In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and (...) cognitive impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)

The author contends that overworking residents cannot be ethically justified. There is evidence that overwork is detrimental both to the resident and to the patient. In addition, thu argument that working long hours is essential to maintain medicine's status as a profession is analyzed. The claim cannot be supported by definitions of professionalism. Although Flexner's definition does specify altruism as an essential component, it does not justify long working hours for residents. Altruism is obligatory in some limited cases, but only (...) when it is required to fulfill some contractual obligation. Keywords: professionalism, altruism, residency, medical education CiteULike Connotea Del.icio.us What's this? (shrink)

The author discusses conceptual problems in psychiatry, illustrated by a debate over inclusion of a new disorder, masochistic personality disorder, in DSM-III-R, the manual of psychiatric diagnoses. While the DSM committee has attempted to avoid assumptions about theory and values in an attempt to be scientific, this has proved impossible, as theory is an integral part of scientific observation and values are a prerequisite for any judgment. The foundation for psychiatry cannot be theory – it can only be patient need. (...) Keywords: psychiatry, diagnosis, disease, illness, mental illness, women CiteULike Connotea Del.icio.us What's this? (shrink)

The evolution of a relevant nosological concept reflects changes in the distinction between what is recognized and defined as normal and pathologic. Attention is directed to the rationale and value of detecting subclinical aging-related modifications in cognitive performance. The position that different kinds of dementias may have precedents in etiological-specific kinds of early or mild cognitive impairments (MCI) supports targeting people earlier for study of these subclinical symptoms. Because heterogeneous disorders can be expected to have multiple patterns of cognitive and (...) behavioral changes, useful conceptual nosologies should be flexible. Yet clinical research primarily restricts its focus to a single pathway where MCI leads to Alzheimer's disease (AD), and uses selective recruitment, washout screenings, repeated trialing of similar compounds, and other methods that bank the published evidence in favor of the existing therapies and their modest efficacy. This focus on AD recursively colors MCI, not as a flexible "human kind" in need of more careful research, but like AD, as an essential "natural kind." Early determination of MCI targets a potential pharmaceutical market of a quarter to a half of the population over sixty-five and the individual experiencing cognitive decline in its early stages is aware and sensitive to their surroundings, to a linked sociodegeneration with neurodegeneration. This paper examines how classifying people changes both the classifier and the subject of classification. The potential for conflict of interest is raised regarding what new causal knowledge and techniques for ascertainment are selected. Reading evidence from epidemiology, neurology, and clinical studies through science studies and bioethics lenses, we explore the possibility of a pluralistic model of cognitive impairment nosology where biological/pathologic processes respond and interrelate with a normal healthy state. (shrink)

Social groups—like teams, committees, gender groups, and racial groups—play a central role in our lives and in philosophical inquiry. Here I develop and motivate a structuralist ontology of social groups centered on social structures (i.e., networks of relations that are constitutively dependent on social factors). The view delivers a picture that encompasses a diverse range of social groups, while maintaining important metaphysical and normative distinctions between groups of different kinds. It also meets the constraint that not every arbitrary collection of (...) people is a social group. In addition, the framework provides resources for developing a broader structuralist view in social ontology. (shrink)

Identity politics has been critiqued in various ways. One central problem—the Reinforcement Problem—claims that identity politics reinforces groups rooted in oppression thereby undermining its own liberatory aims. Here I consider two versions of the problem—one psychological and one metaphysical. I defang the first by drawing on work in social psychology. I then argue that careful consideration of the metaphysics of social groups and of the practice of identity politics provides resources to dissolve the second version. Identity politics involves the creation (...) or transformation of groups in ways that do not succumb to the metaphysical Reinforcement Problem. (shrink)

According to Margaret Cavendish the entire natural world is essentially rational such that everything thinks in some way or another. In this paper, I examine why Cavendish would believe that the natural world is ubiquitously rational, arguing against the usual account, which holds that she does so in order to account for the orderly production of very complex phenomena (e.g. living beings) given the limits of the mechanical philosophy. Rather, I argue, she attributes ubiquitous rationality to the natural world in (...) order to ground a theory of the ubiquitous freedom of nature, which in turn accounts for both the world's orderly and disorderly behavior. (shrink)

A theoretical physicist and feminist theorist, Karen Barad elaborates her theory of agential realism, a schema that is at once a new epistemology, ontology, and ethics.

