Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do not (...) believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

Knowledge translation has been widely taken up as an innovative process to facilitate the uptake of research-derived knowledge into health care services. Drawing on a recent research project, we engage in a philosophic examination of how knowledge translation might serve as vehicle for the transfer of critically oriented knowledge regarding social justice, health inequities, and cultural safety into clinical practice. Through an explication of what might be considered disparate traditions, we identify compatibilities and discrepancies both within the critical tradition, and (...) between critical inquiry and knowledge translation. The ontological and epistemological origins of the knowledge to be translated carry implications for the synthesis and translation phases of knowledge translation. In our case, the studies we synthesized were informed by various critical perspectives and hence we needed to reconcile differences that exist within the critical tradition. A review of the history of critical inquiry served to articulate the nature of these differences while identifying common purposes around which to strategically coalesce. Other challenges arise when knowledge translation and critical inquiry are brought together. Critique is one of the hallmark methods of critical inquiry and, yet, the engagement required for knowledge translation between researchers and health care administrators, practitioners, and other stakeholders makes an antagonistic stance of critique problematic. While knowledge translation offers expanded views of evidence and the complex processes of knowledge exchange, we have been alerted to the continual pull toward epistemologies and methods reminiscent of the positivist paradigm by their instrumental views of knowledge and assumptions of objectivity and political neutrality. These types of tensions have been productive for us as a research team in prompting a critical reconceptualization of knowledge translation. (shrink)

This article explores how ethics and religion interface in everyday life by drawing on a study examining the negotiation of religious and spiritual plurality in health care. Employing methods of critical ethnography, namely, interviews and participant observation, data were collected from patients, health care providers, administrators and spiritual care providers. The findings revealed the degree to which `lived religion' was intertwined with `lived ethics' for many participants; particularly for people from the Sikh faith. For these participants, religion was woven into (...) everyday life, making distinctions between public and private, secular and sacred spaces improbable. Individual interactions, institutional resource allocation, and social discourses are all embedded in social relationships of power that prevent religion from being a solely personal or private matter. Strategies for the reintegration of religion into nursing ethics are: adjusting professional codes and theories of ethics to reflect the influence of religion; and the contribution of critical perspectives, such as postcolonial feminism, to the understanding of lived ethics. (shrink)

'Numbers and Proofs' presents a gentle introduction to the notion of proof to give the reader an understanding of how to decipher others' proofs as well as construct their own. Useful methods of proof are illustrated in the context of studying problems concerning mainly numbers (real, rational, complex and integers). An indispensable guide to all students of mathematics. Each proof is preceded by a discussion which is intended to show the reader the kind of thoughts they might have before any (...) attempt proof is made. Established proofs which the student is in a better position to follow then follow. Presented in the author's entertaining and informal style, and written to reflect the changing profile of students entering universities, this book will prove essential reading for all seeking an introduction to the notion of proof as well as giving a definitive guide to the more common forms. Stressing the importance of backing up "truths" found through experimentation, with logically sound and watertight arguments, it provides an ideal bridge to more complex undergraduate maths. (shrink)

