In the fall of 2005, Mark C. Taylor, the controversial public intellectual and widely respected scholar, suddenly fell critically ill. For two days a team of forty doctors, many of whom thought he would not live, fought to save him. Taylor would eventually recover, but only to face a new threat: surgery for cancer. "These experiences have changed me in ways I am still struggling to understand," Taylor writes in this absorbing memoir. "After the past year, I am persuaded that (...) I have done enough fieldwork to write a book that combines philosophical and theological reflection with autobiographical narrative. Writing is not only possible but actually seems necessary." _Field Notes from Elsewhere_ is Taylor's unforgettable, inverted journey from death to life. Each of his memoir's fifty-two chapters and accompanying photographs recounts a morning-to-evening experience with sickness and convalescence, mingling humor and hope with a deep exploration of human frailty and, conversely, resilience. When we confront the end of life, Taylor explains, the axis of the lived world shifts, and everything must be reevaluated. As Taylor sorts through his remembrances, much that once seemed familiar becomes strange, paradoxical, and contradictory. He reads his experience with and against ghosts from his past, recasting the meaning of mortality, sacrifice, solitude, and abandonment, along with a host of other issues, in light of modern ways of dying. "You never come back from elsewhere," Taylor concludes, "because elsewhere always comes back with you.". (shrink)

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick (...) role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In (...) addition, it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self. (shrink)

Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In (...) addition, it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self. (shrink)

Contemporary issues such as euthanasia, surrogate motherhood, organ transplantation and gene therapy, which occupy the minds of ethicists in the industrialized countries are, for the moment, irrelevant in most developing countries. There, the ethics of scarcity, sacrifice, cross-cultural research, as well as the activities of multinational companies, are germane. In this article, only the ethics of scarcity and sacrifice will be discussed. Structural adjustment programmes, designed to solve the economic problems of the developing countries, muddied the waters. The dilemma confronting (...) practitioners in developing countries is how to adhere to the basic principles of medical ethics in an atmosphere of hunger, poverty, war and ever-shrinking and often non-existent resources. Nowhere else in the world is the true meaning of scarcity portrayed as vividly as in the developing countries. Consequently, the doctor's clinical freedom may have to be sacrificed by the introduction of an essential drugs list and practice guidelines. The principle of greater good, while appealing, must be carefully interpreted and applied in the developing countries. Thus, while health promotion and disease prevention must be the primary focus, health planners should avoid pushing prevention at the expense of those currently sick. Health care reform in developing countries must not merely re-echo what is being done in the industrialized countries, but must respond to societal needs and be relevant to the community in question. (shrink)

In his very valuable study of generic patterns in ancient poetry Francis Cairns assigns Propertius 2.28, [Tib.] 3.10 , and Ovid Am. 2.13 to the genre Soteria, that is works of congratulation and thanksgiving on the recovery from illness of a friend, and he sees the resemblances between the poems as due to the elegists’ attempts to produce ‘dramatized’ examples of the genre, with the situation developing from the girl's illness at the beginning of the poem to her recovery at (...) the end , pp.153–7). Cairns's arguments and interpretation of the poems should, I feel, be scrutinized carefully, especially since his classification of the poems has been accepted recently without demur by at least one scholar , 118 and n.50). (shrink)

