In lieu of an abstract, here is a brief excerpt of the content:Clinicians’ “Folk” Taxonomies and the DSM: Pick Your PoisonG. Scott Waterman (bio)Keywordsnosology, classification, diagnosis, psychopathologyWith attention turning to the process of formulating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; e.g., Kendler et al. 2008), the study by Flanagan and Blashfield (2007) of the similarities and differences between clinicians’ “folk” taxonomies and psychiatry’s official one is timely, and its lessons are in (...) need of analysis. In this commentary I first address questions raised by the existence of multiple de facto taxonomies, and by the characteristics of those taxonomies themselves, before focusing attention on the DSM diagnostic system and its attributes that make acceptance by its constituencies far less than complete. Although the aim of Flanagan’s and Blashfield’s study is explicitly descriptive rather than normative, it provides an important opportunity to examine the extent to which our taxonomies serve the purposes for which they were constructed—whether by experts or by clinicians.There are certainly reasons to expect significant deviations between clinicians’ everyday taxonomies and the official one. Perhaps the most glaring reason is the fact that—even if it were desirable—no one can be familiar with the enormous number of categories codified by the DSM. On the other hand, the remarkable hegemony of the DSM—in the education and training of physicians and clinical psychologists, in clinical communication, and in the ubiquitous administrative functions of billing and coding—makes such deviations at least somewhat surprising and in need of scrutiny and explanation. The first question, however, is whether one should be concerned by the existence (surprising or otherwise) of multiple taxonomies. Flanagan and Blashfield make the compelling case that, given the high rate at which Americans seek clinical attention for psychiatric problems, the stakes are commensurately high for our efforts at categorizing those problems in valid and useful ways. And the extent to which a gulf exists between the way psychiatry and clinical psychology are written about and taught on the one hand, and conceptualized and practiced by clinicians on the other, invites a multitude of problems—among which cynicism about our disciplines may be one of the most pernicious.At least as important as their finding of only moderate correlations between clinicians’ taxonomies [End Page 271] and that of the DSM are the characteristics of clinicians’ diagnostic systems themselves. One potentially major artifact of their methodology, however, must be borne in mind: the instruction to the clinicians in their study to “[p]ut together the diagnoses that have similar treatments…” (emphasis mine). Although they cite previous work (Flanagan and Blashfield 2006) in defense of the proposition that such instruction did not unduly influence their findings, it was certainly an avoidable potential problem, which itself likely reflects the history of our clinical disciplines in which the treatment cart frequently pulled the diagnosis horse. It is, therefore, not unlikely that clinicians’ taxonomies might emphasize treatment considerations even if they had not been directed to do so. The fallacious reasoning behind such intuitively appealing practice, however, must be exposed. The implicit assumption that treatment response is a proxy for other important characteristics of illnesses is predicated on the false proposition that our treatments exert their effects via similar mechanisms across the various indications for their uses, thus allowing us to infer from such responses that what was awry in the first place among the conditions for which a given treatment is effective must be closely related. Categorizing mania and trigeminal neuralgia together by virtue of their shared responses to anticonvulsant therapy, or considering autoimmune platelet deficiencies to be closely related to abdominal trauma due to the fact that each sometimes requires splenectomy, are examples of the potential results of acting on that false premise.Another parameter on which the clinicians in the current study based their nosologies—most explicitly by the “dimensional experts”—is the “environmental” versus “biological” one. Given that a coherent dichotomy would either distinguish environmental from genetic etiological factors, or would contrast psychological (i.e., subjective or first-person) from biological (i.e., objective or third-person) manifestations of illness, a taxonomy one of whose axes purports to represent an environmental/biological continuum cannot... (shrink)

Psychiatry's relation to the rest of medicine is ambivalent. Its legitimacy as a specialty is often conceived as being closely linked to its fidelity to the fundamental paradigms of medicine, especially the centrality of diagnosis and the association of diagnosis with treatment indications. However, as Gagné-Julien notes, a major impetus behind the quest for a solution to the demarcation problem in psychiatry is "growing concerns regarding over-medicalization". Although it could appear that these two considerations point in opposite directions, both arguably (...) would be served by what Gagné-Julien labels "a satisfying definition" of mental disorder. Such a... (shrink)

When we sit down to write an article that we plan to submit for publication, it is usually because we have completed some piece of empirical or conceptual work that has led us to conclusions we wish to share with our scholarly communities. In this instance, though, my essay under discussion was itself the means by which I sought to draw some conclusions about my recent experiences. Contrary to my initial plans—and my custom—I began writing without a clear idea of (...) where I would wind up. The commentaries, taken as a whole, affirm that my ambivalence about the topic at hand—fully revealed to me while formulating the article—came through, albeit in different ways to different commentators. And... (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

This paper explores the concept of hope in Aristotle’s philosophy. First, I note that Aristotle contrasts hopefulness with the virtue of courage, although hopefulness can be a source of courage in some contexts, because hopefulness can create confidence. Next, I examine hope in relation to fear, defending Aristotle’s claim that without hope we cannot fear, and suggesting that hope, as a foundation for both fear and confidence, is a fundamental requirement for deliberation. Finally, I look at the hopefulness that underlies (...) Aristotle’s virtue of high-mindedness, concluding that hopefulness is a foundation for self-confidence and ethical self-improvement. (shrink)

How should religion and ethics be studied if we want to understand what people believe and why they act the way they do? An energetic guide to the study of religion and ethics, rejecting theories from postmodernism and cognitive science in favour of a return to pragmatic enquiry.

