Premenstrual dysphoric disorder was recently moved to a full category in the DSM-5 . It also appears set for inclusion as a separate disorder in the ICD-11 . This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD (...) is a culture-bound phenomenon, not a universal one. I also argue that even if medication produces a desired effect, there are biological correlates with premenstrual anger/distress, such anger/distress seems to occur monthly, and women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one’s environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women’s suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women’s suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications. (shrink)
The creation of the latest version of psychiatry's 'bible' has been surrounded by a great deal of controversy. The latest revision, the DSM-5, contains several controversial diagnoses that have been the subject of much debate. One of the central criticisms of DSM-5 is that it pathologizes some behaviors that were previously considered simply problematic, or variations of normal behavior—for example, fidgetiness, noisiness, abundance of energy, shyness, anxiety, and bereavement. Diagnoses such as Binge Eating Disorder, Disruptive Mood Dysregulation Disorder...
I am grateful to the commentators for their thoughts on my paper. The commentaries present a variety of views on the proposal, ranging from the view that it has too much teeth, to the view that it does not have enough teeth, and come from a range of perspectives, reflecting the spirit of the panel I propose. I respond to the commentaries in themes, clarifying certain points along the way.Some commentators have interpreted me as implying that philosophers have a 'royal (...) road to the truth' or that they are confined to armchair philosophizing, yet I believe neither. In these disciplines, as in other disciplines, strong arguments are based on both sound logic and evidence, and there would need to be evidence underlying... (shrink)
ABSTRACTThe prospect of enhancing ourselves through the use of new biotechnologies is for the most part, hypothetical. Nevertheless, the question of whether we should undertake such enhancement is worthy of discussion as it may become possible in the future. In this article, we consider one form of argument that conservative opponents of biotechnological means of enhancement deploy in opposition to the use of enhancement technologies—the backfiring objection. This is the objection that the use of such technologies is liable to go (...) wrong and lead to outcomes that are inferior to the outcomes intended. We will argue that the objection is not nearly as significant as bioconservatives suppose it to be. Bioconservatives sometimes supplement the backfiring objection by arguing that change will be irreversible, that the new is especially liable to backfire and that humans possess severe and permanent limitations which cannot be overcome. We consider these ways of supplementing the backfiring objection and argue that each of them, when properly understood, is of limited value to the bioconservative. We also consider how traditional approaches to moral education can be supplemented by bioenhancement. (shrink)
What is family-centred care of a hospitalized child? A critical understanding of the concept of family-centred care is necessary if this widely preferred model is to be differentiated from other health care ideals and properly evaluated as appropriate to the care of hospitalized children. The article identifies distinguishable interpretations of family-centred care that can pull health professionals in different, sometimes conflicting directions. Some of these interpretations are not qualitatively different from robust interpretations of the ideals of parental participation, care-by-parent and (...) partnership in care that are said to be the precursors of family-centred care. A prominent interpretation that regards the child and his or her family collectively as the ‘unit of care’ arguably arises from ambiguity and is significantly problematic as a model for the care of hospitalized children. Clinical practice driven by this interpretation can include courses of action that do not aim to do what will best promote a hospitalized child’s welfare, and such cases will not be unusual. More broadly, this interpretation raises challenging questions about the responsibilities and authority of health professionals in relation to the interests of hospitalized children and their families. (shrink)
‘Gender disappointment’ is the feeling of sadness when a parent’s strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents’ pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether ‘gender disappointment’ represents (...) a unique diagnosis. We argue that ‘gender disappointment’ does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents’ distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level. (shrink)
