Clark Carlton brings a much-needed theological sensitivity to the issues surrounding current debates about homosexuality and the ethics of sexual reorientation therapy. Yet, Carlton’s portrayal seems to mischaracterize and unnecessarily dismiss reorientation therapy on etiological and other theoretical grounds. It is suggested that for most therapists engaged in sexual reorientation therapy the role of developmental factors in homosexual attraction is neither overstated nor minimized.

This article evaluates the phenomenon of sexual reorientation therapy from the standpoint of Orthodox Christian theology. It is argued that homosexual desire is the product of the fall of mankind and cannot be considered “normal.” At the same time, however, reorientation therapies, whether secular or Christian, are inherently reductionistic and fail to address the underlying spiritual pathologies involved in homosexual desire. The purpose of therapeia in the Orthodox Church is the psycho-somatic transfiguration of the whole person into (...) the image of Christ, not merely the cessation of homosexual activity or the “reidentification” of one’s “lifestyle.”. (shrink)

In his paper “The Catholic Church, the American Military, and Homosexual Reorientation Therapy,” David W. Lutz ultimately concludes that it is “appropriate, and highly ethical” for the American military to offer reorientation therapy to help homosexuals overcome “the vice of sodomy.” The major thrust of his paper, however, is to call for abandonment of the “Don’t Ask/Don’t Tell” policy currently in place in the military. Lutz’s paper covers much ground, and this review begins by examining whether (...) such a wide view is necessary for the ultimate conclusions. It goes on to ask whether Lutz has omitted to mention important considerations bearing on this issue, and whether Lutz’s call for the introduction of reorientation therapy is a serious call or a symbolic response to homosexual activities. Lutz fails to address essential issues such as the actual experiences of other nations having homosexuals in the military, and issues regarding what constitutes “reorientation therapy,” the latter leading to questions about how such a therapy would actually be implemented. (shrink)

Homosexual activist groups have targeted the Catholic Church and the American military as institutions especially in need of transformation. Associations of healthcare professionals are also under assault from homosexual activists. It is, nevertheless, appropriate for the Church and the military to defend themselves against this assault, to affirm that homosexuality is incompatible with Christian ethics and military service, and to help homosexuals free themselves from the vice of homosexuality. Arguments that homosexual reorientation therapy is unethical are unsound. Such (...) therapy is consistent with the Christian virtue of charity. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

The ideal of virtue demands not only right choice and right behavior but also right desire in the emotions. Homosexual desire, then, even if it does not result in overt homosexual behavior, is contrary to virtue, and the completion of virtue demands right desire. If a homosexual has no plan to marry, then right desire implies only the removal of homosexual desire and not the revival of heterosexual desire at which reorientation therapy aims. On the other hands, if (...) a homosexual is married or plans to marry, then right desire includes heterosexual desire for one’s spouse. If homosexual desire is viewed as an emotional disorder, and not merely as a moral defect, then it may require reorientation therapy to bring about heterosexual desire. The pursuit of virtue, then, may recommend reorientation therapy, but even this recommendation is fairly limited, since reorientation therapy may be burdensome and may not be that effective. In conclusion, married homosexuals or homosexuals planning to marry may have a limited moral obligation to pursue reorientation therapy. (shrink)

Professor Mark A. Yarhouse proposes an ‘identity synthesis’ model of sexual modification therapy for homosexuals. This model is meant primarily to target the process by which one’s sexual identity is synthesized, rather than the changing of sexual orientation itself. I highlight some of the advantages of Yarhouse’s model along with some of its potential pitfalls. My primary point of departure with Yarhouse concerns how one ought to direct those self-identified homosexual clients who fall within our clinical sphere of influence (...) and who, in the end, contrary to our better judgment, decide that they would like to pursue a course of “homosexualization.” Based on the “autonomy”-emphasizing aspects of the identity synthesis model, it appears that Yarhouse is willing to sanction the referral of certain clients to “therapists” who are willing to facilitate these clients’ homosexualization. I do not believe that Christians involved in the care of homosexuals can licitly participate in such referrals. (shrink)

This article addresses the treatment of individuals who experience conflict between their religious convictions and their same-sex attraction. Recently, attention has been drawn to the ethical issues involved in the practice of sexual reorientation therapy (SRT) with such conflicted individuals. This article reviews the ethical arguments for and against SRT through the lens of the general ethical principles of the American Psychological Association's (2002) ethics code. Practitioners are then challenged to think about how they might respond virtuously (Meara, (...) Schmidt, & Day, 1996) when presented with such a client. Thought questions are presented to assist therapists to develop in virtue while working with religious clients who are conflicted about same-sex desire. (shrink)

Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the language used to frame ethical debates concerning “reorientation” therapies. An alternative metaphysical construal is presented oncerning sexual orientation and sexual identity development and synthesis. This alternative construal allows for humility concerning what we know and do not know about sexual orientation, underscores the client's self-determination and autonomy, and demonstrates regard for personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at sexual reorientation, (...) clinicians would do well to provide clients with informed consent and to facilitate identity development and synthesis in keeping with their clients' requests for professional services. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and (...) patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)

While Garfinkel’s early work, captured in Studies in Ethnomethodology, has received a lot of attention and discussion, this has not been the case for his later work since the 1970s. In this paper, we critically examine the aims of Garfinkel’s later ethnomethodological studies of work programme and evaluate key ideas such as the ‘missing what’ in the sociology of work, ‘the unique adequacy requirements of methods’, and the notion of ‘hybrid studies’. We do so through a detailed engagement with a (...) study that has frequently been singled out as exemplary by Garfinkel for his studies of work programme, namely Livingston’s The Ethnomethodological Foundations of Mathematics. We show how Livingston uses the proof of Gödel’s Incompleteness Theorem as a way to exhibit the work involved in understanding mathematical proofs. We then discuss how Livingston uses this example to introduce a distinction between the written ‘proof account’ and the associated ‘lived work’ of working through that proof, which we argue allows Livingston to provide a powerful critique of a formalist understanding of the objectivity of mathematics. We then discuss three aspects that we find problematic in Livingston’s and Garfinkel’s claims about Livingston’s study. Firstly, we question whether written proofs are best conceived of as descriptions or accounts. Secondly, we interrogate whether an ethnomethodological study could teach mathematicians how to make discoveries. Thirdly, we throw doubt on Garfinkel’s claim that Livingston’s results are results in mathematics. We conclude this paper with a discussion of how Livingston’s study Gödel’s proof highlights key tensions in Garfinkel’s later work. Firstly, we argue that there exists an ambiguity in Garfinkel’s treatment of texts as ‘incompetent’. Secondly, we show that Garfinkel’s attempt to extend his idea of classical studies from sociology to other professions and disciplines is problematic. Finally, we question Garfinkel’s proposals to reorient ethnomethodological studies away from sociological audiences and ask whether ethnomethodological studies promise the delivery of a ‘large prize’ or, rather, provide something like ‘helpful therapy’. (shrink)

This essay recounts the author’s journey with her father during his prolonged decline due to dementia. The experience pushed her to break out of the confines of conventional scholarly research in her academic field of architectural history to a multi-disciplinary consideration of nineteenth-century environmental, sensory and horticultural therapies for the mentally ill. During her father’s illness, she discovered the tangible therapeutic benefits of momentary engagements with his environment through his five senses and through the emotional filter of poetry. This (...) class='Hi'>reorientation to sensory and poetic experience had a beneficial impact on the caretaker as well. (shrink)

The later Wittgenstein advanced a revolutionary but puzzling conception of how philosophy ought to be practised: Philosophical problems are not to be coped with by establishing substantive claims or devising explanations or theories. Instead, philosophical questions ought to be treated ‘like an illness’. Even though this ‘non-cognitivism’ about philosophy has become a focus of debate, the specifically ‘therapeutic’ aims and ‘non-theoretical’ methods constitutive of it remain ill understood. They are motivated by Wittgenstein’s view that the problems he addresses result from (...) misinterpretation, driven by ‘urges to misunderstand’. The present paper clarifies this neglected concept and analyses how such ‘urges’ give rise to pseudo-problems of one particular, hitherto little understood, kind. This will reveal ‘therapeutic’ aims reasonable and ‘non-theoretical’ methods necessary, in one clearly delineated and important part of philosophy. I.e.: By developing a novel account of nature and genesis of one important class of philosophical problems, the paper explains and vindicates a revolutionary reorientation of philosophical work, at the level of both aims and methods. (shrink)

The goal of an "integral psychology" is to honor and embrace every legitimate aspect of human consciousness under one roof. This book presents one of the first truly integrative models of consciousness, psychology, and therapy.