This chapter aims to illuminate ways in which hope was significant in the philosophy of classical Greece. Although ancient Greek philosophies contain few dedicated and systematic expositions on the nature of hope, they nevertheless include important remarks relating hope to the good life, to reason and deliberation, and to psychological phenomena such as memory, imagination, fear, motivation, and pleasure. After an introductory discussion of Hesiod and Heraclitus, the chapter focuses on Plato and Aristotle. Consideration is given both to Plato’s direct (...) comments on hope and to the narrative contexts of his dialogues, with analysis of Plato’s positive and negative representations of hope, hope’s relationship to reason, and Plato’s more psychological approach in the Philebus, where hope finds a place among memory, recollection, pleasure, and pain. The chapter then reviews Aristotle’s discussions of confidence, hope, and courage, observing that although Aristotle does not mention hope as a virtue, he does note its importance to human agency and deliberation and as a foundation for the further development of virtue. The chapter concludes that discussions surrounding hope in ancient Greek philosophy are rich and challenging and can serve as a lively stimulus to further exploration of the concept of hope. (shrink)

Jeffrey Stout's "Democracy and Tradition" puts forward a complex argument in favor of American democracy as a healthy and legitimate moral and political tradition in itself. Stout does not dwell on the place of his own work in the "pragmatic" approach to the study of religion in the last thirty years. This paper attempts to situate Stout's work in the approach to religion identified with Mary Douglas and Wayne Proudfoot and to suggest some of the consequences for comparative religious ethics (...) of his making that "pragmatic turn.". (shrink)

Hibbing et al. argue that the liberal–conservative continuum is (a) universal and (b) grounded in psychological differences in sensitivity to negative stimuli. Our commentary argues that both claims overlook the importance of context. We review evidence that the liberal–conservative continuum is far from universal and that ideological differences are contextually flexible rather than fixed.

Mary Douglas's Purity and Danger and Herbert Fingarette's Confucius: The Secular as Sacred have had a continuous impact on cultural anthropology and the study of ancient Chinese thought, respectively, but neither has typically been read as a contribution to comparative religious ethics. This paper argues that both books developed from profound dissatisfaction with the empiricist presuppositions that dominated their fields into the 1970s and that both should be associated with the revival of American pragmatism that is currently driving a reinterpretation (...) of ethics as a social practice embedded in historically contingent discourse about agency, virtue, and social organization. This pragmatic turn results in a shift of comparative ethics away from issues of methods and metaethics in the direction of history and fieldwork as the preconditions for useful comparison. (shrink)

This response suggests that in writing the history of ethics, it is important to take seriously what the principals wrote and believed, distinguishing it carefully from our own responses to their writings, or from subsequent uses to which their writings may have been put. For example, when reading Thomas Aquinas and Francisco de Vitoria on just war against non‐Christian peoples, forcible conversion and conquest are clearly condemned. Whatever the attitudes of their contemporaries, not to mention later thinkers up to the (...) present, there is no foundation in Aquinas and Vitoria for holy war or “exceptionalism,” American or otherwise. (shrink)

Alain Epp Weaver's analysis of the theological foundations of Augustine's proscription of all lies in all circumstances does more than improve our understanding of Augustine. In drawing a plausible and illuminating parallel between the theological logic of Augustine and the theological logic of John Howard Yoder, Weaver not only succeeds in defending the credibility of Christian pacifism but also provides support for interpreting Yoder as a biblical realist. Moreover, the divergence between Weaver and Christopher Kirwan in their critical assessments of (...) the cogency of Augustine's treatment of lying serves to throw into relief the differences between secular philosophical ethics and theological ethics, incidentally suggesting why it is often difficult for twentieth-century thinkers to understand and evaluate premodern texts. (shrink)

Some years ago I mentioned to Wayne Proudfoot what a pleasure it was to teach Religious Experience, if only to show a group of students how to develop an argument over the course of an entire book. Proudfoot shook his head and remarked that one reviewer praised the book as a helpful collection of essays. In the remarks that follow, I want to argue three points: 1) that Religious Experience is a remarkably tight argument, from beginning to end; 2) that (...) the argument vindicates a methodological pluralism that was previously undervalued in the philosophical study of religion; and 3) that Religious Experience established a paradigm for the philosophical study of religion that remains the norm.Other than scholars of... (shrink)