We frequently speak of certain things or phenomena being built out of or based in others. Making Things Up concerns these relations, which connect more fundamental things to less fundamental things: Karen Bennett calls these 'building relations'. She aims to illuminate what it means to say that one thing is more fundamental than another.

Between 1653 and 1655 Margaret Cavendish makes a radical transition in her theory of matter, rejecting her earlier atomism in favour of an infinitely-extended and infinitely-divisible material plenum, with matter being ubiquitously self-moving, sensing, and rational. It is unclear, however, if Cavendish can actually dispense of atomism. One of her arguments against atomism, for example, depends upon the created world being harmonious and orderly, a premise Cavendish herself repeatedly undermines by noting nature’s many disorders. I argue that her supposed difficulties (...) with atomism expose a deeper tension in her work between two fundamental metaphysical commitments each of which has substantial philosophical support: her monist theory of the material world (which maintains that there exists just one natural substance which is the single principal cause) and her occasional theory of causation (which requires multiple finite principal causes in nature -- causes that might be considered individual substances). Her monism undermines atomism while her theory of occasional cause seems to rest on a conception of nature that would be especially friendly to atomism. I argue further that we can solve this tension within a Cavendishian framework in such a way as to preserve her theory of causation and her monism, but that this solution depends upon our taking her monism in a particular (and weak) form. I finally note that we can best make sense of her unique and interesting form of monism by acknowledging her social-political motivations in addition to her motivations in natural philosophy. (shrink)

Introduction: All is trash that reason cannot reach : unenlightened writers and the postmodern world -- Learning to read, learning to listen in Robinson Crusoe -- The hymns of Isaac Watts and postmodern worship : aesthetic knowledge as a response to the Enlightenment critique of religion -- Jonathan Swift's information machine and the critique of technology -- Christopher Smart's poetry and the dialogue between science and theology -- Festival and discipline in revolutionary France and postmodern times -- Remembering things past (...) : tradition as a way of knowing in Edmund Burke and Hans-Georg Gadamer -- Reconciling the heart with the head : the poetry of William Cowper and the thought of Michael Polanyi. (shrink)

In the ninth century BCE, the peoples of four distinct regions of the civilized world created the religious and philosophical traditions that have continued to nourish humanity to the present day: Confucianism and Daoism in China, Hinduism and Buddhism in India, monotheism in Israel, and philosophical rationalism in Greece. Later generations further developed these initial insights, but we have never grown beyond them. Rabbinic Judaism, Christianity, and Islam, for example, were all secondary flowerings of the original Israelite vision. Now, in (...) The Great Transformation , Karen Armstrong reveals how the sages of this pivotal “Axial Age” can speak clearly and helpfully to the violence and desperation that we experience in our own times. Armstrong traces the development of the Axial Age chronologically, examining the contributions of such figures as the Buddha, Socrates, Confucius, Jeremiah, Ezekiel, the mystics of the Upanishads, Mencius, and Euripides. All of the Axial Age faiths began in principled and visceral recoil from the unprecedented violence of their time. Despite some differences of emphasis, there was a remarkable consensus in their call for an abandonment of selfishness and a spirituality of compassion. With regard to dealing with fear, despair, hatred, rage, and violence, the Axial sages gave their people and give us, Armstrong says, two important pieces of advice: first there must be personal responsibility and self-criticism, and it must be followed by practical, effective action. In her introduction and concluding chapter, Armstrong urges us to consider how these spiritualities challenge the way we are religious today. In our various institutions, we sometimes seem to be attempting to create exactly the kind of religion that Axial sages and prophets had hoped to eliminate. We often equate faith with doctrinal conformity, but the traditions of the Axial Age were not about dogma. All insisted on the primacy of compassion even in the midst of suffering. In each Axial Age case, a disciplined revulsion from violence and hatred proved to be the major catalyst of spiritual change. (shrink)

Recently much has been made of the grounding relation, and of the idea that it is intimately tied to fundamentality. If A grounds B, then A is more fundamental than B (though not vice versa ), and A is ungrounded if and only if it is fundamental full stop—absolutely fundamental. But here is a puzzle: is grounding itself absolutely fundamental?

A variety of relations widely invoked by philosophers—composition, constitution, realization, micro-basing, emergence, and many others—are species of what I call ‘building relations’. I argue that they are conceptually intertwined, articulate what it takes for a relation to count as a building relation, and argue that—contra appearances—it is an open possibility that these relations are all determinates of a common determinable, or even that there is really only one building relation.