TamaraKayaliBrowne's suggestion to create a formal role in revision of the Diagnostic and Statistical Manual of Mental Disorders for philosophers, sociologists, and bioethicists is interesting and stems from a well-supported concern about how nosological psychiatric categories interact with both the epistemic norms of science and philosophy and with their consequences in the world. Browne is grappling with a problem that is clearly stated and pressing. However, I am not convinced that her solution, namely, using (...) experts from these disciplines to form a veto-wielding ethics committee, is an ameliorative to this problem.Browne identifies a problem: The process of DSM revision involves making value judgements... (shrink)
TamaraKayaliBrowne's proposal for an Ethics Review Panel for the Diagnostic and Statistical Manual of Mental Disorders conceives of a state-sponsored panel of academic experts—philosophers, sociologists, and bioethicists—dealing in a reflective, systematic, and standardized manner with the "value judgements" that are an "integral and unavoidable part of psychiatric nosology". The panel would consider existing and new diagnostic categories, and issue authoritative vetoes and/or modifications as appropriate. Browne asserts that, "it should not be necessary to have (...) protests and political activism, such as that involved in removing homosexuality from the DSM, in... (shrink)
Important philosophical work has gone into debunking thoroughly entrenched positivist notions that objective science proceeds in a value neutral manner. Dr. TamaraKayaliBrowne's article "A Role for Philosophers, Sociologists, and Bioethicists in Revising the DSM" admirably takes the next step. Given the evaluative elements that permeate, in this case, the science of nosology—how do we deal responsibly with those evaluative elements? She correctly, in my opinion, concludes that dealing with evaluative issues responsibly is tantamount to dealing (...) with them ethically. But, as her concrete example of the ethics of premenstrual dysphoric disorder demonstrates, dealing with the ethics of the science of... (shrink)
Fredrik Svenaeus has applied Heidegger’s concept of ‘being-in-the-world’ to health and illness. Health, Svenaeus contends, is a state of ‘homelike being-in-the-world’ characterised by being ‘balanced’ and ‘in-tune’ with the world. Illness, on the other hand, is a state of ‘unhomelike being-in-the-world’ characterised by being ‘off-balance’ and alienated from our own bodies. This paper applies the phenomenological concepts presented by Svenaeus to cases from a study of depression. In doing so, we show that while they can certainly enrich our understanding of (...) depression, they can also reveal a clash between some societal definitions of illness and the individual’s definition. Phenomenological analysis may thus cause us to question what we mean, or think should be meant, by the terms ‘health’ and ‘illness’. (shrink)
Non-medical sex selection is premised on the notion that the sexes are not interchangeable. Studies of individuals who undergo sex selection for non-medical reasons, or who have a preference for a son or daughter, show that they assume their child will conform to the stereotypical roles and norms associated with their sex. However, the evidence currently available has not succeeded in showing that the gender traits and inclinations sought are caused by a “male brain” or a “female brain”. Therefore, as (...) far as we know, there is no biological reason why parents cannot have the kind of parenting experience they seek with a child of any sex. Yet gender essentialism, a set of unfounded assumptions about the sexes which pervade society and underpin sexism, prevents parents from realising this freedom. In other words, unfounded assumptions about gender constrain not only a child’s autonomy, but also the parent’s. To date, reproductive autonomy in relation to sex selection has predominantly been regarded merely as the freedom to choose the sex of one’s child. This paper points to at least two interpretations of reproductive autonomy and argues that sex selection, by being premised on gender essentialism and/or the social pressure on parents to ensure their children conform to gender norms, undermines reproductive autonomy on both accounts. (shrink)
Before we respond to TamaraBrowne's proposal for an external ethics advisory review panel to oversee content in the Diagnostic and Statistical Manual of Mental Disorders, we wish to introduce ourselves. One of us is a professor of bioethics, a lawyer, and a doctor of public policy, and one of us is a philosopher of psychiatry who studies psychiatric nosology, and who has done bioethics work for two congressional advisory agencies. Based on our backgrounds, we flatter ourselves that (...) we might be considered as members of the DSM ethical review panel Browne proposes. However, we realize that one of us would likely be ineligible because of a lack of experience in psychiatry, and the other would... (shrink)
