This book is a guide to understanding and applying the essential, heretofore elusive notion of context in language study and pedagogy: Éva Illés offers a new, critical, systematic theoretical framework, then applies that framework to practical interactions and issues in communicative language teaching rooted in English as a Lingua Franca. By linking theory and practice for research and teaching around the world, this book brings a new awareness of how context can be conceptualized and related to language pedagogy to advanced (...) students, teachers, teacher educators, and researchers of language teaching, applied linguistics, and pragmatics. (shrink)

This article examines the significance of Friedrich Nietzsche to Albert Camus’ concepts of absurdity and revolt. It rests on three related claims. First, that Nietzsche’s critique of metaphysics is the point of departure for Camus’ absurdist inquiries. Second, that Camus’ philosophy of revolt is informed in crucial ways by Nietzsche’s views on the sources of moral and intellectual authority in the modern world. Finally, that Camusian revolt is an attempt to deal with the political crisis of foundationalism in a way (...) that preserves Nietzsche’s anti-essentialism while also avoiding the excesses of absolutist politics. Ultimately, I suggest that the origins and implications of Camus’ project cannot be grasped apart from an account of its engagement with Nietzsche. (shrink)

The paper begins with the account of a focus group discussion of Hungarian female managers who demonstrated high level of trust. Drawing on the discussion the author explores the nature of trust and looks at works and research findings in different disciplines. In psychology Erikson’s findings on human growth and development are discussed. Representatives of Eastern and Western philosophy are quoted to highlight the underlying differences of thinking in relation to trust. The impact of cultural heritage and the influence of (...) the environment on trust add further dimensions to the argument. In conclusion it is suggested that management education could be a platform for further research and exploration of trust in individuals and organisations. (shrink)

This article examines the significance of Friedrich Nietzsche to Albert Camus’ concepts of absurdity and revolt. It rests on three related claims. First, that Nietzsche’s critique of metaphysics is the point of departure for Camus’ absurdist inquiries. Second, that Camus’ philosophy of revolt is informed in crucial ways by Nietzsche’s views on the sources of moral and intellectual authority in the modern world. Finally, that Camusian revolt is an attempt to deal with the political crisis of foundationalism in a way (...) that preserves Nietzsche’s anti-essentialism while also avoiding the excesses of absolutist politics. Ultimately, I suggest that the origins and implications of Camus’ project cannot be grasped apart from an account of its engagement with Nietzsche. (shrink)

This book explores patient safety themes in developed, developing and transitioning countries. A foundation premise is the concept of 'reverse innovation' as mutual learning from the chapters challenges traditional assumptions about the construction and location of knowledge. This edited collection can be seen to facilitate global learning. This book will, hopefully, form a bridge for those countries seeking to enhance their patient safety policies. Contributors to this book challenge many supposed generalisations about human societies, including consideration of how medical care (...) is mediated within those societies and how patient safety is assured or compromised. By introducing major theories from the developing world in the book, readers are encouraged to reflect on their impact on the patient safety and the health quality debate. The development of practical patient safety policies for wider use is also encouraged. The volume presents a ground breaking perspective by exploring fundamental issues relating to patient safety through different academic disciplines. It develops the possibility of a new patient safety and health quality synthesis and discourse relevant to all concerned with patient safety and health quality in a global context. (shrink)

Supply-side interventions such as prescription drug monitoring programs, “pill mill” laws, and dispensing limits have done little to quell the burgeoning opioid crisis. An increasingly popular demand-side alternative to these measures – now adopted by 38 jurisdictions in the USA and 7 provinces in Canada — is court-mandated involuntary commitment and treatment. In Massachusetts, for example, Part I, Chapter 123, Section 35 of the state's General Laws allows physicians, spouses, relatives, and police officers to petition a court to involuntarily commit (...) and treat a person whose alcohol or drug abuse poses a likelihood of serious harm. This paper explores the ethical underpinnings of this law as a case study for others. First, we highlight the procedural and substantive standards of Section 35 and evaluate the application of the law in practice, including the frequency with which it has been invoked and outcomes. We then use this background to inform an ethical critique of the law. Specifically, we argue that the infringement of autonomy and privacy associated with involuntary intervention under Section 35 is not currently justified on the grounds of a lack of evidenced benefits and a risk of significant of harm. Further ethical concerns also arise from a lack of standard of care provided under the Section 35 pathway. Based on this analysis, we advance four recommendations for change to mitigate these ethical shortcomings. (shrink)