We address the question whether there is an explanation for the fact that as Fodor put it the micro-level “converges on stable macro-level properties”, and whether there are lessons from this explanation for other issues in the vicinity. We argue that stability in large systems can be understood in terms of statistical limit theorems. In the thermodynamic limit of infinite system size N → ∞ systems will have strictly stable macroscopic properties in the sense that transitions between different macroscopic phases (...) of matter (if there are any) will not occur in finite time. Indeed stability in this sense is a consequence of the absence of fluctuations, as (large) fluctuations would be required to induce such macroscopic transformations. These properties can be understood in terms of coarse-grained descriptions, and the statistical limit theorems for independent or weakly dependent random variable describing the behaviour averages and the statistics of fluctuations in the large system limit. We argue that RNG analyses applied to off-critical systems can provide a rationalization for the applicability of these limit theorems. Furthermore we discuss some related issues as, for example, the role of the infinite-system idealization. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflections on InsightDilemmas, Paradoxes, and PuzzlesMarga Reimer (bio)Keywordsinsight, psychosis, treatment adherence, medical model, autonomy, open placebos, rationalityThe Practitioner's DilemmaThe psychiatrist aware of the potential intractability of what Jennifer Radden calls "insightlessness," faces a dilemma. Should she encourage her patient to embrace a medical model of his "troubles," a model whose adoption is likely to motivate treatment adherence? She might then be trying to do the impossible; she might (...) also alienate her patient in the process. Should she instead encourage her insightless patient to embrace his own non-medical model, according to which treatment adherence makes no medical sense whatsoever? She might then see herself as encouraging a kind of uninformed consent: Her insightless patient might be taking powerful, potentially harmful, medication for reasons (such as sound sleep and "peace of mind") that would never medically justify adherence.In my original paper, I suggested that the way out of this dilemma might be to embrace the latter option, while characterizing the very real (and medically based) benefits of treatment adherence in non-medical terms. I now realize that my proposed resolution reflects an oversimplified understanding of what might be called the "practitioner's dilemma." As Michaela Amering (2010) makes clear, the situation for those with mental illness is improving dramatically. With "recovery orientation" as the "guiding principle of mental health policy," the emphasis is on "health promotion, individual strengths, and resilience." The question becomes: Can the practitioner encourage her insightless patient to partake in this "recovery" movement if she does not simultaneously encourage him to embrace a medicalized understanding of his "troubles"?Not obviously. For although a "recovery" model might eschew notions like illness1 and disease, pathology and dysfunction, and even schizophrenia, it will inevitably involve some medical notions. The patient who partakes in the "recovery movement" described by Amering, would seem to have no choice but to accept a model that is essentially medical. Consider the language used by Amering in characterizing that movement. She talks of mental health problems, therapeutic relations, patient self-determination, diagnosis and, of course, recovery. The concepts underlying such language are intrinsic to the patient-oriented movement Amering describes. The question becomes:How can the insightless patient rationally partake in such a movement without embracing some version of the medical model of mental illness? [End Page 85]This question suggests the importance of promoting some kind of insight, even if not insight "into psychosis." At the close of these comments, I consider briefly what such "revisionary" insight might involve.Paradoxes of Conditional and Relinquished AutonomyAutonomy among patients with psychosis presupposes the sort of clear-headedness that arguably comes only with treatment adherence. This may provide some justification for the "coercive treatments" that Anthony (2006) finds so offensive. For patients with psychosis, genuine autonomy is conditional, requiring some degree of insight: Recognition that their "troubles" are at least amenable to medical treatment. Once the patient recognizes this, he can choose freely to decline such treatment (regardless of whether that choice is ultimately respected). Call this the "paradox of conditional autonomy." The conditional nature of autonomy is a familiar point in philosophical discussions regarding free will. There is no genuine freedom without the sort of knowledge required for informed choices. What distinguishes the patient with psychosis from persons more generally is that his autonomy is further conditioned: The knowledge required for autonomous decision making arguably requires some degree of treatment adherence.However, the mentally ill patient has the right, as do all patients, to relinquish autonomy. He may opt for deference to, and dependency on, the relevant experts: Mental health care professionals (Campbell 1994). We are led once again to paradox. To respect the patient's autonomy, the mental health care professional must respect his right to forego autonomy in favor of deference and dependency. This paradoxical situation, involving a kind of deferred autonomy, is not unique to psychiatry but applies to medicine across the board. Indeed, it applies to the human service industry more generally where, as McGorry (1992) suggests, there is an implicit assumption that the service user is to defer to the expertise of the service provider.This assumption is rightly challenged. Suppose Justin and... (shrink)