There are many points on which I agree with KayaliBrowne. I agree that value judgments necessarily play a role in constructing a classification such as the Diagnostic and Statistical Manual of Mental Disorders. I agree that people with different backgrounds and interests are likely to assess problems differently and that it would be a good idea for a more diverse body of people to have some involvement in revising the DSM. I agree that philosophers might usefully play (...) a role when the DSM is being revised.Overall, however, I am not convinced that KayaliBrowne's committee would be a good idea. In her vision, such a committee would constitute a group of wise moral experts who would help to make the... (shrink)
TamaraBrowne proposes a provocative idea: She argues that philosophers, sociologists, and bioethicists should act as an independent editorial panel for future editions of the Diagnostic and Statistical Manual of Mental Disorders. Her paper depends on some well-versed claims in philosophy of psychiatry: She argues that psychiatric classifications are inherently value laden and philosophers, sociologists, and ethicists are best placed to discern the values are that embedded within scientific descriptions of mental disorders, and to speculate on the effects (...) of any such classifications on individuals and the populace at large as a result of these classifications.I agree with Browne that the DSM (and... (shrink)
TamaraBrowne argues that many of the controversies that emerge in the process of revising DSMs could be solved by the creation of an Ethics Review Panel, similar to that of a research ethics committee. Members of such a panel would, in Browne's words, "help inform psychiatric classification". Browne's proposal is important on a number of levels, the most significant one being that it affirms the status of ethics as equal to that of science. An Ethics (...) Review Panel would do more than merely make the processes of scientific and ethical judgments parallel: if Browne's suggestions were followed, it would raise ethical considerations to that of second-order status to scientific judgments in the... (shrink)
In this discussion with Craig Browne, Luc Boltanski comments on how his recent work reconsiders the questions of agency and the nature of social explanation. Boltanski reflects on the connections between his investigations of grammars of justifications and his later work with Eve Chiapello on the historical transition to a new spirit of capitalism. The significance of politics, conflict and critique to Boltanski’s sociology are highlighted. Bolanski explains why he regards May 1968 as a major disruption of the capitalist (...) social order and how the conservative response to this contestation subsequently prevailed in France. The reorganisation of capitalism in recent decades has increased social division, yet Boltanski believes that the recent recession and existing discontent could lead to unexpected outcomes. (shrink)
Tools and technologies expand our capacities, including our cognitive capacities. Microscopes extend our perceptual capacities. Notebooks extend the natural limits of memory. These facts are important, for all that they are obvious. The extended cognition hypothesis wants more. Some external devices and processes are literal parts of cognitive processes themselves. When there is fast and reliable access to external data or processes, then the cognitive processes that occur uncontroversially inside the brain literally and controversially extend out into the world to (...) incorporate external structures or processes. Retrieval of an address from memory and retrieval of the same information from a notebook can both be fully cognitive processes involving fully cognitive representations. So say the proponents of extended cognition.It is an attractive metaphor. But is there any good reason to take it as literal truth? Adams and Aizawa argue that the debate on extended cognition implicates an …. (shrink)
This article starts by noting the general lack of acknowledgment of alternative traditions in the dominant western sustainability discourse in education. After critically analyzing the western human–nature relationship in the context of Enlightenment, modernity and colonial expansion, this article introduces two non-western ecological discourses from Eurasia and Asia, Noöspherism and Neo-Confucianism, which offer clear contrasts to the western sustainability framework. Using theoretical argumentations, the article goes on to examine the cosmological and ontological categories expounded by Vladimir Vernadsky of Russia and (...) Yulgok Yi of Korea, whose philosophical foundations with unique foci on the anthropocosmic and cosmoanthropic types of human–nature relationships could well be alternatives and/or additions to the dominant western discourse. The article concludes with a twofold comparison: between Eurasian and Confucian heritages, and these two with the mainstream western ecological discourse. (shrink)
