not all problems need complex analysis and interventions. Some problems are relatively simple and can have a simple solution. We can also revise the model so we include questions of consumer participation and the provisional nature of the clinical encounter. I see nothing in the biopsychosocial model that contradicts either of these concerns. Yes, the biopsychosocial model needs to be updated, refurbished, expanded, and reimagined. That is my point in the paper.The traction of Brendel’s concerns is not can we reinterpret Engel? or can we refresh the biopsychosocial model?—of course we can. The traction of his concern seems to be “should we?” To this strategic question, Brendel’s answer is no and my answer is yes. I argue that it is a good idea to refresh and refurbish Engel and his biopsychosocial model because it helps to create a connection with an important tradition within both medicine and psychiatry: the tradition of balanced, broadminded, nuanced, patient-centered and anti-reductionistic [End Page 327] care. This tradition is important because medicine and psychiatry seem perpetually vulnerable to the temptations of reductionist approaches and to what Engel, and Nassir Ghaemi more recently, call “dogmatism” (Engel 1977, 130; Ghaemi, 2003, 301). Whether reductionism and dogmatism take the form of biopsychiatry, or psychoanalysis, or antipsychiatry, or cognitive-behavioral therapy, the problems of dogmatism are the same.I am sure Brendel would agree with this, which is why he raises pluralism to such a prominent position in his own reasoning. The difference is that Brendel believes we can better get to this kind of balanced clinical care by letting go of the past figures like Engel and moving into the bright light of the twenty-first century. Maybe so. But my thinking when I wrote the paper goes the other way around. For me, if clinical medicine and psychiatry more carefully tended to its history and tradition, it would be less likely to fall sway to the next Johnny-come-lately reductionistic model.Jeffery Spike’s memories of George Engel during the years they worked together at the University of Rochester School of Medicine provide a good sense of why Engel is an important figure to remember and to pay homage. As Spike puts it, Engel was not only a “legendary figure” with an “almost mythical diagnostic ability,” Engel “probably had more influence on the philosophy of medicine in the United States than any other person, physician, or philosopher.” Both of these accomplishments help to explain why Engel is worth remembering.Those of us in medicine and psychiatry all know mythical clinicians and teachers—the ones who seem like Michael Jordan used to seem on the basketball court, able to somehow make even... (shrink)

Written by three experts in the field, this book explores the understanding of human wellness and disease as fostered through the collaborative contributions of ...

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in (...) moral intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. (shrink)

This article shows how environmental and ambient constructions were used to legitimate traditional gender roles in twentieth-century Europe and the United States. It demonstrates the normative and reactionary character of influential psychological and psychoanalytic theories of childhood and personality development, which instructed women to create, even embody social and emotional environments. This body of thought spanned diverse psychoanalytic schools and extended across generations of psychological experts. They put forth a notion of feminine “environmentality” postulating a woman’s disposition to create, even (...) personify an environment that facilitated normal child development as well as a man’s professional success—and, ultimately, sustained the social order. This construction of women as essentially environmental beings bound them to matrimony and full-time, at-home motherhood, fixing their lives in space and time. It provided a powerful weapon against alternative life-styles and feminist critiques, suggesting that leading conceptions of development, well-being, and identity were not just androcentric, but indeed anti-feminist. (shrink)

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part because the words available to describe intrauterine death—“miscarriage,” “spontaneous abortion,” and “pregnancy loss”—are referentially ambiguous. Despite appearing to refer to one event, they can refer to two distinct events: the baby’s death and his preterm delivery. Disenfranchised grief increases when people understand “miscarriage” as the physical process of preterm delivery alone, (...) for this obscures the baby’s death and excludes non-gestational parents, such as the father. Additionally, focusing on the delivery reinforces the mistaken idea that a gestational mother bears responsibility for her baby’s death, increasing misplaced guilt. When these terms instead shift the focus to the baby’s intrauterine death rather than the preterm delivery, they can obscure the physically difficult and often traumatic experience women have when they deliver their dead children, leaving women shocked by preterm delivery’s physical reality. Given their outsized role in framing the bereaved’s experiences, and their duty to avoid harming their patients, healthcare practitioners in particular should take special care to discuss intrauterine death and preterm delivery appropriately with patients and their families. Changing language to describe intrauterine death and preterm delivery clearly and precisely helps mitigate disenfranchised grief, misplaced guilt, and shock, while also helping to reframe the social response to intrauterine death, making it more obvious why certain steps, such as allowing bereavement leave following an intrauterine death, promote healing. (shrink)