This Article focuses both on the changes that have been made to the legal framework governing post-separation parenting of children in Australia, as well as the processes and discourses via which these matters have been dealt with and debated. Alone among comparable common law jurisdictions such as Canada, the United States, and England, Australia’s family law legislation, and the significant changes made to it in the past fifteen years, can be seen to have been particularly responsive to the lobbying of (...) fathers’ rights groups. It will be suggested that changes to the legislative framework that governs family law in Australia have taken place, at best, without any clear rationale or need and perhaps more problematically, have at times flown in the face of, rather than been undertaken by reference to, the evidence-based research about post-separation parenting practices and what we know about children’s welfare or best interests, the paramount consideration that underpins decision-making in this field. The purpose of this discussion is to attempt to posit some possible explanations for this distinctive path of Australian family law “reform”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy of Music Education Review 12.1 (2004) 4-16 [Access article in PDF] Once More With Feeling Reconciling Discrepant Accounts of Musical Affect Bennett Reimer Northwestern University When I was sixteen, a junior in high school in Brooklyn, I auditioned for the All-City High School Band of New York and was placed as first chair clarinet. At the first rehearsal, a piece we played (I don't remember what it (...) was except that it was new to me) had a long, melodic clarinet solo, with accompaniment. When I finished playing it the director stopped the band and said, "Very nice, first clarinet. Let's do it again, this time with more feeling." Then he said, "Letter C," and we started again.I could not have known, then, that I was to spend much of my life in pursuit of some sort of clarification of what transpired in that episode, as in this paper, where I deal once more with feeling. I had no idea that his apparently simple instruction to me raised issues so complex that many of humankind's most important thinkers had struggled with them in search of a resolution, as I, infinitely more modestly, was also to do. I was unaware that philosophical blood, sweat, and tears had been spilled through the centuries in various contentions as to the relation, if any, of musical feeling to feeling outside musical experience. I knew nothing of metaphor, [End Page 4] of effability and ineffability, of embodiment and designation, of issues of authenticity of feeling, and semantic density, significant form, semiotics, the relation of feeling to emotion, to gender, to meaning, and on and on with seemingly endless and intractable debates centered on how and why and when music is related to feeling.Being unencumbered with any of this (how one longs, sometimes, to return to one's philosophical Garden of Eden), and having to play that solo again immediately, I did what my novice performer's instincts told me to do-the only thing I knew how to do-I placed more emphasis on what the notes of that melody seemed to want to do, where they seemed to want to go and how they got there. Feeling their melodic tendencies more concentratedly and making them more apparent by the way I sounded them, I felt in myself a deeper sense of union-of the music as part of my undergoing-than I had the first time. When I finished the director stopped the band again, looked at me for several seconds, and said, "Lovely, first clarinet. Very musical. Let's go on."I would not have been able at the time that event occurred to describe, as I just did, what I did and how I felt. I did not have the conceptual apparatus to do so, although I did have, luckily for me, enough intuitive musicianship to have survived that test. My description, or perhaps interpretation, of how I reacted and how I experienced it can only reflect who I am now, with the cognitive structure allowing me to understand what happened as I reflect about it. Nevertheless I believe that several important matters relating to musical feeling can be clarified in relation to how I now interpret what I experienced as a youth in that band.I am aware now that I did what I did in ignorance of the fact that I was not the first to have played that solo. If I had known about and studied previous performances by a variety of clarinetists I would have, without doubt, been influenced by their solutions to the challenge of expressive interpretation it presented. Especially if I had been guided by a sensitive teacher, I would have reflected those influences in my own sounding. Perhaps I would have imitated what seemed to me the most musical rendition. If I had done so, I am now aware, that would have been regarded, in my culture at any rate, as a sign of my novice status, a more mature stage of musicianship requiring that I both reflect... (shrink)