From the inception of philosophical counseling an attempt was made to distinguish it from (psychological) therapy by insisting that therapy could not be more misleading. It is true that philosophical counselors should not pretend to be able to heal major mental illness; nevertheless they do contribute to positive health—health understood as something more than the absence of mental disease. This thesis is developed by critiquing Lou Marinoff’s book, Plato not Prozac!, but also by ranging more widely in the (...) literature on philosophical counseling. I also interpret philosophical counseling as a form of philosophical ethics. (shrink)

When bringing philosophical attention to bear on social movement slogans in general, philosophers have often focused on their communicative nature—particularly the hermeneutical failures that arise in discourse. Some of the most popular of these failures are illustrated in ‘all lives matter’ retorts to ‘black lives matter’ pronouncements. Although highlighting and criticizing these failures provides much needed insight into social movement slogans as a communicative practice, I claim that in doing so, philosophers and slogans’ users risk placing too much importance on (...) outgroup understandings. This emphasis is misguided because gaining such uptake is not required of particular slogans to perform their functions; indeed it is an inherent risk of them. I show how such an emphasis can also be distracting to users. Since social movement slogans that express values are first and foremost for users, I argue for a shift in focus in what these slogans (such as ‘Black Is Beautiful’ and the more recent ‘Black Lives Matter’) do for users, as well as what they demand from users and enable them to express. When slogans have done these things, regardless of uptake, we can say they have performed one of their key functions. (shrink)

Advances in medicine in the latter half of the twentieth century have dramatically altered human bodies, expanding choices around what we do with them and how they connect to other bodies. Nowhere is this more so than in the area of reproductive technologies. Reproductive medicine and the laws surrounding it in the UK have reconfigured traditional boundaries surrounding parenthood and the family. Yet culture and regulation surrounding RTs have combined to try to ensure that while traditional boundaries may be pushed, (...) they are reconstructed in similar ways. This paper looks at the most recent RT to be permitted in the UK, mitochondria replacement therapy. Despite controversial media headlines surrounding the technique, MRT is in fact an example of how science and regulation seek to expand models of traditional relatedness in a way that doesn’t challenge the existing order. Yet, like other RTs, while attempts are made to ensure it doesn’t push traditional boundaries too far, fissures and inconsistencies appear in law and culture, which give interesting insights into how genetics, parentage and identity are being mediated in new but familiar ways. (shrink)

Obstacles to Divine Revelation examines the notion that there are obstacles to God giving revelation, if God exists. Rolfe King argues that exploring these significantly refines ideas of evidence for God, including the claim that God must operate within a logically necessary structure of revelation. Examining obstacles to divine revelation clarifies this structure and paves the way to evaluating its significance.

John Dewey and Ludwig Wittgenstein offer devastating critiques of the dominant model of human action that each inherited in their own time. Dewey, very early in his philosophical career, ostensibly put the stimulus–response mechanical understanding of action to rest with his “reflex-arc” concept article. Wittgenstein famously redescribed action as moves within language games that interconnect to constitute an interpretively open-ended form of life. In each case, these fundamental insights serve as heuristics, guiding our intellectual activity with regard to understanding our (...) practices, and as reminders in approaching problems. Several scholars have interpreted Dewey and Wittgenstein as allies in a grand project of... (shrink)

:Since the advent of recombinant DNA technology, expectations about the potential for altering genes and controlling our biology at the fundamental level have been sky high. These expectations have gone largely unfulfilled. But though the dream of being able to control our biology is still far off, gene editing research has made enormous strides toward potential clinical use. This paper argues that when it comes to determining permissible uses of gene editing in one important medical context—germline intervention in reproductive medicine—issues (...) about enhancement and eugenics are, for the foreseeable future, a red herring. Current translational goals for gene editing research involve a different kind of editing than would be required to achieve manipulation of complex traits such as intelligence, and there are more pressing questions that need attention if clinical use of gene editing in reproductive medicine ever becomes a possibility. (shrink)

Letheby’s naturalistic theory of psychedelic therapy argues that the therapeutic power of psychedelics lies in their ability to allow individuals “to discover the contingency, mutability and simulatory nature of their own sense of identity and habitual modes of attention.” The general shape of this project is persuasive; it is hard to see how the claim that successful therapy must involve changes to the self could be objected to, and Letheby sketches a consistent, if speculative, picture of psychedelic experience. (...) But the role of affect in psychedelic therapy is insufficiently explored by Letheby as a comparison to MDMA-assisted therapy indicates. This comparison further suggests that Letheby’s reliance on a particular conceptualization of ego dissolution experiences is in need of further explanation and justification. (shrink)

The therapy-enhancement distinction occupies a central place in contemporary discussions of human genetics and has been the subject of much debate. At a recent conference on gene therapy policy, scientists predicted that within a few years researchers will develop techniques that can be used to enhance human traits. In thinking about the morality of genetic interventions, many writers have defended somatic gene therapy, and some have defended germline gene therapy, but only a handful of writers defend (...) genetic enhancement, or even give it a fair hearing. The mere mention of genetic enhancement makes many people cringe and brings to mind the Nazi eugenics programs, Aldous Huxley's BraveNewWorld, or the recent movie Although many people believe that gene therapy has morally legitimate medical uses, others regard genetic enhancement as morally problematic or decidedly evil. (shrink)

