In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

Northoff provides a compelling argument supporting a kind of “double dissociation” of Parkinson's disease and catatonia. We discuss a related form of akinetic mutism linked to mesodiencephalic injuries and suggest an alternative to the proposed “horizontal” versus “vertical” modulation distinction. Rather than a “directional” difference in patterned neuronal activity, we propose that both disorders reflect hypersynchrony within typically interdependent but segregated networks facilitated by a common thalamic gating mechanism.

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

Nicholas D. Smith considers an original interpretation of the Republic, presenting it as a work about knowledge and education. Smith pays particular attention to Plato's use of images as representations of higher realities in education, as well as the power of knowledge in the Republic.

What model of knowledge does Plato's Socrates use? In this book, Nicholas D. Smith argues that it is akin to knowledge of a craft which is acquired by degrees, rather than straightforward knowledge of facts. He contends that a failure to recognize and identify this model, and attempts to ground ethical success in contemporary accounts of propositional or informational knowledge, have led to distortions of Socrates' philosophical mission to improve himself and others in the domain of practical ethics. He (...) shows that the model of craft-knowledge makes sense of a number of issues scholars have struggled to understand, and makes a case for attributing to Socrates a very sophisticated and plausible view of the improvability of the human condition. (shrink)

The writer responds to the commentary “Physician Burnout Calls for Legal Intervention,” by Sharona Hoffman, in the November‐December 2019 issue of the Hastings Center Report.

Hastings Center Report, Volume 52, Issue 1, Page 21-28, January/February 2022.

Cocreating meaning in collaboration is challenging. Success is often determined by people's abilities to coordinate their language to converge upon shared mental representations. Here we explore one set of low‐level linguistic behaviors, linguistic alignment, that both emerges from, and facilitates, outcomes of high‐level convergence. Linguistic alignment captures the ways people reuse, that is, “align to,” the lexical, syntactic, and semantic forms of others' utterances. Our focus is on the temporal change of multi‐level linguistic alignment, as well as how alignment is (...) related to communicative outcomes within a unique collaborative problem‐solving paradigm. The primary task, situated within a virtual educational video game, requires creative thinking between three people where the paths for possible solutions are highly variable. We find that over time interactions are marked by decreasing lexical and syntactic alignment, with a trade‐off of increasing semantic alignment. However, greater semantic alignment does not translate into better team performance. Overall, these findings provide greater clarity on the role of linguistic coordination within complex and dynamic collaborative problem‐solving tasks. (shrink)

Brickhouse and Smith cast new light on Plato's early dialogues by providing novel analyses of many of the doctrines and practices for which Socrates is best known. Included are discussions of Socrates' moral method, his profession of ignorance, his denial of akrasia, as well as his views about the relationship between virtue and happiness, the authority of the State, and the epistemic status of his daimonion.

Scholars have wrestled with the very troubling but also rather long passage in the Protagoras in which Socrates offers an interpretation of a poem by Simonides (339e-347a). On the one hand, the way in which Socrates develops his interpretation leads to an outcome that makes it look as if Socrates attributes distinctly Socratic views to the poet, which had led a number of scholars to conclude that, albeit in a rather strange way, Socrates is trying to do something philosophically serious (...) in his interpretation. On the other hand, the “philosophically serious” approach must confront several features of the Socratic interpretation that seem anything but serious. Immediately after concluding his interpretation, Socrates contends that the entire enterprise of poetical interpretation is “no different from the second-rate drinking parties of the agora crowd” (347c3-5) and dismisses such a form of entertainment as “childish frivolities” (347d6). In this paper, I argue that Socrates is presented by Plato as (i) doing something philosophically significant in this passage, and also (ii) providing an interpretation of Simonides that would appear to any intelligent reader as both comical (in places) and far-fetched in its conclusions, and also (iii) believing that the interpretation of poetry is an example of “childish frivolity.” Indeed, I claim that it is the third of these claims—which, after all, is the conclusion Socrates himself reaches by the time he is done—that Plato’s Socrates wants most of all for us to accept. (shrink)