There is substantial literature on fetal alcohol spectrum disorder research involving Aboriginal children, but little related literature on other common neurodevelopmental conditions such as autism spectrum disorder or cerebral palsy for this population. As part of our work in cross-cultural neuroethics, we examined this phenomenon as a case study in Canada. We conducted semi-structured interviews with health researchers working on the frontline with First Nation communities to obtain perspectives about: reasons for the lack of ASD and CP research within the (...) Aboriginal context, the potential ethical and social implications of this disparity, and recommendations for change. Participants reported that the major barriers to engage in ASD or CP research are under-reporting and under-diagnosis of these conditions in Aboriginal communities, difficulties in establishing trust between community members and researchers, challenges in accessing children living under the care of child welfare services, and lack of support from universities and funding agencies to encourage community partnerships. They further perceived threats to justice as the population is denied the benefits of ASD and CP research, and stigma related to the possible over-representation of FASD in the population. The adoption of strength- and community-based practices to improve engagement and address disparities, and to create health databases with prevalence rates that are representative of all forms of disability in both Aboriginal and non-Aboriginal populations are critical steps to close these gaps. (shrink)

To date, ethics discussions about stem cell research overwhelmingly have centered on the morality and acceptability of using human embryonic stem cells. Governments in many jurisdictions have now answered these “first-level questions” and many have now begun to address ethical issues related to the donation of cells, gametes, or embryos for research. In this commentary, we move beyond these ethical concerns to discuss new themes that scientists on the forefront of NRM development anticipate, providing a preliminary framework for further discussion (...) between scientists and ethicists. Fostering strong partnerships between neuroscientists and ethicists that operate and collaborate within this evolving framework will maximize the translation of NRM discoveries on the brain into cures that are safe and address the needs of science and society. (shrink)

Objectives To characterize recruitment approaches to research on the brain and mind that involves Indigenous peoples. Methods We conducted a secondary analysis of a Harding et al. (2021) scoping review. Reviewers screened studies (_n_ = 66) for sampling methods, recruitment and engagement, positionality statements, and details on ethics approvals. Synthesis We identified twenty-nine (29) English-language articles relevant to the analysis. Of these, 52% (_n_ = 15/29) reported a mix of sampling methods; 45% (_n_ = 13/29) contained statements or information about (...) author positionalities. While, overall, 24% (_n_ = 7/29) of the studies were missing information about ethics protocols, we observe an improvement over time in the reporting of approvals and use of community-engaged participant recruitment methods. Current brain research studies demonstrate ways of collaborating with Indigenous communities that meet existing ethics guidelines. To be wholly responsive to the needs of Indigenous peoples, however, researchers may need to exceed existing ethical benchmarks.. Positionality statements successfully detailed the relationships of the research teams with the communities with which they work, and contextualized recruitment methods. Conclusion Improved quality and meaningfulness of brain research with Indigenous peoples and trust in the research process and public health will be enhanced when remaining gaps in protecting and reporting of participant recruitment methods are closed. (shrink)

The history and genesis of major public clinical ethics controversies is intimately related to the publication of opinions and responses in media coverage. To provide a sample of public response in the media, this paper reports the results of a content analysis of letters to editors published in the four most prolific American newspapers for the Schiavo controversy. Opinions expressed in the letters sampled strongly supported the use of living wills and strongly condemned public attention to the case as well (...) as political interventions. Letters tended to be against withdrawal of life support, proxy consent and associated procedures as well as against court decisions and legal procedures. In comparison with reports written by journalists, letters to editors contained fewer controversial claims about Schiavo''s neurological condition and behavioural repertoire but similar loaded language to describe withdrawal of life support. Distinct public discourses can be encountered in different stakeholders suggesting complex and extensive pluralism even within the media. (shrink)