The principle objective of a diagnosis is not to categorise symptoms, or group a combination of signs or clinical symptoms in a coherent way, but to cure a patient or improve their quality of life. Diagnoses that are technically correct, but do not seek this objective may become unnecessary labels which convert healthy people, or those who do not consider themselves to be sick, into patients. We propose a limitation of the diagnostic effort in order to reduce the iatrogenic consequences (...) of these unnecessary labels or diagnoses, a new imperative which, in Kantian terms, can be expressed as: examine and treat your patients in such a way that, at the very least, the effects of your actions always improve the quality of their lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"What Is Philosophy?"The Status of World Philosophy in the ProfessionRobert C. SolomonThe question "What is philosophy?" is both one of the most virtuously self-effacing and one of the most obnoxious that philosophers today tend to ask. It is virtuously self-effacing insofar as it questions, with some misgivings, its own behavior, the worth of the questions it asks, and the significance of the enterprise itself. It is obnoxious when it (...) refuses to question its own behavior but instead takes that same behavior as the exclusive standard to delegitimize any other activity that dares to call itself "philosophy." Thus, for most of this century, Anglo-American and most European philosophers have simply ignored the rich philosophical traditions of Africa, Asia, Latin and Native America, and the rest of the world. Some leading African American and African European philosophers have dismissed "ethnophilosophy" as "not philosophy," presumably to protect their own analytic credentials. Universities as far flung as Singapore, Sierra Leone, and New Delhi have prided themselves on their fidelity to Oxbridge philosophy. It seems that the globalization of free market economics goes with the globalization of one brief moment in philosophy, with similarly devastating effects on local cultures and the rich varieties of human experience.Philosophy might be thought of as made up of two components: critical thinking and passionate vision. But "critical thinking" does not necessarily imply the hermeneutics of suspicion, skepticism, or intellectual paranoia—all too often the trademarks of the bright young professional philosopher. One can be "critical," that is, reflective, while at the same time be committed, even devoted, to an idea or a way of thinking. The emphasis on passionate vision, however, is just as essential, and any philosophy that doesn't include both components just isn't worthy of the name. Without passionate vision, we get that utterly eviscerated focus on forms of argumentation—philosophia minimalia—devoid of "empirical" content (that is to say, content) and, as far as most people are concerned, devoid of any interest. Without critical reflection, we get gullibility and the worst of New Age philosophy, accepting of any kind of nonsense, just because it stirs the passions. But simply to assume that philosophy must be as rigorously self-questioning as modern European and Anglo-American philosophy is a subtle form of ethnic chauvinism. It eliminates from the realm of philosophy not only African ethnophilosophy and Latin and Native American and South Pacific mythology but a good deal of the philosophy of religion, the basis (for better or worse) of the development of Western philosophy over much of the past two thousand years. [End Page 100]I have just withdrawn from a recent dispute, in a respectable and supposedly eclectic philosophy journal, in which my worst fears in this regard were rather bluntly confirmed. I had made the point mentioned above—rather matter-of-factly, I thought—that if (analytic) philosophy dismisses or ignores modes of thinking that are not obviously self-critical and are presented poetically instead of by way of positions to be argued for, then a good deal of the world's philosophy, including a good deal of Western philosophy, would be left out of the arena. The journal's board reacted indignantly, to put it mildly, to the suggestion that anything should count as "philosophy" that was not sufficiently self-critical in just this sense. But what about the millennium or so of religious philosophy in the West? Does anyone believe that thinkers like Anselm, or Alvin Plantiga for that matter, are seriously skeptical of the truth of Christianity, as they go through their admittedly brilliant argumentative routines? For that matter, to what extent is the emphasis on logical form and argument subjected to scrutiny in contemporary analytic philosophy? (As one of the foremost practitioners of that art commented, "Metaphilosophy makes me sick.")Some of the hostility to world philosophy, to be sure, turns on the conflict between philosophy and religion, which may have its origins in ancient and medieval philosophy but emerges full-blown with the Enlightenment and its campaign against "superstition." But many people and a good many cultures do not distinguish between philosophy and religion. If we consider the word "philosophy... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"What Is Philosophy?"The Status of World Philosophy in the ProfessionRobert C. SolomonThe question "What is philosophy?" is both one of the most virtuously self-effacing and one of the most obnoxious that philosophers today tend to ask. It is virtuously self-effacing insofar as it questions, with some misgivings, its own behavior, the worth of the questions it asks, and the significance of the enterprise itself. It is obnoxious when it (...) refuses to question its own behavior but instead takes that same behavior as the exclusive standard to delegitimize any other activity that dares to call itself "philosophy." Thus, for most of this century, Anglo-American and most European philosophers have simply ignored the rich philosophical traditions of Africa, Asia, Latin and Native America, and the rest of the world. Some leading African American and African European philosophers have dismissed "ethnophilosophy" as "not philosophy," presumably to protect their own analytic credentials. Universities as far flung as Singapore, Sierra Leone, and New Delhi have prided themselves on their fidelity to Oxbridge philosophy. It seems that the globalization of free market economics goes with the globalization of one brief moment in philosophy, with similarly devastating effects on local cultures and the rich varieties of human experience.Philosophy might be thought of as made up of two components: critical thinking and passionate vision. But "critical thinking" does not necessarily imply the hermeneutics of suspicion, skepticism, or intellectual paranoia—all too often the trademarks of the bright young professional philosopher. One can be "critical," that is, reflective, while at the same time be committed, even devoted, to an idea or a way of thinking. The emphasis on passionate vision, however, is just as essential, and any philosophy that doesn't include both components just isn't worthy of the name. Without passionate vision, we get that utterly eviscerated focus on forms of argumentation—philosophia minimalia—devoid of "empirical" content (that is to say, content) and, as far as most people are concerned, devoid of any interest. Without critical reflection, we get gullibility and the worst of New Age philosophy, accepting of any kind of nonsense, just because it stirs the passions. But simply to assume that philosophy must be as rigorously self-questioning as modern European and Anglo-American philosophy is a subtle form of ethnic chauvinism. It eliminates from the realm of philosophy not only African ethnophilosophy and Latin and Native American and South Pacific mythology but a good deal of the philosophy of religion, the basis (for better or worse) of the development of Western philosophy over much of the past two thousand years. [End Page 100]I have just withdrawn from a recent dispute, in a respectable and supposedly eclectic philosophy journal, in which my worst fears in this regard were rather bluntly confirmed. I had made the point mentioned above—rather matter-of-factly, I thought—that if (analytic) philosophy dismisses or ignores modes of thinking that are not obviously self-critical and are presented poetically instead of by way of positions to be argued for, then a good deal of the world's philosophy, including a good deal of Western philosophy, would be left out of the arena. The journal's board reacted indignantly, to put it mildly, to the suggestion that anything should count as "philosophy" that was not sufficiently self-critical in just this sense. But what about the millennium or so of religious philosophy in the West? Does anyone believe that thinkers like Anselm, or Alvin Plantiga for that matter, are seriously skeptical of the truth of Christianity, as they go through their admittedly brilliant argumentative routines? For that matter, to what extent is the emphasis on logical form and argument subjected to scrutiny in contemporary analytic philosophy? (As one of the foremost practitioners of that art commented, "Metaphilosophy makes me sick.")Some of the hostility to world philosophy, to be sure, turns on the conflict between philosophy and religion, which may have its origins in ancient and medieval philosophy but emerges full-blown with the Enlightenment and its campaign against "superstition." But many people and a good many cultures do not distinguish between philosophy and religion. If we consider the word "philosophy... (shrink)

