Advances in applications of artificial intelligence and the use of data analytics technology in biomedicine are creating optimism, as many believe these technologies will fill the need-availability gap by increasing resources for mental health care. One resource considered especially promising is smartphone psychotherapy chatbots, i.e., artificially intelligent bots that offer cognitive behavior therapy to their users with the aim of helping them improve their mental health. While a number of studies have highlighted the positive outcomes of using smartphone psychotherapy chatbots (...) to handle various anxiety related problems no conclusive data illustrate their effectiveness or warrant their use in mental illness diagnosis and treatment settings. Yet smartphone psychotherapy is highly endorsed by experts in the field of mental health research. In this paper, I focus on the specific features of smartphone psychotherapy chatbots intended for the diagnosis and treatment of mental illness and criticize three popular promises; i.e., they enable early diagnosis and intervention through digital phenotyping; they defy the stigma of mental illness diagnosis and treatment; they offer increased access to mental health treatment globally. Going against the popular enthusiasm, I argue smartphone psychotherapy chatbots have epistemic and ethical limitations in the diagnosis and treatment of illnesses. In light of these, I encourage researchers, clinicians, policy makers, patients, and caregivers to pause before jumping on the artificial intelligence bandwagon to seek solutions for mental illness on the grounds of these three promises. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

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Philosophers and psychologists have advanced a plethora of explanations of the self in relation to narratives, positing varying degrees of connection between them. For some, narratives created by a subject about herself shape her self-constitution (Flanagan 1991; Fivush 1994). For others, they help the subject to participate in social cognition (Hutto 2008). Some represent narratives as merely one basis of personal identity and consider them cognitive tools used by the subject to construct self-concepts (Neisser 1997; Tekin 2011); others render narratives (...) the basis for self-constitution (Dennett 1992; MacIntyre 1981; Schechtman 1996). Some require that the subject create her ‘whole life narrative’ unifying her .. (shrink)

, Looping Effects, the Self, Psychopathology.

Recent advances in brain imaging methods as well as increased sophistication in neuroscientific modeling of the brain’s reward systems have facilitated the study of neural mechanisms associated with addiction such as processes associated with motivation, decision-making, pleasure seeking, and inhibitory control. These scientific activities have increased optimism that the neurological underpinnings of addiction will be delineated, and that pharmaceuticals that target and change these mechanisms will by themselves facilitate early intervention and even full recovery. In this paper, we argue that (...) it is misguided to construe addiction as just or primarily a brain chemistry problem, which can be adequately treated by pharmaceutical interventions alone. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by (...) nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by (...) nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of these disorders (...) in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment. (shrink)

This paper challenges the exclusion of patients from epistemic practices in psychiatry by examining the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. It argues there are epistemic—rather than exclusively social/political—reasons for including patients in the DSM revision process. Individuals with mental disorders are indispensable resources to enhance psychiatric epistemology, (...) especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. (shrink)

In “Mad Narratives: Self-Constitutions Through the Diagnostic Looking Glass,” by using narrative approaches to the self, I explore how the diagnosis of mental disorder shapes personal identities and influences flourishing. My particular focus is the diagnosis grounded on the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM). I develop two connected accounts pertaining to the self and mental disorder. I use the memoirs and personal stories written by the subjects with a DSM diagnosis as illustrations to bolster (...) my claims. First, expanding on the narrative approaches to the self, I explain how narratives about a subject shape her self-constitution. I elucidate how this process is generated by drawing on research in developmental psychology, cognitive science, and social psychology. Next, using this account as a springboard, I argue that the DSM diagnosis of mental disorder serves as a source of narrative, entering into the patients’ autobiographical and social narratives. This plays an important role in the diagnosed subjects’ self-understanding, self-constitution and flourishing. In this vein, how mental disorders are classified is not only a theoretical question about accurately taxonomizing the various experiences related to mental distress but also an ethical question about which ways of talking about mental disorders will allow subjects to respond effectively to their psychological distress, to flourish and to live autonomous and fulfilling lives. Finally, I suggest that the DSM-based narratives wield a double-edged sword when it comes to the subject’s flourishing: On the one hand, there are problems with some DSM-based narratives that stem from the DSM diagnostic schema and the culture of DSM diagnoses. These problems render these DSM-based narratives unbeneficial for flourishing as they constrain the range of adoptive social, cognitive and emotional responses the subjects can give to their mental disorders. On the other hand, there are grounds to believe that some DSM-based narratives help subjects to flourish. For instance, they provide certainty to subjects' otherwise puzzling symptoms and help them reach out to others with similar experiences. Understanding how the DSM-based narratives can both benefit and harm will help us address problems with psychiatric diagnoses and the dissemination of knowledge about mental disorders in popular culture. The project aims to convince both philosophers and psychiatrists that no plausible theory of the self can be developed without attending to the topic of mental disorder and that no theory of mental disorder can be complete without devising the tools provided by the philosophical approaches to the self as well as developmental and social psychology. It also calls for methodological alterations in mental health ethics research, arguing that a careful scrutiny of mental disorder memoirs can advance the ethical underpinnings to the practice of psychiatry. (shrink)

