Moral injury, the experience of having acted incommensurably with one's most deeply held moral conceptions, is increasingly recognized by the mental health disciplines to be associated with postcombat traumatic stress. In this essay I argue that moral injury is an important and useful clinical construct but that the phenomenon of moral injury beckons beyond the structural constraints of contemporary psychology toward something like moral theology. This something, embodied in specific communal practices, can rescue moral injury from the medical model and (...) the means—end logic of techne and can allow for truthful, contextualized narration of and healing from morally fragmenting combat experiences. (shrink)

Although post-traumatic stress disorder is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war’s traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what was (...) done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma. (shrink)

Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, by (...) treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer. (shrink)

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic’s advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury—particularly (...) its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury. (shrink)

Prudence, for Thomas Aquinas, is an intellectual virtue that requires coincident moral virtue for its sustainability. As such, prudence displays a way of living in which intellect, desire, and emotion are harmoniously integrated. This account resonates strongly with the aims of mindfulness practices within contemporary psychology and with the "interpersonal neurobiology" of Daniel Siegel, for whom health is understood as a context-responsive and narrative integration of cognition, emotion, and embodied experience that promotes and allows for stable self-identity and fulfilling interpersonal (...) relationships. Similarly, prudence for Aquinas is an integrative virtue, integrating intellect and will, theory and context, action and agent, reason and emotion, past and future, the individual and his or her community, and the proximate and ultimate ends of human life. Contemporary mindfulness practices are at their best a school for prudence, and thus they shed an interesting light on Aquinas's account. In turn, Aquinas's account of prudence offers theological parameters for Christian participation in contemporary mindfulness practices. (shrink)

Suggesting that underlying some violent behavior is an unhealthy identification of one's self with one's behavior, such that there is no reflective space between the acting self and unwanted or violent action, Alexandra Pârvan echoes many contemporary psychotherapeutic models in suggesting that a central goal of psychotherapy for perpetrators and recipients of violence should be to encourage clients to distance the acting self from the self's experience and behavior. Pârvan observes that this is already a feature of "attachment-informed psychotherapy," but (...) she argues that "the distinction between self and action can only be effectively established from outside strictly psychological perspectives" (p.... (shrink)

The modern editions of the Diagnostic and Statistical Manual of Mental Disorders, beginning with DSM-III in 1980, emerged in response to notable challenges to psychiatry’s practices and ways of knowing in the early 1970s. Because these challenges threatened psychiatry’s scientific self-understanding and moral authority, they exemplify what Alasdair MacIntyre has termed “epistemological crisis.” As a response to crisis, the modern DSM has been a stunning political achievement, providing the central diagnostic constructs around which psychiatric research, practice, and reimbursement has been (...) organized for four decades. Indeed, the DSM’s authority survives in the face of ongoing trenchant scientific and philosophical critique. But if psychiatry is to be healthy, it must be epistemologically humble, reckoning honestly with the limits of the DSM before a future epistemological crisis destabilizes it entirely. (shrink)

In his 1917 lecture “Science as a Vocation,” Max Weber challenged current and aspiring scholars to abandon any pretense that science bears within itself any meaning. In a disenchanted age, he argued, science could at best offer “knowledge of the techniques whereby we can control life... through calculation,” and any meaning or moral direction to scientific research—including religious meaning—must be imposed on it from without. Weber presciently anticipated that many present-day health care practitioners would struggle to find meaning for their (...) work within complex “state-capitalist” health care systems, along with predictable quasi-religious responses. But how are Christian practitioners to practice faithfully in a disenchanted age? The authors of this special issue lean deeply into the loci of Christian theology and Christian practice, some challenging the views of the body and of nature that informed Weber’s theory of disenchantment, and all offering resources and paths by which practitioners might “look the fate of the age full in the face” with courage and wisdom. (shrink)

Anastasia Philippa Scrutton renders helpful service to philosophers and mental health clinicians by highlighting strongly voluntarist approaches to depression within some present-day Christian writers and communities, particularly Pentecostal and Evangelical Christian communities in the United States and the United Kingdom. Drawing on a number of evangelical Christian books and online resources, she argues that these resources are "voluntaristic because they emphasize the role of libertarian free will and choice in the attitudes and behaviors of people with depression, such that depression (...) is seen to be a sin, or the result of sin, because depression sufferers are able to do otherwise." She counters these... (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 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, 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)