Direct-to-consumer advertising of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians but DTCA is an increasing part of global promotional spending for prescription drugs. Latest estimates suggest that DTCA now represents (...) an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion's share is going to the 20 most prescribed pharmaceuticals. (shrink)

Background: The research community has a mandate to discover effective treatments for neurodegenerative disorders. The ethics landscape surrounding this mandate is in a constant state of flux, and ongoing challenges place ever greater demands on investigators to be accountable to the public and to answer questions about the implications of their work for health care, society, and policy. Methods: We surveyed US-based investigators involved in neurodegenerative diseases research about how they value ethics-related issues, what motivates them to give consideration to (...) those issues, and the barriers to doing so. Using the NIH CRISP database we identified 1,034 researchers with relevant, active grants and invited them to complete an online questionnaire. We received 193 responses. We used exploratory factor analysis to transform individual survey questions into a smaller set of factors, and linear regression to understand the effect of key variables of interest on the factor scores. Results: Ethics-related issues clustered into two groups: research ethics and external influences. Heads of research groups viewed issues of research ethics to be more important than the other respondents. Concern about external influences was related to overall interest in ethics. Motivators clustered into five groups: ensuring public understanding, external forces, requirements, values, and press and public. Heads of research groups were more motivated to ensure public understanding of research than the other respondents. Barriers clustered into four groups: lack of resources, administrative burden, relevance to the research, and lack of interest. Perceived lack of ethics resources was a particular barrier for investigators working in drug discovery. Conclusions: The data suggest that senior level neuroscientists working in the field of neurodegeneration (ND), and drug discovery specifically, are motivated to consider ethics issues related to their work, but the perceived lack of ethics resources thwarts their efforts. With bioethics centres at more than 50% of the institutions at which these respondents reside, the neuroscience and bioethics communities appear to be disconnected. Dedicated ethical, legal and social implications (ELSI) programs, such as those fully integrated into genetics and regenerative medicine, provide models for achieving meaningful partnerships not yet adequately realized for scholars and trainees interested in drug discovery for ND. (shrink)

BackgroundDepressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen. Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects (...) in patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety.DiscussionThe use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use.ConclusionWe urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine. (shrink)

The Internet has quickly gained popularity as a major source of health-related information, but its impact is unclear. Here, we investigate the extent to which advocacy websites for three neurodevelopmental disorders—cerebral palsy (CP), autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD)—inform stakeholders about treatment options, and discuss the ethical challenges inherent in providing such information online. We identified major advocacy websites for each disorder and assessed website accountability, the number, attributes, and accessibility of treatments described, and the valence (...) of treatment information. With the exception of FASD websites, we found that advocacy websites provide a plethora of information about a wide variety of readily available products and services. Treatment information is primarily targeted at families and is overwhelmingly encouraging, regardless of the type or conventionality of treatments. Many websites acknowledge corporate sponsors. While the majority do not overtly advertise or endorse specific brands, they also do not prominently display disclaimers about the nature and intent of treatment information. Thus, while advocacy websites are organized to serve as information clearinghouses, they implicitly appear to provide endorsement of selected treatments and services. We conclude with recommendations for new partnerships between government-funded health organizations, advocacy and investigators to make more transparent the role of online information in informing treatment options and improving the evaluation of information. (shrink)

This paper presents the preliminary results from my research focused on beliefs and practices related to the life cycle and certain health-illness processes related to their different stages, in two Mbya communities in the province of Misiones, in the Argentinian northeast. We have centered our research on parasite illnesses and the groups' numerous beliefs and experiences around their origin, diagnosis, prevention and therapeutics.We used observations and interviews to characterize the diagnosis, treatment and prevention strategies performed by different individuals as (...) well as recognize and define risk situations related with parasite infestation and transmission in the context of their domestic activities.Our investigation showed that certain forms of child care, in particular those related to respecting food prescriptions and taboos are meant to protect children from possible risk situations. (shrink)