This guide is an exploration of political reality as understood by Eric Voegelin. Voegelin employed the revolutionary concepts found in ancient Greek noetic and Christian pneumatic philosophy that describe political reality and the means to know it. This guide begins with a biographical sketch of Voegelin, the historical milieu that inspired his resistance to "unreality" and terms and symbols he uses to identify the spiritual sickness he believes is destroying Western civilization's traditional basis of order, it then examines Voegelin's theories (...) of consciousness, philosophy and science fundamental to understanding reality. Given the extensive nature and volume of his work, a consolidation and explanation of it is offered, and an example on how to apply it is outlined. Critiques of Voegelin's work are detailed to outline weaknesses in his theories and methods. This guide concludes by defining political reality, how to use Voegelinian techniques to analyze reality, and how to live a life that cultivates the pursuit of human knowledge in keeping with Western philosophic traditions. Book jacket. (shrink)

The concept of the sick role entered sociology in 1951 when Talcott Parsons creatively separated the sick person out of the doctor–patient dyad. The idea became fundamental in the subdiscipline of medical sociology. By the 1990s, the concept had almost disappeared from the research literature. Beyond the generational and theoretical changes that explain how the sick role idea could become irrelevant or unnecessary to sociologists, there were two immediate factors: the negative politicization of the concept and the shift of medical (...) sociologists to a focus on applied health behavior. In the later, fragmented discipline of sociology, final, total abandonment was still uncertain. (shrink)

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its supposedly generic human subject, as well as the fact that the tradition does not view womens rights as human rights. This essay traces the way in which this invisible gendering of the universal renders the other gender invisible and silent. It shows how this attenuation of the human in man is a source of sickness, both cultural and individual. Finally, it suggests several ways in which images (...) drawn from womens experience and womens bodies might contribute to a constructive rethinking of basic ethical concepts. (shrink)

Calling on the methodology of psychology, the authors explore the way illness alters the self-image of the sick person, and the way the experience changes the person who is ill. The reader is taken through the psychological impacts of the first clinical moment when the patient realizes he or she is in the altered state of illness, as well as the subsequent effects of pain, hospitalization, being bed-ridden, fatigued or disabled. The central thesis is that an integral picture of medicine (...) must include social-cultural aspects, the institutionalization of health care, and an attempt to provide patient-centered care. The approach taken is the empirically based psychosocial reflection of the disturbances to a person's self-image caused by various kinds of illness. Focusing on the world of the patient, the authors relate to problems concerning self-image, pain, exhaustion, isolation, handicaps, aging, dying and death. The relationships between patients and medical personnel are also examined. Concluding the work is an excellent bibliography keyed to the chapters of the text. (shrink)

In contemporary society nothing upsets us more than having to wait for our bodies. Our bodies serve us as we direct and when they break down we become angry that they have failed us. Christians, however, are called to be a patient people even in illness. Indeed, impatience is a sin. Learning to be patient when sick requires practicing patience while healthy. First, we must learn that our bodies are finite — they will die. Second, we must learn to live (...) with one another in patience as Christians with the love that the presence of others can and does create in us. Third, in life there is time for the acquisition of habits that come from worthy activities that require time and force us to take first one step and then another. In patience one can live with God. (shrink)

A biographical and psychological analysis of Nietzsche's thought, written from a religious point of view. The author concludes that Nietzsche's philosophy is a reflection of four dominant factors: his sickly condition, his sensuality, his pride, and his godlessness.--C. L.