This paper presents an in-depth analysis of the anatomy of both thermodynamics and statistical mechanics, together with the relationships between their constituent parts. Based on this analysis, using the renormalization group and finite-size scaling, we give a definition of a large but finite system and argue that phase transitions are represented correctly, as incipient singularities in such systems. We describe the role of the thermodynamic limit. And we explore the implications of this picture of critical phenomena for the questions of (...) reduction and emergence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy in the School Music ProgramBennett ReimerWho is philosophy of music education for? Several groups of people immediately spring to mind. First, it is for those of us in music education who produce it and consume it as a major or important responsibility in our work—people like members of our Special Research Interest Group at MENC. Second, teachers of music education courses at the undergraduate and graduate levels who (...) deal with it either in a full course or series of courses or seminars devoted to philosophy, or as one part of courses devoted to other topics (as I believe is most often the case.) Third, school music teachers, many of whom have taken or are taking such courses (and many who have not) who are expected to have some level of acquaintance, however rudimentary, with philosophical issues so as to be able to cope with them, as when writing curriculum guides, or explaining to other teachers, administrators, school boards, and parents why music education is valuable and deserves support. If we stretch it, we might include among those who need to be involved with philosophy of music and music education all educational professionals, since all, in one way or another, exert some sort of influence on the fortunes of music education. But that begins to strain a bit at the edges.No doubt there are other constituencies that can be identified. But one that has not been conceived as requiring substantive encounters with philosophical issues of music is that of students in schools, K-12. We all assume that philosophy can and should play a major role in determining what is most valuable for students to learn in their study of music. But seldom has it been argued, to my [End Page 132] knowledge, that philosophical issues should be addressed in all programs of music education intended to produce people who are, in any convincing sense, musically educated.My premise is that philosophical reflection relating to music and to the teaching and learning of music should be foundational in school music programs. Further, philosophy needs to be present in our programs in three distinctive ways, reflecting common practices of education in America and all over the world. That is, as integral in the general music education of all students, as a component of all elective offerings, and as one particular, focused offering among the electives available to all students.My position is that what we call "general music" (which, as we know, goes by a variety of names around the world including just "music") is not complete; in fact is invalid, if it does not provide philosophical challenges of the same level of complexity, and the same degree of authenticity, as everything else we believe all students should know and be able to do in music. What we call the "music elective program," or the "music specialization program," is incomplete, in fact is invalid, if philosophical matters are not addressed as they relate to the particularities of each elective offered. And, in addition, philosophy needs to be a standard elective offering, taught with the same level of expertise by specialist teachers as we now routinely make available in performance and in the meager smattering of other electives we manage to offer.What? Philosophical thinking for all children, even in the primary grades, and as electives starting perhaps at the middle school or high school level? Electives taught by music educators whose specialization is the teaching of philosophy of music to youngsters? Am I serious? After all, even those of us who are devoted to it as a major aspect of our professionalism are constantly at the edges of our competence given the deep challenges philosophy presents to our intellect. And I expect children—all children—to be able to deal with it authentically?Well, we could ask precisely the same questions about, say, mathematics, and science, and history, and social studies, all the ways of thinking which constitute the basic learnings in all grades of our schools. As educators we know better than to conceive the nature of those subjects as only apparent at the level of professional work in them. We recognize the obvious: while at... (shrink)

Three views of demonstrative reference are examined: contextual, intentional, and quasi-intentional. According to the first, such reference is determined entirely by certain publicly accessible features of the context. According to the second, speaker intentions are criterial in demonstrative reference. And according to the third, both contextual features and intentions come into play in the determination of demonstrative reference. The first two views (both of which enjoy current popularity) are rejected as implausible; the third (originally proposed by Kaplan in Dthat) is (...) argued to be highly plausible. (shrink)

In this study, we examine the influence of senior leadership on firms’ corporate social responsibility. We integrate upper echelons research that has investigated either the influence of the CEO or the top management team on CSR. We contend that functional experience complementarity between CEOs and TMTs in formulating and implementing CSR strategy may underlie differentiated strategies in CSR. We find that when CEOs who have predominant experience in output functions are complemented by TMTs with a lower proportion of members who (...) have experience in output functions, there is a pronounced effect on the community, product, and diversity dimensions of CSR. In turn, when output-oriented CEOs are complemented by output-oriented TMTs, we observe an effect on the employee relations dimension of CSR. Interestingly, we find no influence of CEO-TMT complementarity on the environment dimension of CSR. In general, our empirical results support the relevance of the interaction between CEOs and their TMTs in defining their firms’ CSR profile. (shrink)

Attempts to understand farmer conservation behavior based on quantitative socio-demographic, attitude, and awareness variables have been largely inconclusive. In order to understand fully how farmers are making conservation decisions, 32 in-depth interviews were conducted in the Eagle Creek watershed in central Indiana. Coding for environmental attitudes and practice adoption revealed several dominant themes, representing multi-dimensional aspects of environmental attitudes. Farmers who were motivated by off-farm environmental benefits and those who identified responsibilities to others (stewardship) were most likely to adopt conservation (...) practices. Those farmers who focused on the farm as business and were most concerned about profitability were less likely to adopt practices. The notion of environmental stewardship in particular was found to be much more complex than the way it is traditionally measured in quantitative studies. The interplay between on-farm and off-farm benefits to practice adoption is an issue that quantitative studies largely do not address. This study seeks to increase understanding of farmers’ environmental attitudes and the connections to conservation behavior. (shrink)