The chapter outlines Nietzsche's view of decadence, its history and effects. The philosopher held decadence to be any condition, deceptively thought good, which limits what something or someone can be. This concept informs his critical and affirmative projects, acting as a versatile tool to identify and overcome his own decadence and to resist the decadence of Western culture. Decadence appears in five major areas of concern to Nietzsche: physiology; psychology; art and artists; politics; and philosophy. Physical and mental phenomena provide (...) the substrate of his understanding, but they manifest in cultural, political, and philosophical forms that, in turn, affect the body and mind. In each of the five areas, the concept of decadence for Nietzsche serves 1) to unmask valued cultural phenomena as corrupt, 2) to name and analyze degenerate effects, and 3) to spur reflection on how to respond. (shrink)

Scholars still struggle to characterize, evaluate, and understand the mesmerizing prose pieces of Ficciones that raised Jorge Luis Borges to the first ranks of literary fame. Speaking to Philosophy and Literature, Borges once described his work as "the fiction of philosophy," and the two prologues he wrote for Ficciones leave enticing clues about what this means in practice. I argue that these long-neglected prologues open critical space for Ficciones, slyly mocking three idols of literary cant: that genre informs a work, (...) that epic tomes best represent the real, and that great authors write unprecedented books. Borges knew better. (shrink)

The chapter considers philosophical views of satire, philosophy as an object of satiric scorn, kinship and tension between satire and philosophy as activities, and what philosophy's relationship to satire suggests about philosophy as a discipline.

The article explores Nietzsche’s view that the Greek agonistic impulse in sport led to an ancient culture that prized the dialectics of philosophy and its humane offspring. The Greeks did not invent physical contests, but the Olympics are unique in the ancient world for bringing together once and future enemies under formal terms of contest. What did this signify? And what were its consequences? In Nietzsche’s view, the ancient Greek obsession with agon (contest) led to the greatest civilization of the (...) western world. How so? The paper shows how the Greeks learned to “spiritualize” violence and redirect its otherwise destructive power. This aggressive but rule-bound ethos became the competitive force in Greek culture to which we owe the disciplines of philosophy, drama, history, and science,—because each was conceived as a new arena of intellectual or artistic competition on the model of competitive sport. (shrink)

It has been argued that Plato sought to make his rulers invulnerable to any kind of wrongdoing. In this paper we argue that this (humanly impossible) claim misunderstand the ways in which Plato shapes his state precisely in order to make the rulers safe from what could corrupt them.

In this paper we explore plato's paradoxical remarks about the philosophical rulers' use of dishonesty in the "republic"--Rulers who, On the one hand, Are said to love truth above all else, But on the other hand are encouraged to make frequent use of "medicinal lies." we establish first that plato's remarks are in fact consistent, According to the relevant platonic theories too often forgotten by both critics and defenders of plato. Finally, We reformulate the underlying moral issue of the purported (...) right not to be lied to, And its alternative in platonic political philosophy: paternalism. (shrink)

This paper contrasts Socrates’ attitude towards poetry in the early dialogues with the sharply critical view of poetry expressed in Plato’s Republic. The difference between these two views constitutes further evidence for a developmentalist interpretation of Plato.

The Philosophy of Knowledge: A History presents the history of one of Western philosophy's greatest challenges: understanding the nature of knowledge. Divided chronologically into four volumes, it follows conceptions of knowledge that have been proposed, defended, replaced, and proposed anew by ancient, medieval, modern and contemporary philosophers. This volume covers the Presocratics, Sophists, and treatments of knowledge offered by Socrates and Plato. With original insights into the vast sweep of ways in which philosophers have sought to understand knowledge, The Philosophy (...) of Knowledge: A History embraces what is vital and evolving within contemporary epistemology. Overseen by an international team of leading philosophers and featuring 50 specially-commissioned chapters, this is a major collection on one of philosophy's defining topics. (shrink)

Research exploring risk factors of gun violence is limited, especially research involving women as perpetrators of violence. Yet, women account for 18–21% of convicted violent crime. The present study aimed to test if psychopathy, a notable risk factor for violence, was related to past convictions of gun violence, general forms of violence, and non-violent crime. In a sample of 206 female offenders, multinomial logistic regressions assessed how interpersonal, affective, and behavioral psychopathic traits increased the likelihood of women belonging to the (...) gun violence group, a violent crime group, and a non-violent crime group. Results showed the interpersonal and affective facets increased the likelihood of women belonging to the gun violence group compared to both the violent and non-violent crime groups. The behavioral facet increased the likelihood of women belonging to the violent crime group when compared to the gun violence and non-violent crime groups. These results suggest that gun violence has different risk factors than violent and non-violent crime. This line of inquiry indicates that existing violence prevention strategies may need to be modified to address gun violence. (shrink)