Existential analysis, according to Binswanger, is not a psychopathology, and is not necessarily therapeutic; it is not founded upon the medical standards of "sick" and "healthy." The eight writers in this volume illustrate that the suspension of such norms widens and deepens the field of philosophical anthropology, and hold that we may talk meaningfully about the "human condition." Taking "alienation" as an aspect of that condition, four of the authors explore some of its manifestations and its place in the totality (...) of experience. As a whole, the volume is bold and engaging, and balances scholarly rigor with adventurous speculation.--R. C. D. (shrink)

The concept of vulnerability has been the topic of considerable discussion in research bioethics, largely because of dissatisfaction with early constructions of the concept that were based on subpopulations of research subjects. These subpopulations have attributes likely to undermine their capacity to provide autonomous informed consent: persons who are relatively or absolutely incapable of protecting their own interests through negotiations for informed consent. Several subpopulations were seen as requiring special protections, including children, pregnant women, prisoners, racial minorities, the economically disadvantaged, (...) the very sick, and the institutionalized. Recent years have witnessed the identification of other subpopulations with attributes that could render them vulnerable, as well. For example, the Council for the International Organization of Medical Societies has named such potentially vulnerable groups as the homeless, nursing home residents, patients with incurable diseases, patients in the emergency department, employees, students, and members of communities who are unfamiliar with modern medicine. (shrink)

Although the specific subject matter is the psychology of crime, which aims at "concrete knowledge of criminal man in situation," the general problems of method in the humane sciences, of the nature and dynamics of interhuman relations, of experience, and especially of value, are treated here in a way which brings their philosophical import to light. Hesnard emphasizes that truly psychopathological criminals are the minority, and sees crime as a peculiar form of breakdown within a world of lived values. The (...) criminal psychologist's job is not to assess degrees of "responsibility" in terms of psychic sickness, nor to explain causal histories of criminal acts, but to comprehend the total man by focussing upon what society's laws call crime. This is an informative, daring book, rich with unsolved problems, and deserving of much better editing than it received.--C. D. (shrink)

Philosophy adds humanness to nursing and facilitates holistic care. Philosophies like Ubuntu which purports that a person is only a person through other people and emphasises community cohesion and caring for each other can add humanness to nursing. Because Ubuntu validates subjective experience and its meaning in the lifeworld, it exemplifies the basis of holistic and individualised caring in nursing. Although nurses can make their own philosophy through critical reflexivity, the convergent point is the goal of meaningful caring that is, (...) sustaining health and the well‐being of patients and significant others. Philosophy transcends job description, it encompasses visceral experience, personal beliefs and goals, resulting in purpose and deeper meaning to the nursing profession of caring as emulated by Florence Nightingale. While contemporary philosophy has been met with criticism as being detached from human concern, narrowly focussed and technical, it evokes critical thinking and promotes sociality in nursing practice. The Covid‐19 pandemic vividly brought philosophy to the fore as nurses sacrificially and vulnerably rose to the challenge of caring not only for the sick, but also for families who through infection control measures were deprived of sociality. This paper argues that philosophy adds humanness and substance to nursing in the context of COVID‐19. (shrink)

Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...) to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would. (shrink)

This work contains ten essays published by Spaemann between 1965 and 1975, as well as an exchange between Spaemann and J. Habermas concerning one of the essays. Another of the essays, "Remarks on the Problem of Equality," is accessible in translation ; this essay embodies many of the themes discussed by Spaemann in the other pieces reprinted in the book. In the introduction written for the book, Spaemann summarizes the theme common to the essays: "It is always a question of (...) rational objections against the abstract utopia of radical-emancipatory rule of reason.... The thesis of this book is that this utopia is irrational". The irrationality consists both in the assumption that economic scarcity can be abolished and in the assumption that perfect social and individual rationality will be implemented at a future date, but is at present accessible only to the revolutionary vanguard which has appointed itself as the representative of the ideal. The fact that the majority of the populace does not consent to the revolutionaries’ ideal, much less tactics, is then perceived by the revolutionaries as proof that the majority is "immature" or "sick." Spaemann cannot be said to have demonstrated the falsity of the first assumption. The bulk of his essays is channeled into multiform attacks on the second assumption. Spaemann shows, to my mind successfully, that in practice the unrestrained passion for justice results, in a "dialectical" way, in injustice. In this context Spaemann criticizes liberation theology, as well as reliance on conscience as a basis for political action. In essence the same observation about the dangers of the passion for justice is made, as Spaemann knows well, by Plato’s Republic. The classical conception of restrained and tolerant rule in a regimen mixtum is superior to the fanaticism and totalitarianism which results from the passion just referred to. Spaemann finds the modern theoretical basis of the utopian "emancipation" doctrine articulated by Marx. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to identify nurses’ agreement with the duty to care despite high risks for themselves and/or their families, (...) describe nurses’ well-being and describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution. Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study. Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to take (...) the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