Mental disorder is an urgent and growing public health problem.1 Scientific investigation of this problem has the pragmatic goals of identifying the causes of mental disorders and developing strategies to effectively treat them. Philosophers of psychiatry have participated in the inquiry into the empirical examination of mental disorders, predominantly by debating whether psychopathology is a legitimate target of scientific inquiry and, if so, how mental disorders should be explained, predicted, and intervened on. However, as I show in this paper, these (...) philosophical discussions have mostly neglected the actual state of inquiry in psychiatry and relevant disciplines, as well as the first-person experiences... (shrink)

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches (...) in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

A human who open their eyes to life finds themselves within a religious tradition and culture. They encounter religious objects and places, meets religious people and live in communication with them. They learn about religion from their family and their surroundings; they see people who perform their religious worship, and from time to time, they themselves participate in these worships. They ask questions, do research, and turn to the use of religious words and concepts. Childhood period has a significant impact (...) on the formation of religious belief, attitudes and behaviours in adulthood, in other words, on the construction of religious identity. The study examined the origins of individual and collective religious identity, religious experiences from childhood to adulthood and cultural contexts. Thus, it was investigated that how participants constructed their religious identities by making sense of the reference frameworks that they acquired from religious narratives and traditions. In this context, the factors that shape and define the construction of religious identity have been analysed in two dimensions, theoretical and field research. 60 participants aged 25 to 75 living in Kahramanmaraş were interviewed in between 2021 and 2022. The study analysed findings about how adult religious individuals build their religious identities using phenomenological patterns from qualitative data collection methods. In the study, the participants were selected with the purposeful sampling method identified with the phenomenological pattern and the study conducted 40-160 minutes of face-to-face in-depth interviews with semi- structured questions prepared separately for 5 main and 13 sub-categories. The data obtained was analysed and categorised using the MAXQDA 12 package program. At this point in our research, the question of what are the factors that influence the formation and maintenance of a person’s religious identity is sought in the framework of the research findings. According to the findings obtained as a result of the study which is based on the basic approaches of role theory it has been observed that the family factor is prominent in building an individual’s religious identity. In addition to the influence of parents on family members in shaping religious identity, it has been observed that some participants are influenced by extended family members such as grandparents. On the other hand, it has been found that schools and courses attended under the referral of the family or the society, the religious officials and religious groups met, and media programmes followed are factors that influence the building of the individual’s religious identity after the family. It has been determined that religious texts and folkloric elements provide stereotyped roles in making choices such as the style of clothing eating and drinking, which are symbolically reflected in the individual’s life, in the implementation of religious orders and moral principles, in short, the construction of religious identity. (shrink)

Experimental Phenomena of Consciousness is the definitive collection of consciousness phenomena in which awareness emerges as an experimental variable.

The scientific investigation of mental disorders is an invigorating area of inquiry for philosophers of mind and science who are interested in exploring the nature of typical and atypical cognition as well as the overarching scientific project of ‘carving nature at its joints’. It is also important for philosophers of medicine and bioethicists who are concerned with concepts of disease and with the development of effective and ethical treatments of mental disorders and the just distribution of mental health services. Philosophical (...) worries surrounding mental health and its care have recently extended beyond the bounds of academia, becoming a vigorous topic of debate in a variety of public domains in the wake of the publication of the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , the psychiatric classification system used by mental health professionals in the USA, and increasingly, by those around the world.The DSM-5 lists mental disorders according to the observable symptoms presented by patients. It is designed for pragmatic use across a variety of settings to accomplish several tasks: to facilitate clinical treatment, to provide clear criteria of eligibility for various administrative and policy related purposes ), and primarily, to further scientific research into mental disorder aetiology. Although designed to meet the needs and interests of various stakeholders , the recently revised manual has not fully satisfied any of them. This failure challenges the assumption that a single manual …. (shrink)