Citizenship status is meant to be secure, that is, inviolable. Recently, however, several democratic states have adopted or are considering adopting laws that allow them the power to revoke citizenship. This claimed right forces us to consider whether citizenship can be treated as a “conditional” status, in particular whether it can be treated as conditional on the right sort of behavior. Those who defend such a view argue that citizenship is a privilege rather than a right, and thus in principle (...) is revocable. Participating in a foreign state's military, treason, spying, or committing acts that otherwise threaten the national security of one's state may all warrant revocation. This article assesses the justifications given for the claimed power to revoke citizenship in democratic states and concludes that, ultimately, such a power is incompatible with democracy.I begin with a brief account of the claims given by contemporary democratic states for the “right to revoke.” Democratic citizenship is today commonly understood to beegalitarian, that is, it protects an equal basic package of rights for all citizens; and to be “the highest and most secure legal status,” that is, it is meant to be secure from unilateral withdrawal by the state. Formally, many democratic states have revocation laws on the books, but most of these have long been in disuse. Although I argue in this article that all revocation laws are inconsistent with democratic citizenship, I focus on the recent surge in proposed and implemented revocation laws, which are justified as essential to protecting national security.In the second section I outline three reasons to object to revocation laws. First, revocation laws discriminate between citizens based on their citizenship status. Second, since they single out those who are eligible for revocation, they apply unequal penalties for the same crime. Third, they are inadequately justified, in general, but also particularly to those who may be subject to them, because they are not adequately connected to the policy goal they are said to fulfill. I conclude with some brief observations concerning the ways in which revocation permits states to abrogate their shared responsibility for protecting the global community from dangerous individuals. (shrink)
Despite their centrality and importance to both science and philosophy, relatively little has been written about thought experiments. This volume brings together a series of extremely interesting studies of the history, mechanics, and applications of this important intellectual resource. A distinguished list of philosophers and scientists consider the role of thought experiments in their various disciplines, and argue that an examination of thought experimentation goes to the heart of both science and philosophy.
To what extent can philosophical thought experiments reveal norms? Some ethicists have argued that certain thought experiments reveal that people draw a morally significant distinction between "doing" and "allowing". I examine one such thought experiment in detail and argue that the intuitions it elicits can be explained by "prospect theory", a psychological theory about the way people reason. The extent to which such alternative explanations of the results of thought experiments in philosophy are generally available is an empirical question.
Cosmopolitan principles of justice tell us that it is the responsibility of the wealthy to ensure the immediate transfer of resources to the poor. Yet, it cannot be denied that most countries, and most individual citizens, seem unwilling to act as these principles demand. At issue is motivation: although many people would agree that cosmopolitan principles of justice are right, at least to some extent, few seem motivationally inspired to act upon them. This paper evaluates one set of proposals for (...) securing the transfer of resources from the wealthy to the poor, namely, those that suggest that the right way to achieve cosmopolitan objectives is to generate institutions that will, over time, produce cosmopolitans. I argue that we should focus, doubly, on the generation of supra-national institutions as a way to create a?global demos? and on harnessing the motivational resources available at the nation-state level. (shrink)
Currently there is little guidance given to teachers in selecting focal issues for socio-scientific issues -based teaching and learning. As a majority of teachers regularly collaborate with other teachers, understanding what factors influence collaborative SSI-based curriculum design is critical. We invited 18 secondary science teachers to participate in a professional development on SSI-based instruction and curriculum design. Through intentional design, we studied how these teachers formed curriculum design teams and how they selected focal issues for SSI-based curriculum units. We developed (...) substantiative grounded theory to explain these processes. Key findings include how teachers’ tensions and agential moves worked in tandem in the development of a safe and shared place to share discontentment and generate opportunities to form design teams and select issues. Teacher passion and existing resources are factors as influential as considerations for issue relevance. Implications for teacher professional development and research are included. (shrink)
Offering a panoramic view of much of Benjamin’s thought, and concentrating in particular on his early writings, this book derives from a philosophical analysis of readings and studies by Benjamin that have not heretofore been considered in detail.