This article introduces the perspectivist interpretation of Nietzsche’s On the Genealogy of Morality, characterized by two core theses. According to the results thesis, the three treatises of GM introduce three types of critical results, respectively: psychological claims about the value of morality for the interests of various character types; physiological claims about its value for the ‘progress of the species’; and medical claims about its value for health. According to the distinction thesis, the critical results of GM are descriptive, while (...) their reader-specific implications are normative. This interpretation illuminates the genealogical method of GM by answering four fundamental questions about its historical method, the history of morality that it reveals, the critical results of GM, and their intended therapeutic effects. Challenging the widespread assumption that the critical results of GM are evaluative claims, the perspectivist interpretation reveals the novelty of Nietzsche’s “new demand” for a critique of values not only relative to his predecessors’ approach to critique, but also to his own previous works. GM offers a critique that is grounded on factual claims, at once extramoral and external to morality, and internal to its readers’ evaluative perspectives, even those who remain beholden to moral values. Consequently, its authority and therapeutic efficacy are not threatened by discrepancies between it and its readers’ affective-evaluative preferences. (shrink)

In Kimber v. Thiokol Corp., 196 F.3d 1092, the U.S. Court of Appeals for the Tenth Circuit upheld a U.S. District Court's grant of summary judgment against an employee's claim that an employeroperated disability insurance plan, which offered different levels of compensation for disabilities due to mental and physical conditions, violated Title I of the Americans with Disabilities Act. The Court of Appeals found that the Thiokol plan administrator's interpretations of the plan were not arbitrary and capricious, and that the (...) plan's different treatment of disabilities caused by physical and mental conditions did not violate the ADA. (shrink)

In Kimber v. Thiokol Corp., 196 F.3d 1092, the U.S. Court of Appeals for the Tenth Circuit upheld a U.S. District Court's grant of summary judgment against an employee's claim that an employeroperated disability insurance plan, which offered different levels of compensation for disabilities due to mental and physical conditions, violated Title I of the Americans with Disabilities Act. The Court of Appeals found that the Thiokol plan administrator's interpretations of the plan were not arbitrary and capricious, and that the (...) plan's different treatment of disabilities caused by physical and mental conditions did not violate the ADA. (shrink)

Self-management interventions are a heterogeneous group of interventions that are regarded as important tools for the management of chronic diseases. They consist of a broad range of techniques and are available for a large variety of chronic organic as well as mental conditions or illnesses, which are by definition generally chronic. These interventions aim that the individual concerned takes substantial responsibility for managing the symptoms, treatment, and physical and psychosocial consequences associated with having a chronic medical condition, disability or disease. (...) Alternate terms used in this context, among others, are self-care... (shrink)

Perhaps nothing so radically changes one’s value perspective as psychosis. In a moving article, writer Mark Lukach describes his wife Giulia’s struggle with an illness presumed to be bipolar disorder. A woman with a “concrete life plan … to become a director of marketing at a fashion company and have three kids by the time she turned 35”, Gulia’s acute psychosis resulted in her ranting “unintelligible babble about heaven, hell, angels, and the devil”. For her husband, Gulia had become a (...) different person; “the person you love is no longer there, replaced by a stranger who’s shocking and exotic”.Yet, change to value systems is ubiquitous and usually far less dramatic than that occurring in... (shrink)