Using masking techniques combined with electrophysiological recordings is a promising way to study neural correlates of visual awareness, as shown in recent studies. Here I comment on the following puzzling aspects typical for this endeavour that have made obstacles for a potentially even more impressive progress. First, the continuing practice of confounds between objective stimulus variables and subjective dependent measures. Second, complexity of timing the emergence of subjective conscious percept which is partly due to complex interactivity between target and mask. (...) Third, the ambiguity of the concept of neural correlates of awareness. (shrink)

Improvement in performance after the end of the training session, termed “Offline improvement,” has been shown in procedural learning tasks. We examined whether Offline improvement in learning a novel orthography depends on the type of reading instruction. Forty-eight adults received multisession training in reading nonsense words, written in an artificial script. Participants were trained in one of three conditions: alphabetical words preceded by direct letter instruction (Letter-Alph); alphabetical words with whole-word instruction (Word-Alph); and nonalphabetical (arbitrary) words with whole-word instruction (Word-Arb). (...) Offline improvement was found only for the Letter-Alph group. Moreover, correlation with a standardized measure of word reading ability showed that good readers trained in the Letter-Alph group exhibit greater Offline improvement, whereas good readers trained in the Word-Arb group showed greater Within-session improvement during training. These results suggest that different consolidation processes and learning mechanisms were involved in each group. We argue that providing a short block of direct letter instruction prior to training resulted in increased involvement of procedural learning mechanisms during training. (shrink)

Background Whistleblowing is an action that particularly requires moral courage. Understanding the relationship between nurses’ levels of moral courage and their whistleblowing approaches is important for reducing adverse situations in healthcare services. Objectives This study aims to understand and analyze the relationship between nurses’ levels of moral courage and their whistleblowing approaches. Research design This is a descriptive and correlational study. Methods The study sample consists of 582 nurses actively working in a province in northwest Türkiye. Research data were collected (...) using an Information Form, the Nurses’ Moral Courage Scale, and the Whistleblowing Scale. Ethical considerations Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection. Findings Nurses were found to perceive their moral courage as high, and their whistleblowing levels were at a moderate level. There was a significant and moderate relationship between participants’ levels of moral courage and whistleblowing levels ( p <.05). Conclusions The findings emphasize the importance of promoting moral courage and creating an appropriate environment for exposing ethical violations. This study can contribute to the development of strategies to enhance nurses’ moral courage and foster a more ethical working environment in healthcare services. (shrink)

The economic shutdown and national lockdown following the outbreak of COVID-19 have increased demand for unpaid work at home, particularly among families with children, and reduced demand for paid work. Concurrently, the share of the workforce that has relocated its workplace to home has also increased. In this article, we examine the consequences of these processes for the allocation of time among paid work, housework, and care work for men and women in Israel. Using data on 2,027 Israeli adults whom (...) we followed since the first week of March, we focus on the effect of the second lockdown in Israel on the gender division of both paid and unpaid work. We find that as demand for housework caused by the lockdown increases, women—especially with children—increase their housework much more than men do, particularly when they work from home. The consequences of work from home and other flexible work arrangements for gender inequality within the family are discussed. (shrink)

Educators who start a philosophy of medicine or medical ethics class with a philosophical discussion on the definition of basic concepts in medicine, such as health and disease, might relate to this anecdotal account. Students initially find the topic engaging because of the ubiquity of the concept of disease regulating not only their direct encounter with health-related contexts, for example, when veterans returning to school receive accommodations after being diagnosed with Post Traumatic Stress Disorder, but also their social world, say, (...) when they get in an argument with their classmates about whether vaccines cause or prevent diseases, or when they join the campus gym to improve their health. Yet their enthusiasm wanes when they read the seminal naturalist and normative accounts of disease. This happens not because such conceptual work does not have any philosophical sophistication and value but because the discussion seldom makes direct contact with the common uses of the disease concept in the medical, social, moral and institutional contexts in which the students are heavily embedded. As the authors of ‘Rethinking ‘Disease’: A Fresh Diagnosis and a New Philosophical Treatment’ argue, the notion of disease central to the naturalist and normativist positions is conceptually insulated from its applications in various institutional settings in healthcare and also from its personal, social and economic contexts. This insularity largely stems from the fact that traditional conceptual analysis in philosophy assumes a lot more than it can show, including the assumption that concepts, such as disease, have necessary and sufficient conditions that exist independently of the world as we encounter it and are accessed through our intuitions. This is a problem, because the concept of disease plays a crucial role in medical epistemology, scientific research, and ethical and policy-related issues; a philosophical account of disease that does not directly engage …. (shrink)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout (...) Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