In a world of partially overlapping and partially conflicting interests there is good reason to doubt that self-seeking behaviour at the micro-level will spontaneously lead to desirable social outcomes at the macro-level. Nevertheless, some sophisticated economic writers advocating a laissez-faire policy prescription have proposed various 'invisible hand' mechanisms which can supposedly be relied upon to 'educe good from ill'. Smith defended the 'simple system of natural liberty' as giving the greatest scope to the unfolding of God's will and the working (...) out of 'natural' providential processes free of interference by 'artificial' state intervention - the expression not of divine order but of fallible human reason. Hayek, adopting a similar policy stance, based it in an evolutionary process in which those institutional forms best adapted to reconciling individual interests would, he believed, spontaneously be selected for in the inter-group struggle for survival. Keynes shares the holistic approach of Smith and Hayek, but without their reliance on invisible hand mechanisms. If spontaneous processes cannot be relied upon to generate desirable social outcomes then we have to take responsibility for achieving this ourselves by establishing the appropriate institutional framework. Keynes takes a historical view of the role of capitalism and analyses its pathology as rooted in what we would now refer to as a multi-player prisoners' dilemma. The paper draws out the significance of his methodological standpoint here. Keynes's policy standpoint assigns a critical role to his own class, the 'educated bourgeoisie' in the reform process he maps out. A distinction, but also an intimate connection, is highlighted between, on the one hand, micro-level individualism (the 'Manchester System, and, on the other, the macro-level collective action ('planning') required to preserve it. Finally Keynes is considered in relation to the themes of laissez-faire, holism, reductionism, providentialism and the invisible hand. (shrink)

“You need to listen better to your body!” is a common prescription in contemporary health discourse. From a phenomenological perspective, we can say that the ability to hear your body implies body awareness. In this paper, I will provide a phenomenological analysis of the different ways in which the “audible body” can appear, and how this is related to health, drawing on the work of Merleau-Ponty, Shusterman, Leder, and Nancy. In Merleau-Ponty’s early work, so I explain, the “lived body” emerges (...) as an “audible” body, but it is only faintly audible and only so on the surface. Moreover, we find no explicit clues in his work for the injunction to learn to listen to the audible body. Shusterman, on the other hand, claims that we should train and increase somatic attention, and thus better listen to our bodies in order to cure bad bodily habits such as poor bodily posture. Subsequently, I describe how Leder argues that phenomenological analyses of the body should not only involve the surface body and its motor-sensory capacities. They should also involve the recessive, inner body. According to him it is healthy to increase one’s capacity for introception in order to increase “inside insights.” In the final part of this paper, I explain, on the basis of Nancy’s work, that listening to one’s body might become unhealthy when this listening goes hand in hand with amplifying the strangeness of one’s own body. (shrink)

In a democratic society, the social rules are imposed by all upon each. As “recipients” of the rules, we tend to think that they should be designed to engender the best attainable distribution of goods and ills or quality of life. We are inclined to assess social institutions by how they affect their participants. But there is another, oft-neglected perspective which the topic of health equity raises with special clarity: As imposers of the rules, we are inclined to think that (...) harms we inflict through the rules have greater moral weight than like harms we merely fail to prevent or to mitigate. What matters morally is not merely how we affect people, but how we treat them through the rules we impose. While current (consequentialist and Rawlsian) theorizing is dominated by the first perspective and thus supports purely recipient-oriented moral conceptions, an adequate approach to social justice requires a balancing of both. Such balancing results in a relational conception of justice, which distinguishes various ways in which an institutional scheme may causally affect the quality of life of its participants.This essay argues that the strength of our moral reason to prevent or mitigate particular medical conditions depends not only on what one might call distributional factors, such as how badly off the people affected by these conditions are in absolute and relative terms, how costly prevention or treatment would be, and how much patients would benefit from given treatment. Rather, it depends also on relational factors, that is, on how we are related to the medical conditions they suffer. It then discusses some implications of this view for understanding responsibilities for international health outcomes. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