This article aims to give an analysis of the phenomena of unjust misappropriation of marginalised groups’ terms online, using the example misappropriation of ‘woke’ from the Black community on Twitter. I argue that using terms such as these outside their original context warps their meaning, decreasing the intelligibility of the experiences of the marginalised agents who use them when attempting to express themselves both within their community and without. I intend to give an analysis of this phenomena, with the expectation (...) that understanding it better will provide a crucial step in combatting it. To this end, I argue it can be understood as a specialised form of what Kristie Dotson calls ‘contributory injustice’, injustices which involve the suppression of a marginalised community’s existing hermeneutical resources, combined with a specific consequence of what Boyd and Marwick call ‘context collapse’, the removal of social norms created through the homogenising effect of social media sites like Twitter. The result is a novel misappropriation phenomenon, I label ‘Context-Collapsed Contributory Injustice’ or ‘CC.CI’. This type of misappropriation is particularly harmful due to it being faster-acting than historical varieties of misappropriation. Furthermore, unchecked continual cases of CC.CI can cause a novel from of what Miranda Fricker calls ‘hermeneutical injustice’, which is demarcated from standard cases by its ability to reintroduce conceptual lacunas through undermining existing hermeneutical resources. I finish by disambiguating cases of CC.CI from natural meaning change and critically analysing some existing philosophical treatments of “woke”. (shrink)

Plato recognizes faction as a serious threat to any political community. The Republic’s proposed solution to faction relies on bringing citizens into a relation of ὁμόνοια. On the dominant line of interpretation, ὁμόνοια is understood along the lines of “explicit agreement” or “consensus.” Commentators have consequently thought that the καλλίπολις becomes resistant to faction when all or most of its members explicitly agree with one another about certain fundamentals of their political association—for example, they agree regarding who should govern in (...) the καλλίπολις.We argue that ὁμόνοια in Plato’s political philosophy has been under-analyzed and misunderstood. We show that, in Alcibiades I, rendering ὁμόνοια simply as agreement results in confusion about how expertise, political friendship, and civic unity are compossible in a well-ordered political community. In our view, Plato refines and adds philosophical depth to the concept of ὁμόνοια in the Republic. We claim that ὁμόνοια is a relation of psychological “like-mindedness” that obtains among members of different occupational classes in a political community. A community is rendered resistant to faction, then, when its members are, in some significant way, psychologically alike. Additionally, while Platonic ὁμόνοια can naturally be expected to result in substantive agreement among citizens, we argue that Platonic ὁμόνοια does not consist solely in agreement. (shrink)

Kenneth Dover proposes an explanation of this joke in which the gist is to be understood in terms of ‘homosexual rape as an expression of dominance’, so that Dicaeopolis is offering himself up for use as a pathic by Lamachus. Dover believes that the joke becomes ‘intelligible if the assumption is that the erastēs handles the penis of the erōmenos during anal copulation’. Others have seen a circumcision joke here. Alan Sommerstein explains how the joke would work either of these (...) ways. (shrink)

Nietzsche's Ecce Homo was published posthumously in 1908, eight years after his death, and has been variously described ever since as useless, mad, or merely inscrutable. Against this backdrop, Nicholas D. More provides the first complete and compelling analysis of the work, and argues that this so-called autobiography is instead a satire. This form enables Nietzsche to belittle bad philosophy by comic means, attempt reconciliation with his painful past, review and unify his disparate works, insulate himself with humor from (...) the danger of 'looking into abysses', and establish wisdom as a special kind of 'good taste'. After showing how to read this much-maligned book, More argues that Ecce Homo presents the best example of Nietzsche making sense of his own intellectual life, and that its unique and complex parody of traditional philosophy makes a powerful case for reading Nietzsche as a philosophical satirist across his corpus. (shrink)

This volume brings together mostly previously unpublished studies by prominent historians, classicists, and philosophers on the roles and effects of religion in Socratic philosophy and on the trial of Socrates. Among the contributors are Thomas C. Brickhouse, Asli Gocer, Richard Kraut, Mark L. McPherran, Robert C. T. Parker, C. D. C. Reeve, Nicholas D. Smith, Gregory Vlastos, Stephen A. White, and Paul B. Woodruff.