Bu çalışmada Feminist teologların Yahudilik ve Hıristiyanlıkta var olduğunu iddia ettikleri eril Tanrı anlayışına yönelik getirdikleri eleştiriler ve bunların tutarlılığı objektif bir biçimde ele alınacaktır. Ayrıca Yahudilik ve Hristiyanlıkta ataerkil ve toplumsal baskılardan dolayı oluşan, teolojiye atfedilmiş kadın karşıtı görüşler ve ortaya çıkardıkları sonuçlar araştırılmaktadır. Eleştirel, yorumlayıcı ve bütüncül yöntemler perspektifinde analizlerden faydalanılarak bir bağlam oluşturulmaya gayret gösterdiğimiz bu makalede, Feminist teologların iddia ettiği gibi Yahudilik ve Hıristiyanlık dinlerinin erkeklerin tekelinde olup/olmadığı, bu konuda ataerkil zihniyetin baskınlığı iddiası, din dilinin daima (...) erkekler tarafından kullanıldığı gibi meseleler incelenmiş, bu sorulara yanıtlar aranmıştır. Bunun yanı sıra cinsiyet rolleri konusunda farklı öğretilerin mevcudiyeti, günümüzde birçok toplumda kadın-erkek rollerinin eşitliği üzerine odaklanan tartışmalar, Yahudilik ve Hıristiyanlığın kadın ve erkek rollerine geliştirdiği tanımlar üzerinde durulmuştur. Bu perspektifte Feminist teoloji, genellikle dini metinlerin cinsiyetle ilişkilendirilmesi, kadının da teolojik alanda söz sahibi olmasını vurgulamaktadır. Feminist teoloji, bu düşüncenin Yahudilik ve Hıristiyanlıkta var olduğu savını, eril Tanrı anlayışına ve erkek egemen zihniyetine getirdiği birtakım argümanlarla eleştirmektedir. Feminist teolojinin amacı özellikle de teolojik alanda kadınlar için oluşturulmuş genellemeleri ortadan kaldırmaktır. Ayrıca Feminist teoloji, kadınların da erkekler gibi teolojik alanda söz sahibi olduklarını ortaya koyma düşüncesindedir. Feminist teoloji, cinsiyet konularını dini alanda inceleyen ve eleştiren bir tür disiplindir. Bu disiplin, geleneksel olarak eril bir bakış açısıyla yorumlanmış olan dini metinleri ve uygulamaları yeniden ele alarak bir eleştiriye tâbi tutmaktadır. Feminist teologlar, çağlar boyu, nesilden nesile aktarılan teolojik öğretilerin tek bir cinse isnat edilmesini eleştirmektedir. Feminist teolojinin amacı, dini deneyimi ve inancı cinsiyet eşitliği ve adaleti temel alarak yeniden şekillendirmektir. Bu disiplin, geleneksel olarak erkek egemen olarak kabul edilen dini doktrinleri, metinleri ve uygulamaları eleştirel bir bakış açısıyla değerlendirmektedir. Bu bağlamda mevcut uygulamaların değişmesini temenni etmektedir. Dinin cinsiyet alanında önemli bir role sahip olan feminist teoloji, daha adil ve eşitlikçi bir yapıya doğru ilerlemeye katkı sağlamakta ve kadınların dini alanda daha fazla görünürlük ve etki alanı elde etmelerini desteklemektedir. Cinsiyet ve dini konular arasındaki ilişkileri daha derinlemesine anlamak ve toplumda daha adil bir yapı oluşturmak için önemli bir katkı sağlamaktadır. Bu makalede de Feminist teolojinin ele aldığı sorunlar, bunların çözümleri ve Eril tanrı anlayışına yönelik eleştirileri ele alınacaktır. (shrink)

ABSTRACTChristopher Achen and Larry Bartels’s Democracy for Realists makes a persuasive case that standard theories of democracy rest on shaky empirical ground, and that optimistically interpreted empirical findings about public competence do not save the day. However, I argue that the solution does not lie with theories of elite competition or accountability to other institutions. Instead, I turn to theories of symbolic politics. These theories capture the empirical reality of how voters engage with politics and make decisions. While they tend (...) to emphasize human irrationality, they also contain the potential for a symbolic kind of rationality that could provide a solid foundation for democratic politics. (shrink)