Over the last several years asylum cases relating to activities of criminal gangs have greatly increased in frequency. Cases involving Central American gangs, the so-called maras, have attracted the most attention but similar cases have arisen out of South Eastern and Eastern Europe as well. Applicants in such cases face a number of difficulties as their cases do not fit into paradigm categories for asylum claims. These cases almost always involve non-state actors, for example, acting for reasons that are not, (...) at least at first glance, clearly political. Additionally, the reasons why gangs target particular individuals often do not obviously fit into one of the traditional protected grounds. If applicants fleeing gang activity are to successfully apply for asylum they will have to overcome these apparent difficulties. In this paper, a contribution to the University of Memphis Law Review Spring Symposium on immigration reform, I break down gang-related asylum claims into three main categories and show how at least some cases in each category fit within the area set out for protection by asylum and refugee law. I briefly discuss a conceptual framework which explains how some gang-related cases should be seen as falling in the area that asylum law seeks to protect (thereby providing a concrete example of the sort of protection that I claim in my dissertation refugee law is meant to provide) and give advice to practitioners about how to formulate meritorious claims. (shrink)

In this article I aim to make progress towards the philosophical goal of ascertaining what, if anything, all mental illnesses have in common, attempting to unify a large sub-set of them that have a relational or interpersonal dimension. One major claim is that, if we want a promising theory of mental illness, we must go beyond the dominant western accounts of mental illness/health, which focus on traits intrinsic to a person such as pain/pleasure, lethargy/liveliness, fragmentation/integration, and falsehood/authenticity. A (...) second major claim is that the relational facets of mental illness are plausibly understood theoretically in terms of a person’s inability to identify with others or to exhibit solidarity with them, relational values that are salient in the African philosophical tradition. I show that these two extrinsic properties well explain several intuitive instances of mental illness, including, amongst several others, being abusive, psychopathic, narcissistic, histrionic, paranoid, and phobic. (shrink)

John Rawls's ?veil of ignorance? approach to ethical decision making is a staple in mass media ethics literature, but Rawls's overarching theory of distributive justice receives less consideration in public relations ethics than in other communication disciplines. Public relations ethicists who describe the veil often divorce it from Rawls's original intention. This paper describes Rawls's theory; its uses and misuses in contemporary discussions of public relations ethics; six reasons why the veil seems to be a difficult fit for public relations (...) practitioners; and Rawlsian considerations in the context of three commonly accepted public relations models. (shrink)

The ills of psychiatry are currently diagnoses with the aid of deficient etiologies. The currently proposed prescriptions for psychiatry are practically impossible. The defective part of the profession is its leadership which in its very defensiveness sticks to the status quo, thereby owning the worst defects and impeding all possible cure. The current discussions of the matter are pretentious and thus woolly. The minimal requirement from the profession as a whole and from each of its individual members is that they (...) be not defensive and clear. In this vein I offer here preliminary discussions of propriety, of responsibility and of science. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic (...) coping plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

Illness anxiety disorder, formerly known as hypochondria, has been conceptualised in the psychological literature as an anxiety disorder, and its dimensional correlate is usually referred to as hea...

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self‐management and the traditional individualistic view of autonomy. (...) I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy. (shrink)

If connectionist computational models explain the acquisition of complex cognitive skills, errors in such models would also help explain unusual brain activity such as in creativity – as well as in mental illness, including childhood onset problems with social behaviors in autism, the inability to maintain focus in attention deficit and hyperactivity disorder (ADHD), and the lack of motivation of depression disorders.

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, (...) despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

ObjectivesQuality of Life depends on the discrepancy between desired and current experiences, thus in chronic illness, adjustment of expectations and interpretation of the current situation are crucial. Depression is known to influence this gap, and the present study aims to further assess the role of resilience and health locus of control.MethodsA total of 94 patients with neurological disorders were screened via telephone regarding depression, resilience and HLC. Current and desired state of several life domains were assessed, such as Fitness, (...) General Health, Pain, Daily Activities, Finances, Leisure, and Family. Elastic net regularization and analyses of variance were used to disentangle the impact of depression, resilience, HLC, and sociodemographic factors on the perception of current and desired state, and the gap between both.ResultsA gap was present for all domains but largest for pain. Interpretation of the current state was linked to desired state, HLC, and age. All gaps were related to depression; certain domains were in addition influenced by resilience, HLC and sociodemographic factors. Of note, for most domains, patients did not select the highest possible desired state.ConclusionOlder patients with neurological disorders report a gap between current and desired state for many aspects of life. Adjusting expectations is beneficial in the face of declining health, but a reasonably increased desired state may positively influence the perception of the current situation. Depression negatively influences the interpretation of the Calman gap. (shrink)

Objective: Illness perceptions are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors and examine the impacts of IP on perceived stress and preventive behaviors.Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns (...) were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution. (shrink)

It is only in the past 20 years that the concept of 'recovery' from mental health has been more widely considered and researched. This book is unique in addressing philosophical issues - including conceptual challenges and opportunities - raised by the notion of recovery of people with mental illness.