In this study, we examine the influence of senior leadership on firms’ corporate social responsibility. We integrate upper echelons research that has investigated either the influence of the CEO or the top management team on CSR. We contend that functional experience complementarity between CEOs and TMTs in formulating and implementing CSR strategy may underlie differentiated strategies in CSR. We find that when CEOs who have predominant experience in output functions are complemented by TMTs with a lower proportion of members who (...) have experience in output functions, there is a pronounced effect on the community, product, and diversity dimensions of CSR. In turn, when output-oriented CEOs are complemented by output-oriented TMTs, we observe an effect on the employee relations dimension of CSR. Interestingly, we find no influence of CEO-TMT complementarity on the environment dimension of CSR. In general, our empirical results support the relevance of the interaction between CEOs and their TMTs in defining their firms’ CSR profile. (shrink)

In this paper, I argue against Davidson's (1986) view that our ability to understand malapropisms forces us to re-think the standard construal of literal word meaning as conventional meaning. Specially, I contend that the standard construal is not only intuitive but also well-motivated, for appeal to conventional meaning is necessary to understand why speakers utter the particular words they do. I also contend that, contra Davidson, we can preserve the intuitive distinction between what a speaker means and what his words (...) mean, even while retaining the standard construal of literal word meaning as conventional. (shrink)

What happens to politics in the postmodern condition? The Politics of Postmodernity is a political tour de force that addresses this key contemporary question. Politics in postmodernity is carefully contextualized by relating its specific sphere - the polity - to those of the economic, social, technological and cultural. The authors confront globalization and the notion of postmodernity as disorganized capitalism. They analyze the role of the mass media, the changing ways in which politics is used, the role of the state (...) and the progressive potential of politics in postmodern times. Closing with a postscript on the future of the discipline of political science, this book offers a profound yet highly accessible account. (shrink)

Standard attempts to defend Russell's Theory of Descriptions against the problem posed by incomplete descriptions, are discussed and dismissed as inadequate. It is then suggested that one such attempt, one which exploits the notion of a contextually delimited domain of quantification, may be applicable to incomplete quantifier expressions which are typically treated as quantificational: expressions of the form AllF's, NoF's, SomeF's, Exactly eightF's, etc. In this way, one is able to retain the plausible claim that such expressions ought to receive (...) their usual quantificational analyses. The conclusion tentatively drawn is that perhaps definite descriptions arenot amenable to a (Russellian) quantificational analysis. (shrink)

Understanding factors that motivate farmers to perform conservation behaviors is seen as key to enhancing efforts to address agri-environmental challenges. This study uses survey data collected from 277 farmers in the La Moine River watershed in western Illinois to develop new measures of farmers’ environmental attitudes and examine their influence on current usage of agricultural best management practices (BMPs). The results suggest that a Dual Interest Theory approach reflecting two separate, competing psychological frames representing a stewardship view of the environment (...) and a farm as a business (or profit maximization) view of the environment are present within the decision making domain. Using a cluster analysis technique to examine the interaction between these attitude frames reveals four groups of farmers who hold distinct views of the environment. Further exploration of these distinct belief systems reveals little evidence of differences in participation or willingness to participate in agricultural BMPs; however, we observe significant differences between these groups with regard to their willingness to support rural conservation planning priorities that address agri-environmental challenges. Further discussion focuses on the implications of these interactive dual interest typologies and the implications of these findings on efforts to engage farmers in conservation efforts. (shrink)

Stephen Schiffer has recently claimed that the currently popular “hidden‐indexical” theory of belief reports is an implausible theory of such reports. His central argument for this claim is based on what he refers to as the “meaning‐intention” problem. In this paper, I claim that the meaning‐intention problem is powerless against the hidden‐indexical theory of belief reports. I further contend that the theory is in fact a plausible theory of such reports.

Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.

In his classic paper, “Delusional thinking and perceptual disorder,” Brendan Maher (1974) argues that psychiatric delusions are hypotheses designed to explain anomalous experiences, and are “developed through the operation of normal cognitive processes.” Consider, for instance, the Capgras delusion. Patients suffering from this particular delusion believe that someone close to them—such as a spouse, a sibling, a parent, or a child—has been replaced by an impostor: by someone who bears a striking resemblance to the “original” and who (for reasons unknown) (...) is intent on passing herself off as that individual. On Maher's view, the “Impostor Hypothesis” is the response of a rational agent to the anomalous experience it is invoked to explain. Recently, a number of philosophers have argued that Maher's analysis of delusion doesn't work when applied to the Capgras delusion. In this paper, I defend Maher's analysis against these arguments. However, my aim is not merely to defend Maher's analysis, but also to draw attention to some of the methodological problems that have led to its hasty dismissal. (shrink)