This paper develops a domination-based practice-dependent approach to justice, according to which it is practices of systemic domination which can be said to ground demands from justice. The domination-based approach developed overcomes the two most important objections levelled to alternative practice-dependent approaches. First, it eschews conservative implications and hence is immune to the status quo objection. Second, it is immune to the redundancy objection, which doubts whether empirical facts and practices can really play an irreducible role in grounding justice. In (...) theorising dominating practices in terms of practices of social power, a domination-based approach makes justice dependent on factual information in three ways: First, the principle of non-domination is indeterminate and can only be spelled out by taking into view particular contexts of domination. Second, the principle of non-domination is conditional on the existence of practices of social power. Third, social power possesses a structural ontology – to know whether A has social power over B we need to turn to social rules distributing agents' higher order status of normative authority towards each other. This explains in what way practices of social power – and of domination – are both factual and normative practices and hence how such practices are non-redundant in grounding justice. (shrink)
The Ebola epidemic that broke out inWest Africa West AfricaAfrica towards the end of 2013 had been brought under reasonable control by 2015. The epidemic had severely affected three countries. This case study is about a phase I/II clinical trial Phase I/II clinical trial of a candidate Ebola virus vaccine in 2015 in a sub-Saharan AfricanSub-Saharan Africa country which had not registered any cases of the Ebola virus disease. The study was designed as a randomized double-blinded trialRandomized double blinded trial. (...) It was sponsored and funded by one of the biggest Northern multinational pharmaceutical companiesPharmaceutical companies. The protocol received ethics clearance from the relevantNational Ethics Committee national ethics committeeEthics committee. The study was coordinated and managed at the local branch of a big Northern diagnostic laboratoryDiagnostic laboratory and a laboratory of a local regional hospital. The overall study was a multi-countryMulti-country, multi-siteMulti-site trial aimed at recruiting a total of 3,000 research participantsResearch participants across four or five sub-Saharan African countries. For this country, the recruitmentRecruitment sites were two big cities, each aiming to recruit 200 participants: adults at the first site and childrenChildren at the second. The target sampleSample size was almost achieved at the first site but, before the study commenced at the second site, some members of raised the alarm that the governmentGovernment was carelessly risking the health, safetySafety and lives of citizens in the cause of an unproven vaccine that could precipitate a public health disaster. The trial was immediately suspended. A commentary on this case, and on the importance of trustTrust, is provided by Katharine Browne and Doris Schroeder at the end of this chapter. It highlights differences between this case and a phase I Ebola vaccine trial in CanadaCanada in 2014. (shrink)
This article focuses on the follow question: Are human enhancement technologies likely to be justice impairing or justice promoting? We argue that human enhancement technologies may not be inherently just or unjust, but when situated within obtaining social contexts they are likely to exacerbate rather than alleviate social injustices.
Resisting oppression evokes images of picket lines and crowds of protestors demanding large-scale reform. But not all resistance is political or publicly broadcast. Some acts of resistance are done solo, in private, aim to achieve personal goals, and may not even be recognizable as resistance by others. I present a taxonomy of resistance to oppression that distinguishes acts of resistance along four dimensions: their subject, target, scope, and tone. The taxonomy brings to light a range of forms of resistance that (...) differ significantly from political activism and that theories of the morality of resistance should be able to evaluate. (shrink)
In this paper I propose a partition semantics for sentences containing objective predicates that takes into account the phenomenon of occasion-sensitivity associated with so-called Travis cases. The key idea is that the set of worlds in which a sentence is true has a more complex structure as a result of different ways in which it is made true. Different ways may have different capacities to support the attainment of a contextually salient domain goal. I suggest that goal-conduciveness decides whether some (...) utterance of a sentence is accepted as true on a particular occasion at a given world. The utterance will not be accepted as true at a world which belongs to a truth-maker which is less conducive to a contextually salient goal than other truth-makers. Finally, the proposed occasion-sensitive semantics is applied to some cases of disagreement and cancellability. (shrink)
Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)