Background Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death (...) and the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Main text Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. Conclusion There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

It has been known for long time that the cosmic sound wave was there since the early epoch of the Universe. Signatures of its existence are abound. However, such an acoustic model of cosmology is rarely developed fully into a complete framework from the notion of space, cancer therapy up to the sky. This paper may be the first attempt towards such a complete description of the Universe based on classical wave equation of sound. It is argued that one (...) can arrive at a consistent description of space, elementary particles, Sachs-Wolfe acoustic theorem, up to a novel approach for cancer therapy, starting from this simple classical wave equation of sound. We also discuss a plausible extension of Acoustic Sachs-Wolfe theorem based on its analogue with Klein-Gordon equation to become Acoustic Sachs-Wolfe-Christianto-Smarandache-Umniyati (ASWoCSU) equation. It is our hope that the new proposed equation can be verified with observation data. But we admit that our model is still in its infancy, more researches are needed to fill all the missing details. (shrink)

Imagery is one of the new, exciting frontiers in cognitive therapy. From the outset of cognitive therapy, its founder Dr. Aaron T. Beck recognised the importance of imagery in the understanding and treatment of patient's problems. However, despite Beck's prescience, clinical research on imagery, and the integration of imagery interventions into clinical practice, developed slowly. It is only in the past 10 years that most writing and research on imagery in cognitive therapy has been conducted. The Oxford (...) Guide to Imagery in Cognitive Therapy is a landmark book, which will play an important role in the next phase of cognitive therapy's development. Clinicians and researchers are starting to recognise the centrality of imagery in the development, maintenance and treatment of psychological disorders - for example, in social phobia, agoraphobia, depression, PTSD, eating disorders, childhood trauma, and personality disorder. In the fields of cognitive psychology and cognitive neuroscience, researchers are identifying the key role that imagery plays in emotion, cognition and psychopathology.The Oxford Guide to Imagery in Cognitive Therapy has been written both for clinicians and researchers. For clinicians, it is a user-friendly, practical guide to imagery, which will enable therapists to understand imagery phenomenology, and to integrate imagery-based interventions into their cognitive therapy practice. For researchers, it provides a state-of-the-art summary of imagery research, and points the way to future studies. Written by three well-respected CBT researcher-clinicians, it is essential reading for all cognitive therapists, who have recognised the limitations of purely 'verbal' CBT techniques, and want to find new ways to work with clients with psychological disorders. Readership: CBT therapists. (shrink)

The purpose of the present study was to evaluate the effectiveness of a physical activity intervention program designed to enhance levels of engagement in PA. Despite robust evidence supporting the beneficial effects of PA on overall health, only about 22% of individuals engage in the recommended minimum amount of PA. Recent surveys suggested that most individuals express intentions to be physically active, though the psychological state of amotivation dismissed these struggles. In the current study, we pilot-tested a new intervention program, (...) aimed at enhancing engagement in PA among sedentary individuals. The intervention was based on two behavioral change and motivational psychological frameworks: Self-Determination Theory and Acceptance and Commitment Therapy. During a 14-week intervention program, 94 sedentary Israeli college students were randomly assigned into one of three groups: SDT and ACT-based intervention, traditional intervention, and a non-treatment group. Prior to and following the intervention, participants completed the Behavioral Regulation in Exercise Questionnaire-3 to examine motivation to exercise and the International Physical Activity Measurement IPAQ to evaluate their training frequency. Results showed that the SDT and ACT-based intervention group exhibited a significant increase in motivation to exercise between time 1 and time 2, while the other two groups showed insignificant differences in motivation to exercise. Furthermore, neither of the groups showed significant differences in their training frequency per week. However, those in the SDT and ACT-based groups reported an increase in activity intensity from time 1 to time 2 compared to the two other groups. Further, exercise psychology consultants and scholars can use the intervention protocol and utilize these findings to improve PA behaviors and promote health in the general population. Limitations, future directions, and implications are discussed in detail. (shrink)

The field of regenerative medicine has considerable therapeutic promise that is proving difficult to realize. As a result, governments have supported the establishment of intermediary agencies to “accelerate” innovation. This article examines in detail one such agency, the United Kingdom’s Cell and Gene Therapy Catapult. We describe CGTC’s role as an accelerator agency and its value narrative, which combines both “health and wealth.” Drawing on the notion of sociotechnical imaginaries, we unpack the tensions within this narrative and its instantiation (...) as the CGTC cell therapy infrastructure is built and engages with other agencies, some of which have different priorities and roles to play within the RM field. (shrink)