Molly Farneth’s Hegel’s Social Ethics hearkens back to the tradition of Josiah Royce, which has continued in the work of Richard Bernstein and Jeffrey Stout. At the same time, it reflects the impact of three decades of interpretive work which has offered an alternative to the 19th and early 20th century reading of Hegel as a metaphysical systematizer. In this new reading he was from the beginning a social critic and political theorist who looked to lay the groundwork for post‐Enlightenment (...) vision of the social world as evolving toward one of social cooperation based on mutual recognition. Farneth has developed this reading of Hegel into one of powerful resources for democratic pluralism. (shrink)

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting (...) Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core. (shrink)

J. B. Schneewind's "The Invention of Autonomy" has been hailed as a major interpretation of modern moral thought. Schneewind's narrative, however, elides several serious interpretive issues, particularly in the transition from late medieval to early modern thought. This results in potentially distorted accounts of Thomas Aquinas, Hugo Grotius, and G. W. Leibniz. Since these thinkers play a crucial role in Schneewind's argument, uncertainty over their work calls into question at least some of Schneewind's larger agenda for the history of ethics.

J. B. Schneewind's The Invention of Autonomy has been hailed as a major interpretation of modern moral thought. Schneewind's narrative, however, elides several serious interpretive issues, particularly in the transition form late medieval to early modern thought. This results in potentially distorted accounts of Thomas Aquinas, Hugo Grotius, and G. W. Leibniz. Since these thinkers play a crucial role in Schneewind's argument, uncertainty over their work calls into question at least some of Schneewind's larger agenda for the history of ethics.

Paul Ricoeur writes of these essays that they “do not properly speaking constitute the chapters of a book.... Yet these texts do not come down simply to being occasional writings for some particular circumstance”. This is too modest. This short volume limns a comprehensive account of ethics, politics, and the law that “one might call neo-Aristotelian”. What makes Ricoeur’s position neo-Aristotelian is the insistence that “the question what ought I to do? is secondary in relation to the more elementary question (...) of knowing how I might wish to live my life”. When legal push comes to philosophical shove we must acknowledge the priority of the good over the right. (shrink)

H. G. Liddell & R. Scott, A Greek-English Lexicon, rev. and aug. by Sir H. S. Jones. with the ass. of R. McKenzie, Oxford, Clarendon Press, 1940. ῥυθμός , Ion. ῥυσμός (v. infr. 111, IV), ὁ : (ῥέω) :— A. any regular recurring motion (“πᾶς ῥ. ὡρισμένῃ μετρεῖται κινήσει” Arist.Pr.882b2) : I. measured motion, time, whether in sound or motion, Democr.15c ; = ἡ τῆς κινήσεως τάξις, Pl.Lg.665a, cf. 672e ; “ὁ ῥ. ἐκ τοῦ ταχέος (...) - Études grecques (...) et latines. (shrink)

Comment by Aaron L. Mackler on “‘Through Her I Too Shall Bear a Child’: Birth Surrogates in Jewish Law” by Elie Spitz Reply by Elie Kaplan Spitz Research Note by G. Scott Davis.

Comment by Aaron L. Mackler on “‘Through Her I Too Shall Bear a Child’: Birth Surrogates in Jewish Law” by Elie Spitz Reply by Elie Kaplan Spitz Research Note by G. Scott Davis.

Experiential education produces numerous benefits to students in terms of higher order thinking skills such as the ability to evaluate, analyze, and synthesizeinformation , engagement , and work-readiness . Partnering with community organizations provides a means to create experiential education opportunities for students. In this symposium, we discussed three examples of experiential education to promote learning around themes of sustainability, providing a brief outline of the activities, the intended outcomes, and the lessons learned from our experiences. We concluded with a (...) meditation on the importance of working with community partners and managing expectations so that students, the community, and the institutions gain the best possible outcomes when creating town-gown partnerships for sustainability education. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

This article presents the results of a study that investigated the roles that religiosity and ones money ethic play in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. One dimension of religiosity – intrinsic religiousness – was studied. Four separate dimensions of a money ethic scale were initially examined, but only one was used in the final analyses. Results indicated that both intrinsic religiousness and one’s money ethic were significant determinants of most types of consumer ethical beliefs.

This article presents the results of a study that investigated the role that religiosity plays in determining consumer attitudes/beliefs regarding various questionable consumer practices. Additionally, other personal factors were examined including idealism, relativism, consumer alienation and selected demographics such as income and age. All of these constructs were examined as antecedents of consumer ethical beliefs. The results of a post hoc analysis indicated that religiosity was a significant determinate of both idealism and relativism, and since idealism and relativism determine consumer (...) ethical beliefs, religiosity is a significant indirect determinate of consumer ethical beliefs. (shrink)

This article presents the results of an exploratory study that investigated the role that religiosity plays in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. Two dimensions of religiosity – intrinsic and extrinsic religiousness – were studied. Results indicated that an intrinsic religiousness was a significant determinant of consumer ethical beliefs, but extrinsic religiousness was not related to those beliefs.