Recently, approach-avoidance tendencies and visual perception biases have been increasingly studied using bistable point-light walkers (PLWs). Prior studies have found a facing-the-viewer bias when one is primed with general threat stimuli (e.g. angry faces), explained by the “error management theory”, as failing to detect a threat as approaching is riskier than the opposite. Importantly, no study has explored how disease threat – linked to the behavioural immune system – might affect this bias. This study aimed to explore whether disease-signalling cues (...) can alter how we perceive the motion direction of ambiguous PLWs. Throughout 3 experiments, participants indicated the motion direction of a bistable PLW previously primed with a control or disease-signalling stimuli – that is, face with a surgical mask (Experiment 1), sickness sound (Experiment 2), or face with a disease cue (Experiment 3). Results showed that sickness cues do not significantly modulate the perception of approach-avoidance behaviours. However, a pattern emerged in Experiments 2 and 3, suggesting that sickness stimuli led to more facing away percepts. Unlike other types of threat, this implies that disease-related threat stimuli might trigger a distinct perceptual bias, indicating a preference to avoid a possible infection source. Nonetheless, this finding warrants future investigations. (shrink)

As social theorists seek to understand the contemporary challenges of radical populism, we would do well to reconsider the febrile insights of the psychoanalytic social theorist Erich Fromm. It was Fromm who, at the beginning of the 1930s, conceptualized the emotional and sociological roots of a new ‘authoritarian character’ who was meek in the face of great power above and ruthless to the powerless below. It was Fromm, in the 1950s, who argued that societies, not only individuals, could be sick. (...) This essay traces the intertwining of psychoanalytic and sociological methods that allowed Fromm to create such new ideas. At the same time, it highlights how Fromm’s sociology was hampered by an economistic Marxist approach to the institutions and culture of democratic capitalist societies. Such theoretical restriction prevented Fromm from conceptualizing how institutions like democracy, science, and psychotherapy can provide resources for widespread emotional recuperation and civil repair. (shrink)

Keats’ misgivings about science unweaving the rainbow and robbing Nature of its mystery were shared by many of contemporaries, and successive generations have been compelled to ask how this rapidly escalating knowledge of the universe would affect their understanding of themselves and the world they lived in. This is the concern of most of the essays in these two volumes: how are we to live with science and the issues scientific discoveries and propositions raise? And how has this relationship with (...) science been explored and expressed in literary works? Yet even before science became such a challenge to the imagination, an awareness of how people interact with the natural world – in terms of sickness and health, medicine, mathematics – had already been a literary subject, also reflected in a number of articles in Restoring the Mystery of the Rainbow: Literature’s Refraction of Science. In the twentieth century doubt became a crucial component of science as well as literature, and the relativism and uncertainty of quantum physics have proved fruitful to a wide range of dramatist, poets and novelists as many articles indicate. A systematic desire for objective criteria, verifiability, and conceptual frameworks has also increased the importance of methodology and of criticism: the many approaches adopted by the contributors to these volumes further point to the refraction of science in literature. (shrink)