This book discusses the notion that quantum gravity may represent the "breakdown" of spacetime at extremely high energy scales. If spacetime does not exist at the fundamental level, then it has to be considered "emergent", in other words an effective structure, valid at low energy scales. The author develops a conception of emergence appropriate to effective theories in physics, and shows how it applies (or could apply) in various approaches to quantum gravity, including condensed matter approaches, discrete approaches, and loop (...) quantum gravity. (shrink)

Dummett's output has been prolific and highly influential, but not always as accessible as it deserves to be. This book sets out to rectify this situation.

Over 700,000 copies of the original hardcover and paperback editions of this stunningly popular book have been sold. Karen Armstrong's superbly readable exploration of how the three dominant monotheistic religions of the world—Judaism, Christianity, and Islam—have shaped and altered the conception of God is a tour de force. One of Britain's foremost commentators on religious affairs, Armstrong traces the history of how men and women have perceived and experienced God, from the time of Abraham to the present. From classical (...) philosophy and medieval mysticism to the Reformation, the Enlightenment, and the modern age of skepticism, Armstrong performs the near miracle of distilling the intellectual history of monotheism into one compelling volume. (shrink)

The basic form of the exclusion problem is by now very, very familiar. 2 Start with the claim that the physical realm is causally complete: every physical thing that happens has a sufficient physical cause. Add in the claim that the mental and the physical are distinct. Toss in some claims about overdetermination, give it a stir, and voilá—suddenly it looks as though the mental never causes anything, at least nothing physical. As it is often put, the physical does all (...) the work, and there is nothing left for the mental to do. (shrink)

Lord Ritchie-Calder tells John Cogley in a conversation, that the world will continue 'mucking things up' beyond repair unless science comes under public control while time remains." Cf Publisher's catalog, 1971.

A lot of people believe that distinct objects can occupy precisely the same place for the entire time during which they exist. Such people have to provide an answer to the 'grounding problem' – they have to explain how such things, alike in so many ways, nonetheless manage to fall under different sortals, or have different modal properties. I argue in detail that they cannot say that there is anything in virtue of which spatio-temporally coincident things have those properties. However, (...) I also argue that this may not be as bad as it looks, and that there is a way to make sense of the claim that such properties are primitive. (shrink)

The paper is an extended discussion of what I call the ‘dismissive attitude’ towards metaphysical questions. It has three parts. In the first part, I distinguish three quite different versions of dismissivism. I also argue that there is little reason to think that any of these positions is correct about the discipline of metaphysics as a whole; it is entirely possible that some metaphysical disputes should be dismissed and others should not be. Doing metametaphysics properly requires doing metaphysics first. I (...) then put two particular disputes on the table to be examined in the rest of the paper: the dispute over whether composite objects exist, and the dispute about whether distinct objects can be colocated. In the second part of the paper, I argue against the claim that these disputes are purely verbal disputes. In the third part of the paper, I present a new version of dismissivism, and argue that it is probably the correct view about the two disputes in question. They are not verbal disputes, and the discussion about them to date has not remotely been a waste of time. At this stage, however, our evidence has run out. I argue that neither side of either dispute is simpler than the other, and that the same objections in fact arise against both sides. (For example, the compositional nihilist does not in fact escape the problem of the many, and the one-thinger does not in fact escape the grounding problem.). (shrink)

How much of philosophical, scientific, and political thought is caught up with the idea of continuity? What if it were otherwise? This paper experiments with the disruption of continuity. The reader is invited to participate in a performance of spacetime (re)configurings that are more akin to how electrons experience the world than any journey narrated though rhetorical forms that presume actors move along trajectories across a stage of spacetime (often called history). The electron is here invoked as our host, an (...) interesting body to inhabit (not in order to inspire contemplation of flat-footed analogies between ‘macro’ and ‘micro’ worlds, concepts that already presume a given spatial scale), but a way of thinking with and through dis/continuity – a dis/orienting experience of the dis/jointedness of time and space, entanglements of here and there, now and then, that is, a ghostly sense of dis/continuity, a quantum dis/continuity. There is no overarching sense of temporality, of continuity, in place. Each scene diffracts various temporalities within and across the field of spacetimemattering. Scenes never rest, but are reconfigured within, dispersed across, and threaded through one another. The hope is that what comes across in this dis/jointed movement is a felt sense of différance, of intra-activity, of agential separability – differentiatings that cut together/apart – that is the hauntological nature of quantum entanglements. (shrink)