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)

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 took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, 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)

The Epicurean philosophical system has enjoyed much recent scrutiny, but the question of its philosophical ancestry remains largely neglected. It has often been thought that Epicurus owed only his physical theory of atomism to the fifth-century BC philosopher Democritus, but this study finds that there is much in his ethical thought which can be traced to Democritus. It also finds important influences on Epicurus in Democritus' fourth-century followers such as Anaxarchus and Pyrrho, and in Epicurus' disagreements with his own Democritean (...) teacher Nausiphanes. The result is not only a fascinating reconstruction of a lost tradition, but also an important contribution to the philosophical interpretation of Epicureanism, bearing especially on its ideal of tranquillity and on the relation of ethics to physics. (shrink)

Once upon a time, logical conventionalism was the most popular philosophical theory of logic. It was heavily favored by empiricists, logical positivists, and naturalists. According to logical conventionalism, linguistic conventions explain logical truth, validity, and modality. And conventions themselves are merely syntactic rules of language use, including inference rules. Logical conventionalism promised to eliminate mystery from the philosophy of logic by showing that both the metaphysics and epistemology of logic fit into a scientific picture of reality. For naturalists of all (...) stripes, this was paradise. Alas, paradise was lost. By the end of the twentieth century, logical conventionalism had been almost universally abandoned. But more recently, it has been revitalized. This chapter provides an overview of logical conventionalism and its history, clears away misunderstandings, and briefly responds to both the canonical objections to conventionalism (from Quine, Dummett, Boghossian, and many others) as well as new objections (from Field and Golan). From paradise lost, to paradise regained: logical conventionalism is back. (shrink)

This book is the first extensive treatment of Husserl's phenomenology of time-consciousness. Nicolas de Warren uses detailed analysis of texts by Husserl, some only recently published in German, to examine Husserl's treatment of time-consciousness and its significance for his conception of subjectivity. He traces the development of Husserl's thinking on the problem of time from Franz Brentano's descriptive psychology, and situates it in the framework of his transcendental project as a whole. Particular discussions include the significance of time-consciousness for (...) other phenomenological themes: perceptual experience, the imagination, remembrance, self-consciousness, embodiment, and the consciousness of others. The result is an illuminating exploration of how and why Husserl considered the question of time-consciousness to be the most difficult, yet also the most central, of all the challenges facing his unique philosophical enterprise"--Provided by publisher. (shrink)

The ancient philosophical school of Epicureanism tried to argue that death is "nothing to us." Were they right? James Warren provides a comprehensive study and articulation of the interlocking arguments against the fear of death found not only in the writings of Epicurus himself, but also in Lucretius' poem De rerum natura and in Philodemus' work De morte. These arguments are central to the Epicurean project of providing ataraxia (freedom from anxiety) and therefore central to an understanding of Epicureanism (...) as a whole. They also offer significant resources for modern discussions of the value of death--one which stands at the intersection of metaphysics and ethics. If death is the end of the subject, and the subject can not be benefited nor harmed after death, is it reasonable nevertheless to fear the ceasing-to-be? If the Epicureans are not right to claim that the dead can neither be benefited nor harmed, what alternative models might be offered for understanding the harm done by death and do these alternatives suffer from any further difficulties? The discussion involves consideration of both ethical and metaphysical topics since it requires analysis not only of the nature of a good life but also the nature of personal identity and time. A number of modern philosophers have offered criticisms or defences of the Epicureans' views. Warren explores and evaluates these in the light of a systematic and detailed study of the precise form and intention of the Epicureans' original arguments. Warren argues that the Epicureans also were interested in showing that mortality is not to be regretted and that premature death is not to be feared. Their arguments for these conclusions are to be found in their positive conception of the nature of a good and complete life, which divorce the completeness of a life as far as possible from considerations of its duration. Later chapters investigate the nature of a life lived without the fear of death and pose serious problems for the Epicureans being able to allow any concern for the post mortem future and being able to offer a positive reason for prolonging a life which is already complete in their terms. (shrink)

Because of the “all-or-none” character of nervous activity, neural events and the relations among them can be treated by means of propositional logic. It is found that the behavior of every net can be described in these terms, with the addition of more complicated logical means for nets containing circles; and that for any logical expression satisfying certain conditions, one can find a net behaving in the fashion it describes. It is shown that many particular choices among possible neurophysiological assumptions (...) are equivalent, in the sense that for every net behaving under one assumption, there exists another net which behaves under the other and gives the same results, although perhaps not in the same time. Various applications of the calculus are discussed. (shrink)

Renouvier's place in nineteenth-century French thought -- Renouvier's critique of Comtean positivism -- Renouvier and mathematics -- Renouvier on evolution -- Kant, free will, and the social contract -- Hypothesis and convention in Renouvier's philosophy of science.