It was love at first sight when Jonathan Calvert saw the Matterhorn in 1953. Something in the way the mountain held sway over him inspired a lifelong passion for natural beauty and adventure. Over the next fifty years, Calvert climbed, hiked, trekked, sailed, kayaked, and dog-sledded in wild places across the globe, following his urge to know. And he hasn t quit yet. In July 2014, he will spend a month in Central Asia traveling the Silk Road through the Pamirs (...) and Tian Shan mountains. In 2015 Calvert returns to the Antarctic in a sailboat to kayak and camp. This book is a record of his adventures, told through memoir, journals, and photographs. Calvert has devoted his life to exploring the world and himself, and he has never gotten to the bottom of the wellspring that is curiosity. Calvert has walked in the footsteps of early explorers, camped above the clouds, come face-to-tusk with a walrus, and, within yards of a summit, talked down the inner voice that cajoled him to quit. He has stumbled into crevasses, kayaked in quiet waters above whales, suffered altitude sickness, and called his family via radio and cell phone relay from a precipitous ledge to say, I made it. Discovering early in life that striking out by himself got the job done best, Calvert is no stranger to singular travels and travails. Yes, he adventures with comrades roped in as a team, paddling together, or taking his turn at the ship s helm but ultimately the journey is one s own. Throughout his life, Calvert has jumped at chance after chance, among them: climbing Alaska s Mount McKinley, Argentina s Aconcagua, and mountains in Switzerland, France, Tanzania, and Nepal; trekking in Tibet, Bhutan, England, and Pakistan; and kayaking the coast of Greenland and the Zhupanova River in the Kamchatka Peninsula. Where s that? Explore these pages, and then you will know.". (shrink)

What does the word clinic mean? The clinic is first a place to diagnose and treat sick persons. The clinic is also a way of thinking and speaking; it is a discursive practice that links health with knowledge. For Michel Foucault the clinic is a mode of perception and enunciation that allows us to see and name disease and to place statements about illness among statements about birth and death. Within the clinic resides understanding of disease visible on the surface, (...) yet hidden within the tissual depths, of an ailing patient. Foucault shows that by the dawn of the nineteenth-century medicine is no longer a two-dimensional reading of symptoms, but a three-dimensional probing from symptomatic surface into disease interior. The anatomical site of disorder hidden within tissual depths is visible to the scrutiny of pathologist, endoscopist or radiologist. The clinic, a discourse that enables us to think about disease when we make statements about health and death, operates not only in its familiar textual domain, the medical journal, but in pictures of the scene at the sickbed, and poetry about disease. The truth of disease and placement of that truth in a general plan of the world in Renaissance woodcuts and John Donne's poetry is different from the regime of truth after the birth of the clinic in Bichat'sTreatise on Membranes, the paintings of Laennec, Agnew and Gross, the modern lithographs and the verse of Walt Whitman and L. E. Sissman. Foucault's clinic is where knowledge and sickness some together in the modern period. (shrink)

Modern medicine emphasizes treatment of the sick. It is often said that the widespread genetic testing soon to follow the completion of the Human Genome Project will usher in a new era of preventive medicine. Such changes require new ways of thinking, however. For example, there may be nothing clinically wrong with a healthy patient who requests genetic testing, even if the tests reveal disease genes. Since all individuals have genetic skeletons in their closets, it is important to be careful (...) not to confuse having disease genes with having the diseases that they cause. Unfortunately, many in the public have adopted a kind of genetic determinism that sees genes as destiny: for example, having the gene associated with colon cancer means they will develop colon cancer. Physicians tend to be more careful, yet even they are not immune to subtle versions of genetic determinism. One example of this is the uncritical categorization of certain diseases as “genetic”. In fact, an adequate concept of genetic disease is extremely difficult to come by. The simplest notion would require a 1:1 correspondence between a disease and its genes, but this is the exception rather than the rule. For example, cystic fibrosis (CF) is often put forward as a good example of a genetic disease, since it seems to result from mutations in a single gene, CFTR. Even in this case, however, the exact relationship between CFTR mutations and disease is not clear, as virtually every possible combination of sweat chloride test results, genetic test results, and symptoms has been observed.[1] If a patient presents with the classic symptoms of CF and is found to have a mutation in the CFTR gene, the physician might understandably infer that the mutation caused the disease. But if an asymptomatic patient is tested and it is discovered that he or she has a CFTR mutation, it is unclear what this means. The doctor might tell the patient the gene is abnormal and that he or she is likely to develop pulmonary problems, etc., but it’s not really known whether even this qualified prognosis is true.. (shrink)