Traditionally, social entities (i.e., social properties, facts, kinds, groups, institutions, and structures) have not fallen within the purview of mainstream metaphysics. In this chapter, we consider whether the exclusion of social entities from mainstream metaphysics is philosophically warranted or if it instead rests on historical accident or bias. We examine three ways one might attempt to justify excluding social metaphysics from the domain of metaphysical inquiry and argue that each fails. Thus, we conclude that social entities are not justifiably excluded (...) from metaphysical inquiry. Finally, we ask how focusing on social entities could change the character of metaphysical inquiry. We suggest that starting from examples of social entities might lead metaphysicians to rethink the assumption that describing reality in terms of intrinsic, independent, and individualistic features is preferable to describing it in terms of relational, dependent, and non-individualistic features. (shrink)

A theoretical pillars of vision science in the information-processing tradition is that perception involves unconscious inference. The classic support for this claim is that, since retinal inputs underdetermine their distal causes, visual perception must be the conclusion of a process that starts with premises representing both the sensory input and previous knowledge about the visible world. Focus on this “argument from underdetermination” gives the impression that, if it fails, there is little reason to think that visual processing involves unconscious inference. (...) Here an alternative means of support for this pillar is proposed, based on another foundational challenge for the visual system: recognizing invariant properties of objects in the environment even though anything we encounter is never seen exactly the same way twice. Explaining how the visual system solves this invariance problem requires positing visual processes that exhibit many commonalities with inductive inference. Thus, this novel “argument from invariance” reveals one way in which visual processing clearly involves unconscious inference. (shrink)

I think that there is an awful lot wrong with the exclusion problem. So, it seems, does just about everybody else. But of course everyone disagrees about exactly _what_ is wrong with it, and I think there is more to be said about that. So I propose to say a few more words about why the exclusion problem is not really a problem after all—at least, not for the nonreductive physicalist. The genuine _dualist_ is still in trouble. Indeed, one of (...) my main points will be that the nonreductive physicalist is in a rather different position vis à vis the exclusion problem than the dualist is. Properly understanding nonreductive physicalism—and clearly recognizing that it is, after all, a form of _physicalism_—goes a long way toward solving the exclusion problem. (shrink)

This collection brings together fourteen contributions by authors from around the globe. Each of the contributions engages with questions about how local and global bioethical issues are made to be comparable, in the hope of redressing basic needs and demands for justice. These works demonstrate the significant conceptual contributions that can be made through feminists' attention to debates in a range of interrelated fields, especially as they formulate appropriate responses to developments in medical technology, global economics, population shifts, and poverty.

Relationships between current theories, and relationships between current theories and the sought theory of quantum gravity (QG), play an essential role in motivating the need for QG, aiding the search for QG, and defining what would count as QG. Correspondence is the broad class of inter-theory relationships intended to demonstrate the necessary compatibility of two theories whose domains of validity overlap, in the overlap regions. The variety of roles that correspondence plays in the search for QG are illustrated, using examples (...) from specific QG approaches. Reduction is argued to be a special case of correspondence, and to form part of the definition of QG. Finally, the appropriate account of emergence in the context of QG is presented, and compared to conceptions of emergence in the broader philosophy literature. It is argued that, while emergence is likely to hold between QG and general relativity, emergence is not part of the definition of QG, and nor can it serve usefully in the development and justification of the new theory. (shrink)

I argue that it is intuitive and useful to think about composition in the light of the familiar functionalist distinction between role and occupant. This involves factoring the standard notion of parthood into two related notions: being a parthood slot and occupying a parthood slot. One thing is part of another just in case it fills one of that thing's parthood slots. This move opens room to rethink mereology in various ways, and, in particular, to see the mereological structure of (...) a composite as potentially outreaching the individual entities that are its parts. I sketch one formal system that allows things to have individual entities as parts multiple times over. This is particularly useful to David Armstrong, given Lewis's charge that his structural universals must do exactly that. I close by reflecting upon the nature and point of formal mereology. (shrink)

Nursing staff of many specialities are taking on and developing their roles in new and advanced practice areas. Patients will be offered new services from highly skilled advanced nurse practitioners. Such nurses need guidance, direction and information to assist them in their new roles. This book will offer insight and guidance on a variety of issues that are likely to be encountered by the Nurse Practitioner in everyday practice.