Writings by a thinker—a psychiatrist, a philosopher, a cybernetician, and a poet—whose ideas about mind and brain were far ahead of his time. Warren S. McCulloch was an original thinker, in many respects far ahead of his time. McCulloch, who was a psychiatrist, a philosopher, a teacher, a mathematician, and a poet, termed his work “experimental epistemology.” He said, “There is one answer, only one, toward which I've groped for thirty years: to find out how brains work.” Embodiments of (...) Mind, first published more than fifty years ago, teems with intriguing concepts about the mind/brain that are highly relevant to recent developments in neuroscience and neural networks. It includes two classic papers coauthored with Walter Pitts, one of which applies Boolean algebra to neurons considered as gates, and the other of which shows the kind of nervous circuitry that could be used in perceiving universals. These first models are part of the basis of artificial intelligence. Chapters range from “What Is a Number, that a Man May Know It, and a Man, that He May Know a Number,” and “Why the Mind Is in the Head,” to “What the Frog's Eye Tells the Frog's Brain” (with Jerome Lettvin, Humberto Maturana, and Walter Pitts), “Machines that Think and Want,” and “A Logical Calculus of the Ideas Immanent in Nervous Activity” (with Walter Pitts). Embodiments of Mind concludes with a selection of McCulloch's poems and sonnets. This reissued edition offers a new foreword and a biographical essay by McCulloch's one-time research assistant, the neuroscientist and computer scientist Michael Arbib. (shrink)

Stable URL: http://links.jstor.org/sici?sici=0048-3915%28198923%2918%3A4%3C334%3AAIACTD%3E2.0.CO%3B2-P..

Warren Quinn was widely regarded as a moral philosopher of remarkable talent. This collection of his most important contributions to moral philosophy and the philosophy of action has been edited for publication by Philippa Foot. Quinn laid out the foundations for an anti-utilitarian moral philosophy that was critical of much contemporary work in ethics, such as the anti-realism of Gilbert Harman and the neo-subjectivism of Bernard Williams. Quinn's own distinctive moral theory is developed in the discussion of substantial, practical (...) moral issues. For example, there are important pieces here on the permissibility of abortion, the justification of punishing criminals when no particular good seems likely to result, and on the distinction between killing and allowing to die, a distinction crucial to the subject of euthanasia and other topics in medical ethics. The volume would be ideally suited to upper-level undergraduate courses and graduate seminars on the foundations of ethics. (shrink)

"Ashby includes the great thinkers and periods that have shaped Western ethics: the Greeks, the Hebrew prophets, the Roman Stoics, St. Augustine, the medieval ethicists, the Renaissance and Reformation, the Enlightenment, the Romantics, and the radical revolutions of the late nineteenth and early twentieth centuries. In the period from 1850 to 1920, Ashby notes, the transformations wrought by the four great modern thinkers - Darwim, Marx, Nietzsche, and Freud - both extended and significantly challenged the traditional core beliefs of the (...) West and, as a result, bestowed upon us a profound moral crisis, one that we have not yet successfully met. Consequently, as we stand at the brink of the twenty-first century, with its further technological breakthroughs and social upheavals, how will we deal with the moral uncertainties that await us? In his final chapter Ashby contends that while remaining alive to our Western ethical heritage, we will have no choice but to confront its basic presuppositions as we move into a more pluralistic society, for he asserts that the ideology of the future cannot be exclusively Western; future history cannot be purely Western history. So, while this history of ethics cannot tell us how to live, it can offer to the reader what is prerequisite to a more satisfying life: an insightful and inclusive history of where our own ethical beliefs have come from and a sense of the challenges that await us all.". (shrink)