In this Response to Professor Peters, Professor Greenawalt argues that prescriptive equality does have meaningful normative force. Prescriptive equality plays a reinforcing role when it agrees with nonegalitarian justice and is not incoherent when it pulls against nonegalitarian justice. Specifically, when one individual has been treated better than is required by nonegalitarian justice, a similarly situated and significantly related individual who is aware of that treatment may merit equivalent treatment because of widespread and deep-seated feelings about equality.

Neuroscience and psychiatry -- Psychotherapy and psychiatry -- Diagnosis in psychiatry -- The boundaries of mental disorders -- Mood and mental illness -- Psychiatry's problem children -- Evidence-based psychiatry -- Psychiatric drugs: miracles and limitations -- Talk therapies: the need for a unified method -- Psychiatry in practice -- Training psychiatrists -- Psychiatry and society -- The future of psychiatry.

The present paper constitutes a development of the position that illness, whether bodily or mental, should be analyzed as an incapacitating failure of bodily or mental capacities, respectively, to realize their functions. The paper undertakes this development by responding to two critics. It addresses first Szasz’s continued claims that (1) physical illness is the paradigm concept of illness and (2) a philosophical analysis of mental illness does not shed any light on the social and legal role (...) of the idea. Then, in reply to Wakefield, the aim is to defend the account as an interpretation of Aristotle and to argue that this Aristotelian view of mental illness is preferable to one that rests on a supposed value free account of human function. More generally the discussion points to the fact that both Wakefield and Szasz rely on a number of metaphysical assumptions about the supposedly empirical nature of medical diagnosis, about the relation between facts and values, and about mind and body (among others), which are open to challenge. In particular the paper indicates an aristotelian approach to the fusion, in the natural world, of so-called facts and values, and the relevance of this fusion to the analysis of the concept of illness. This suggests the debate over distinct conceptions of that concept must both illumine and be illuminated by these deeper metaphysical questions. (shrink)

This conversational opinion article between two parties – Kate, a disability performance scholar and Sarah, an interdisciplinary artist-scholar with lived experience of disability – considers the dancing body as redeemer in the specific case of a dancer experiencing ‘chemo fog’, or Chemotherapy-Related Cognitive Impairment (CRCI) after undergoing oncological treatments for Hodgkin Lymphoma. This work draws on Pini’s own lived experience of illness (Pini & Pini, 2019) in dialogue with Maguire-Rosier’s study of dancers with hidden impairments (Gibson & Maguire-Rosier, 2020). (...) In an exploratory account based on an interview with one another, the authors ask: when our senses and perceptions of ourselves and the world we become are obfuscated, what is the nature of the new relationship between the performing self and its absent body/mind/world? How can we shape our narrative and articulate who we are, what we are doing or where we are going, if we are moving in the ‘fog’? Our discussion reveals how Pini’s dancing body elucidates healing, while recovering an agentic perspective in her experience of alienation and frustration tied to chemo fog and related impairments. With this work we offer an original perspective on how a dancing body can resist theoretical diagnosis. (shrink)

The insight a patient shares into their own psychosis is fundamental to their condition - it goes to the heart of what we understand 'madness' to be. Can a person be expected to accept treatment for a condition that they deny they have? Can a person be held responsible for their actions if those actions are inspired by their own unique perceptions and beliefs - beliefs that no-one else shares? The topic of insight in schizophrenia and related disorders has become (...) a major focus of research in psychiatry and psychology. It has important clinical implications in terms of outcome, treatment adherence, competence, and forensic issues. In order to study 'insight' a broad perspective is required. This involves applying knowledge from the cognitive and brain sciences, as well as from philosophy and the social sciences. Insight and Psychosis comprises a series of in-depth, well-referenced, scholarly overviews from each of these perspectives with a strong empirical foundation - including in some cases the presentation of new data and meta-analysis of the published literature. These are integrated and synthesised by the editors, both acknowledged experts in the field. The scope is truly international and spans theoretical perspectives, clinical practice, and consumer views. The book will act as a source for students and researchers interested in pursuing any number of questions and controversies around lack of insight and awareness, and will guide clinical psychologists and psychiatrists who seek a broader view of the many facets of insight that might arise during their day-to-day work. (shrink)