As the concept of universal access to healthcare comes to America, an ethical paradox emerges. “Access” is the code word for being assured that sick people without financial resources get appropriate medical care. There is an ethical imperative to provide care for the sick – whether paying or not – and this value ought to give direction to any reformed system.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Politics and the Earthly City in Augustine's City of God by Veronica Roberts OgleAaron C. EbertPolitics and the Earthly City in Augustine's City of God by Veronica Roberts Ogle (Cambridge: Cambridge University Press, 2021), x + 201 pp.Politics is not a word in Augustine's lexicon—at least, it's not something he speaks of, in the abstract, in his great work of political theology, the City of God. This curious (...) omission from Augustine's late magnum opus et arduum has given rise to many a divergent reading of his political thought. Lacking an express account of the very term in question, his politics can seem to admit of a wide range of interpretations. On one side of the spectrum, it has been described as anticipating the religious neutrality of modern liberalism. On the other side, it has been interpreted as consolidating politics into religion by transposing political philosophy into the key of ecclesiology and making the Church the new realm of politics.1 In her elegantly written and insightful new book, which builds on the work of her 2014 dissertation at the University of Notre Dame and on a few published articles, Veronica Roberts Ogle charts a new interpretive path for reading Augustine on politics. She does this by means of two principal interventions.The first is by elucidating City of God's rhetorical purpose, what Ogle calls its "psychagogic character" (6). Psychagogy, "the art of leading [agô] souls [psychai] to a state of health," was the rhetorical aim and genre of much ancient philosophy (3). It took its cue from the philosopher's perception that his readers were sick with the disease of unhealthy attachment to the things of the world. Philosophers were physicians of the soul: they applied "the medicinal art of contraries" to their sick patients. This meant that their literary curatives often met patients/readers with the bitter taste of a poison (4). But—and this is the crucial point for Ogle—the poison was given for the purpose of health. What this means for Augustine's City of God, Ogle argues, is that we ought not take the work's biting and at-times-venomous rhetoric as evidence that Augustine is trying to poison his reader's vision of politics. Rather, he is trying to cure them of their attachment to the myths and delusions of politics-according-to-Rome and, instead, "to help us see the world, even the political world, anew: as part of a created order that is good, but that points beyond itself all the same" (4). Augustine's descriptions of Rome—indeed his frequent equations of Rome with the civitas [End Page 1426] terrena—are indeed meant to shock. But, so Ogle argues, they are meant to shock us out of destructive attachments so that we can learn to make the right attachments, first to Christ, and then, through Christ, to our earthly communities as pilgrims. City of God's pessimistic rhetoric is not Augustine simply denouncing the natural project of politics. It is a bitter medicine for a people deathly ill with an addiction to earthly glory.The second intervention of Ogle's book lies in its attention to what she calls City of God's "sacramental ethos" (5). This, I would argue, is the book's most important contribution. It is also the insight on which the heart of the book's argument depends. Sacraments, for Augustine, are signs that point us to God. Understood in this broad sense, the whole created order—that is, everything that is not God—has the quality of a sacrament by virtue of its very existence. This is connected closely to Augustine's understanding of evil as privatio boni: all that exists, to the extent that it exists, is good; and all that exists is, by nature, a sign (signum) pointing beyond itself to the Lord.These are not new insights into Augustine's doctrine of creation, but Ogle's application of them to the question of politics and the earthly city is suggestive. For what emerges is a new account of the relationship between politics and the earthly city. The whole created order... (shrink)

One gains the impression from occasional remarks in the psychiatric literature that there is a feeling of dissatisfaction with the state of flux of the various concepts, serving as tools to help us understand our patients. This paper is submitted as an attempt to point out some of the reasons why psychiatric notions suffer from certain deficiencies. If, for the time being, we set aside the specific psychiatric problems confronting us in our daily work and muse over the structure of (...) our psychological and psychiatric methods of explanation, we might come to the startling conclusion that these methods are quite inadequate. We medical people think in terms of the mechanistic natural sciences, particularly in terms of physics, chemistry and biochemistry. The importance of these auxiliary sciences to our art of healing the sick increases year after year and the outstanding results of chemotherapy, for instance, show how heavily our profession leans on chemistry. Beyond a doubt, the natural sciences are essential to the pursuit and the development of the practice of medicine, nevertheless, the question arises whether psychiatry should be based upon mechanistic methods in approaching our specific material, the human mind. Posed in this fashion, the question implies that psychiatric thinking is basically mechanistic in its general characteristics. I believe that one can prove this thesis on the premise that descriptions and explanations of human behavior are based upon neurological facts and theories. Since the purpose of neurology lies in a different direction than the goal of psychiatry, it was necessary to alter neurological concepts so that they would be more appropriate and fitting to psychic material, and this elaboration upon neurological principles when applied to mental phenomena leads to psychiatric conceptions with inherent deficiencies. (shrink)

Kierkegaard’s critique of Hegel and Hegelianism anticipates major twentieth-century philosophical movements ranging from structuralism, existentialism, and phenomenology, to post-structuralism and postmodernism. This paper analyzes Kierkegaard’s interpretation of the relationship between subjectivity and temporality in pivotal passages in The Sickness Unto Death and The Concept of Anxiety. Heidegger’s account of the interplay between presentation (Darstellung) and representation (Vorstellung) imagination points to Kant’s theory of the imagination and suggests the way in which the Kierkegaardian subject is constituted by an irreducible alterity that (...) is never present but is always already past. The infinite qualitative difference of the divine is reflected in the inescapable interiority of the subject. Kierkegaard’s abyssal other returns in Barth’s wholly other God, Heidegger’s aletheia, Derrida’s différance, and Lacan’s real. For each of these writers, subjectivity is haunted by another it can neither exclude nor appropriate. This interior exteriority is the condition of the possibility of both desire and hope. (shrink)