This book evaluates the consequences of economic, social, environmental and cultural change on people living and working within Teesside in the North-East of England. It assesses the lived experiences, working lives, health and cultural perspectives of residents and key stakeholders in the wake of serious de-industralisation in the region. The narrative is embedded within the long-term industrial history of Stockton: an area once dominated by steel, coal and chemical industries. This past still continues to shape its future and influences the (...) ways in which that future is conceived and envisioned. The author explores a 'biography of place' analytical framework to offer a holistic view of the area, which considers the interaction between the social, economic, cultural, visual and environmental legacy of the community, which is firmly grounded in the past, present and future prospects of those who live and work there. (shrink)

Drawing from moral foundations theory, we show that differences in sensitivity to distinct moral norms help explain differences in the perceived fairness of punishing employees for off-duty deviance. We used an initial study to validate realistic examples of non-criminal behavior that were perceived as violating a specific moral foundation. Participants in the main study evaluated scenarios in which co-workers were fired for those behaviors, which took place outside of work but were revealed via social media. The extent to which participants (...) valued the norm violated by the co-worker positively predicted perceived fairness of the firing, and negatively predicted expressed intent to take retributive action against the responsible manager. This effect was moderated by the presence of a pre-existing organizational policy regarding off-duty conduct, which uniformly decreased negative reactions to the firing. Because social media now makes the revelation of an employee’s off-duty behavior to a broad audience increasingly likely, our results suggest the importance of developing an approach for responding to employee off-duty deviance while highlighting the relevance of moral pluralism to the study of third-party reactions. (shrink)

An article by Warren Reich in the December 1994 issue of this journal concludes that the word "bioethics" and the field of study it names experienced a "bilocated birth" in 1970/1971 under Van Rensselaer Potter, at the University of Wisconsin, and André Hellegers, at Georgetown University. Further historical inquiry confirms (1) that there were, from the start, some major differences—even clashes—between the Potter and the Hellegers/Georgetown understandings of bioethics; and (2) that the Hellegers/Georgetown approach came to be the more (...) widely accepted meaning of the term, while Potter's idea of bioethics remained largely marginalized. However, this inquiry also results in a third, unanticipated, conclusion: that Hellegers (in contrast to the dominant model offered by the Georgetown scholars) actually proposed a global approach to bioethics, bringing his vision much closer to Potter's evolving view than previously has been acknowledged. (shrink)

Extensive historical sleuthing reveals that the word "bioethics" and the field of study it names experienced, in 1970/1971, a "bilocated birth" in Madison, Wisconsin, and in Washington, D.C. Van Rensselaer Potter, at the University of Wisconsin first coined the term; and André Hellegers, at Georgetown University, at the very least, latched onto the already-existing word "bioethics" and first used it in an institutional way to designate the focused area of inquiry that became an academic field of learning and a movement (...) regarding public policy and the life sciences. A further comparison of the Potter and the Hellegers/Georgetown understandings of bioethics and the relative acceptance of the two views will appear in the March 1995 issue of this journal. (shrink)

The prior research on different forms of what can be referred to as corporate social responsibility reporting is vast. As CSR reporting becomes more commonplace, the theoretical and empirical analysis of this type of reporting has matured and both academics and practitioners have begun to explore the possibility of having CSR disclosures assured. This paper makes an important contribution by synthesising the findings on emerging forms of CSR assurance practice. It summarises the ground covered to date and provides a comprehensive (...) review of the literature on the characterises, use and limitations of CSR assurance services. It develops a conceptual model which distinguishes between determinants of CSR assurance at the national- and firm-level and shows how the nature of assurance services, a company’s reporting infrastructure and current technologies of assurance enable or constrain the benefits of having CSR disclosures assured. Areas for future research, based on identified weaknesses in the current CSR assurance environment, are also identified. (shrink)

The prior research on different forms of what can be referred to as corporate social responsibility reporting is vast. As CSR reporting becomes more commonplace, the theoretical and empirical analysis of this type of reporting has matured and both academics and practitioners have begun to explore the possibility of having CSR disclosures assured. This paper makes an important contribution by synthesising the findings on emerging forms of CSR assurance practice. It summarises the ground covered to date and provides a comprehensive (...) review of the literature on the characterises, use and limitations of CSR assurance services. It develops a conceptual model which distinguishes between determinants of CSR assurance at the national- and firm-level and shows how the nature of assurance services, a company’s reporting infrastructure and current technologies of assurance enable or constrain the benefits of having CSR disclosures assured. Areas for future research, based on identified weaknesses in the current CSR assurance environment, are also identified. (shrink)