Illness has a way of disorientating us, as if we are cast adrift in a foreign land. Like strangers in a dessert we seek oasis to recollect ourselves, find refuge and learn to build our own shelters. Using the philosophy of Levinas and Derrida, we can interpret health care providers (HCP), and the sites from which they act (e.g. hospitals), as _dwelling hosts_ that offer hospitality to strangers in this foreign land. While often the dwellings are physical (e.g. hospitals), (...) this is not always the case. Language represents a mobile home of refuge to the sick. Using language the HCP has built a shelter so as to dwell in the land of illness. However, while hospitality is an inviting concept, it also implies hostility. The door that opens may also be slammed shut. This article explores the paradox of the linguistic mobile home offered to patients. It highlights the power of language to construct a safe place in a strange land, but also explores the inherent violence. It ends with an exploration of the ways language can be used by HCP to assist patients to construct their own mobile shelters. (shrink)

In her book, Illness as Metaphor, Susan Sontag focuses on metaphors and myths on diseases such as cancer and tuberculosis, which occur in different historical periods. Sontag argues that the metaphors produced related to illness overhaul illness and the things that define illness now have become metaphors produced related to them rather than their concrete and physical aspects. Illness becomes not just an illness, but a phenomenon defined by evil, mystery, fear, evil, madness, passions, (...) wealth and poverty, temporal loginess or speed, and a set of metaphors or myths that are spatially identified with the space. Metaphors and myths turn into means of socially stigmatizing the illness itself rather than giving a meaning to illness. The disease literally turns into a situation that needs to be hidden in order to avoid social stigma. The explanation of mass diseases through metaphors and myths has been seen since ancient times and this understanding of mass diseases continues to exist today. As a matter of fact, the Covid-19 pandemic has also ceased to be the subject of only medical science since it first emerged, and it has turned into an issue that concerns many areas from politics to economics, from sociology to psychology. The metaphors generated on the Covid-19 disease, which we have witnessed its reflections in many areas from the discourses of daily life to the discourse of politicians, from art to literature, have a similar function with the metaphors attributed to diseases like cancer and tuberculosis that Sontag discussed. Covid-19 is not only seen as a disease, but as a disease defined by a series of metaphors such as mysterious, evil, invisible enemy, insidious danger, and democratic virus. The metaphors generated on the disease cause the struggle against the disease itself to be explained with various metaphors. The metaphors derived from Covid-19 such as "invisible enemy" and "biological war" cause the struggle against it to be turned into a military terminology, and the metaphor of "Chinese virus" is a means of social stigmatization / marginalization by racializing the virus directly. This study tackles the issue of how Covid-19, which is the subject of medical science, has become the subject of unscientific myths and metaphors attributed to the disease, and that the disease is perceived through metaphors rather than itself in the context of Susan Sontag's thought. In the study, answers for the questions of what kind of effects appeared due to the stigmatizing power of metaphors derived from the Covid-19 and whether the metaphors are the outcomes of the strategy for coping with the pandemic will be sought. (shrink)

This chapter argues that a successful plea of legal insanity ought to rest upon proof that a criminal act is causally related to symptoms of a mental disorder. Diagnosis of a mental disorder can signal to the court that the defendant had very little control over relevant moral ignorance or incompetence. Must we draw the same conclusion for defendants who lack moral knowledge due to miseducation or other extreme environmental conditions, unrelated to a mental disorder? Adults who were brainwashed as (...) children, for example, might seem “insane” due to their lack of moral knowledge. However, since legal culpability rests on the capacity to understand the criminal law’s moral demands, to reflect on these demands across time, and to control one’s behavior in light of them, simple ignorance of morality's demands does not excuse. (shrink)