Schwartz quite decisively puts to rest the long-standing myth that Johnson was, if not openly hostile to science, at least indifferent to it. What emerges is a picture of a man committed to the task of mediating between the new science and the demands of religion and morality. We are presented with some very interesting and provocative historical background on the nature of science, with particular emphasis on its acceptance by literati. Schwartz describes Johnson thus: "His is neither the self-assured (...) smile, the heady, breathless dream, nor the sickness unto death, but rather the measured view." This way of looking at Johnson’s Weltanschauung permeates the entire book. Schwartz is at pains to show that Johnson’s Weltanschauung was one in which religion, morality and science were natural and necessary compliments of one another. Johnson believed that the primacy should be placed on one’s self-knowledge. (shrink)

Beyond Consent examines the concept of justice, and its application to human subject research, through the different lenses of various research populations: children, the vulnerable sick, captive and convenient populations, women, people of colour, and subjects in international settings. Separate chapters address the evolution of research policies, implications of the concept of justice for the future of human subject research, and the ramifications of this concept throughout the research enterprise.

The novel coronavirus has not only brought along disruptions to daily socio-economic activities, but sickness and deaths due to its high contagion. With no widely acceptable pharmaceutical cure, the best form of prevention may be precautionary measures which will guide against infections and curb the spread of the disease. This study explored the relationship between COVID-19 knowledge, risk perception, and precautionary behavior among Nigerians. The study also sought to determine whether this relationship differed for men and women. A web-based cross-sectional (...) design approach was used to recruit 1,554 participants from all geopolitical zones in Nigeria, through social media platforms using a snowball sampling technique. Participants responded to web-based survey forms comprising demographic questions and adapted versions of the Ebola knowledge scale, SARS risk perception scale, and precautionary behavior scale. Moderated mediation analysis of the data showed that risk perception mediated the association between COVID-19 knowledge and precautionary behavior and this indirect effect was in turn moderated by gender. Results indicate that having adequate knowledge of COVID-19 was linked to higher involvement in precautionary behavior through risk perception for females but not for males. It was also noted that awareness campaigns and psychological intervention strategies on COVID-19 related activities may be particularly important for males more than females. Drawing from the health belief model, we recommend that COVID-19 awareness campaigns should target raising more awareness of the risks associated with the infection to make individuals engage more in precautionary behaviors. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

Concerns are frequently raised about the extent to which formal consent procedures actually lead to “informed” consent. As part of a study of consent to high-risk medical procedures, we analyzed in-depth interviews with 16 health care professionals working in bone-marrow transplantation in Sydney, Australia. We find that these professionals recognize and act on their responsibility to inform and educate patients and that they expect patients to reciprocate these efforts by demonstrably engaging in the education process. This expectation is largely implicit, (...) however, and when it is not met, this can give rise to trouble that can have adverse consequences for patients, physicians, and relationships within the clinic. We revisit the concept of the sick role to formalize this new role expectation, and we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness. (shrink)

Within a given culture – whether industrialized or more tradition oriented – essentially the same fundamental medical theories, practices, and pharmacopoeia tend to be applied to human and non-human sickness and patients. In modern industrialized societies, however, healthcare services are sharply divided between human and veterinary medicine. There is likewise a sharp division between practitioners in these two health sectors: medical doctors and veterinarians. Yet in non-Western, traditional or indigenous medical systems, the same practitioners often treat both humans and animals. (...) There is a growing body of literature that attests to the efficacy of traditional health practices and herbal medicines for the prevention and treatment of both human and livestock ailments.The authors argue for an intersectoral approach to human and veterinary health services in poor countries, especially those targeted to rural people with LIMITED access to modern health services. Extension of conventional medical and veterinary services is particularly difficult and costly in Third World countries where the necessary infrastructure (roads, clinics, labs, cold chains, etc.) is poorly developed and where much of the populace and their livestock reside in remote, rural areas, or where people may be nomadic or transhumant. Consideration should therefore be given to the joint delivery of human and livestock healthcare and related services, as well as to linking informal, ethnoveterinary practices and practitioners with more formalized systems of veterinary AND medical practice. Several advantages of such an approach are identified and explored. (shrink)

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable (...) when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)