In lieu of an abstract, here is a brief excerpt of the content:Plato on Knowledge as a Power1Nicholas D. SmithAt 471C4 in Plato’s Republic, the argument takes a sudden turn when Glaucon becomes impatient with all of the specific prescriptions Socrates has been making, and asks to return to the issue Socrates had earlier set aside—whether or not the city he was describing could ever be brought into being. In response to Glaucon’s impatient question, Socrates articulates his “third wave of (...) paradox” (472ag–7), namely, that the ills of the cities will never be ended until either philosophers become rulers or rulers become philosophers (473c11–d6). Glaucon immediately responds that such a view is likely to be greeted with violence and scorn (473e6–474a4), and so Socrates must hasten to explain his odd claim. His explanation, it turns out, is that true philosophers have an enormous cognitive advantage over non-philosophers—philosophers have and use knowledge (ἐπιστήμη), whereas non-philosophers have and use only opinion (δόξα).2 This distinction, between επιστήμη and δόξα, turns out: to be a distinction between two different cognitive powers (δυνάμεις—477d7–e3). And different powers, Plato clearly tells us, apply to or take as their objects (Plato says they are “ἐπί”) different things (477dl).In this paper, I shall argue that the relationship between the cognitive powers and their various objects has been fundamentally misunderstood, which has led scholars into one or more misinterpretations of important and explicit features of the text. At the heart of these misunderstandings, I claim, is [End Page 145] their shared misconception of the relation between the cognitive power and its objects as interpretable in terms of the relationship between a cognitive stale and what the content of that state is of or about.3 One consequence of the view for which I shall argue is that what has come to be known as the “two-worlds theory”4 of Plato’s epistemology is seriously mistaken, but no less mistaken than the alternatives given by its recent critics. Another consequence that I shall draw from my argument is that Plato should be understood neither as a kind of foundationalist with regard to knowledge and warrant, as some have supposed him to be,5 nor as a coherentist, as others have supposed,6 but, rather, as a kind of causal reliabilist. [End Page 146]1. KNOWLEDGE AS A POWERScholarly interpretations of Plato’s epistemology have routinely sought to understand the relationships between each cognitive power of Republic Book V and the objects of the ἐφ’ ᾦ (“what it is related to”) condition by which it is differentiated from other δυνάμεις as Plato’s way of telling us what each sort of cognition is of or aboul. 7 So, for example, we find Gail Fine using the expressions “belief [δόξα] is set over [Fine’s translation of Plato’s ἐπί] …” and “knowledge is set over …” interchangeably with “belief is of …” or “belief is about…” and “knowledge is of …” or “knowledge is about …”8 Against the “two-worlds theory,” Fine argues that, for Plato, there can be knowledge of sensibles and beliefs about Forms. Accordingly, since she assimilates the power-ἐπί-object set of relations to the cognilion-of/about-object relation, she concludes—in order to account for knowledge of sensibles and beliefs about Forms—that the objects of knowledge and opinion must be propositions. Plato’s claims that knowledge is ἐπί what is, whereas opinion is ἐπί what is and is not, Fine understands as, “One can only know true propositions; one can believe both true and false propositions.”9 We shall see later that this “veridical” understanding of what Plato means to identify as “what is,” and “what is and is not” fails to account for important and explicit elements of Plato’s exposition of the epistemological and metaphysical distinctions he is making. For now, it is enough to note that Fine understands the ἐφ’ᾦ) relation in terms of our cognition-of/about-object relation. One finds the same assimilation made by those who advance existential readings of Plato’s “is” and “is not,”10 as [End Page 147] well as those who have urged that we adopt predicative readings of “is” and “is not.”11But I think there are very serious problems with this assimilation. Plato is very... (shrink)