The object of this essay is to discuss Ludwig Wittgenstein's remarks inPhilosophical Investigationsand elsewhere in the posthumously published writings concerning the role of therapy in relation to philosophy. Wittgenstein's reflections seem to suggest that there is a kind of philosophy or mode of investigation targeting the philosophical grammar of language uses that gratuitously give rise to philosophical problems, and produce in many thinkers philosophical anxieties for which the proper therapy is intended to offer relief. Two possible objectives of (...) later Wittgensteinian therapy are proposed, for subjectivepsychologicalversus objectivesemanticsymptoms of ailments that a therapy might address for the sake of relieving philosophical anxieties. The psychological in its most plausible form is rejected, leaving only the semantic. Semantic therapy in the sense defined and developed is more general and long-lasting, and more in the spirit of Wittgenstein's project on a variety of levels. A semantic approach treats language rather than the thinking, language-using subject as the patient needing therapy, and directs its attention to the treatment of problems in language and the conceptual framework a language game use expresses in its philosophical grammar, rather than to soothing unhappy or socially ill-adjusted individual psychologies. (shrink)

`Hans Cohn has given us a personal and valuable statement about the theoretical underpinnings of his work as a psychotherapist. These can be little doubt about his contribution to our thinking practice is invaluable. Students will find Cohn's easygoing exposition of complex ideas enormously helpful' - Professor Emmy van Deurzen, Existential Analysis `One of the most important books published this year. This long-awaited book by the foremost expert on the relationship between Heidegger and psychotherapy, manages to encapsulate the essence of (...) Heidegger's thinking and make of understandable and relevant to therapists without losing any of the original meaning' - Counsellingbooks.com Anyone interested in modern philosophy is familiar with the name of Martin Heidegger but there is a serious gap in even the most complete accounts of his life and thought. This is Heidegger's association with, and influence on, psychotherapy. Hans C Cohn explores the role of Heidegger's thought in providing an alternative basis for psychotherapeutic practice to the dominant psychodynamic, humanistic and cognitive approaches, also focusing strongly on the practical therapeutic relevance of Heidegger's ideas. This book will be essential reading for students and teachers of modern philosophy, as well as existential psychotherapists, and all practitioners interested in existential approaches to therapy. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the (...) concept of malady is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

Der Artikel spürt den subtilen Veränderungen nach, die bei Patienten, die mit tiefer Hirnstimulation behandelt werden, möglicherweise beobachtet werden können. Dabei sollen im Rückgriff auf Konzeptionen zur narrativen Identität mittels einer möglichst genauen Beschreibung und Analyse der Selbstwahrnehmung der Patienten sowie der Wahrnehmung ihres Umfelds die Änderungen im praktischen Selbstverhältnis untersucht werden, u. a. am Beispiel technomorpher Metaphern, die von den Patienten in ihren Selbstbeschreibungen verwendet werden. Ziel ist es, die Neuartigkeit und das Spezifische der Neurotechnologien – über die bisherigen (...) Untersuchungen hinaus – hinsichtlich des Umgangs mit sich selbst herauszuarbeiten und greifbar zu machen. Abschließend werden auf Basis der Analyse der Patienten-Narrationen die entsprechenden normativen Implikationen für eine ethische Bewertung des Einsatzes von Neurotechnologien benannt. (shrink)

It has been debated for quite some time among bioethicists and others whether or not the distinction between therapy and research in healthcare can and should be maintained. This paper tries to clarify what the disagreement is about, and argues that the distinction can be maintained in most, if not all, situations. However, even if it can be maintained, it does not necessarily follow that it should. It is argued here that there are good reasons to maintain the distinction (...) both for the sake of protecting research interests and the sake of patient safety. In addition, recognizing the distinction provides a barrier against unreasonable prioritization between patients. However, there may be situations, such as innovative last-resort treatment, in which regulatory requirements from both therapy and research should be considered. (shrink)

ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with (...) COMISA. We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (...) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

In 1937, John Dewey delivered a lecture to the College of Physicians in Saint Louis. His clear message was that in the practice of medicine it does not suffice for physicians to treat just the body, or to look to just the body for the mechanism of disease. Emphasizing the relational nature of organism-environment, he argued that the physician must treat the whole patient and must therefore consider the environment of the patient. It makes no sense, he suggested, to provide (...) medicine to address a problem with the patient's lungs and then to send him back into the coal mine. As he put it: "We must observe and understand internal processes and their interactions from the standpoint of their interactions with what is... (shrink)