Adolf Grünbaurn’s criticisms of psychoanalytic theory are the most sustained and powerful effort in our time to make the philosophy of science useful, useful in the pursuit of theories and evidence and useful in the relief of suffering. His work shows, I think, that some important claims that psychoanalytic theory has achieved certain scientific goals at best express unjustified hopes. These failures will not discourage those who think that the goals of the human sciences are radically different from those (...) of the natural sciences. But, like Professor Griinbaum, I don’t think there is a relevant difference, here. Psychoanalytic theory, like any field of science, strives for at least approximately true descriptions of causes, that are justified in light of the data.Still, I think that there is a core of psychoanalytic theory that is empirically justified. Moreover, most people whose theoretical commitments are psychoanalytic are now fully committed to no more than this core. In responding to his paper, ‘The Role of the Case Study Method in the Foundations of Psychoanalysis,’ I’ll start by sketching this core, indicating why I take it to embody the same scientific goals as familiar, well-justified natural-scientific theories. My view of the goals of theorizing is so basic to my failure to be converted by Professor Griinbaum that this prelude will be the longest part of my comments. If it turns out that he doesn’t want to convert someone with this kind of theory, i.e., that these claims for psychoanalysis are acceptable to him - that will itself be significant as clarifying the aims of his important work. (shrink)

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary (...) principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. (shrink)

The concept of psychologist as clinical scientist has found increasing support in recent years from diverse corners of professional psychology. Yet differences in how these advocates understand the nature of clinical scientific practice persist, fueled by philosophical differences over the nature of knowledge. Two epistemological paradigms that are the center of much discussion in contemporary philosophy are briefly explained: internalism vs. externalism. Modern clinical psychology has emerged largely within an internalist theory of knowledge. While psychologists have discerned (...) important features of how one obtains knowledge in a clinical setting, it is argued that these discoveries are better positioned in an externalist epistemology. The implications of externalist clinical science for a number of relevant topics are discussed including: whether there is, or should be, a normative scientific method, the role of clinical judgment as a source of knowledge, and how science can be demarcated from pseudo-science without presupposing a methodological hegemony. (shrink)

Since the time of Hippocrates, medical science sought to develop a practice based on "knowledge rather than opinion". However, in the light of recent alternative approaches to healing and a philosophy of science that, through thinkers like Kuhn, Rorty, and Foucault, is critical of claims to objective truth, we must reappraise the way in which medical interventions can be based on proven pathophysiological knowledge rather than opinion. Developing insights in Foucault, Lacan, and Wittgenstein, this essay argues for a recovery of (...) the Aristotelian idea of a techne, where there is a dynamic interplay between praxis and conceptualization. The result is a post-Kuhnian epistemology for medical science that recognizes the evaluative dimension of knowledge, but that also looks to a Platonic conception of the good as the ultimate constraint on human thought, thus avoiding the radically self-contained accounts of truth found in some post-modern thinkers. Keywords: normal science, power, truth, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

Of central concern to the philosophy of medicine is an understanding of the relationship that arises between science and ethics when decisions involve human beings. To examine this relationship, we must consider the status of claims to medical knowledge and whether there exists within medical practice a style of collecting and analyzing data and mak- ing therapeutic decisions that is properly called science. Since ideally, in medicine, knowledge guides practice, to a significant extent our factual claims will legislate our behavior (...) toward our fellowman. Clearly, other considerations compete with science for influence over medical deci- sions—for example, law, custom, patient preferences, convenience. However, without a "science of clinical medicine" and without a clear understanding of how we distinguish between valid and invalid factual claims, medical opinion loses much of its moral force. (shrink)

Anthropologische Medizin (AM) i. S. Viktor von Weizsäckers sieht grundlegende Selbsterfahrungen des Menschen (Leiblichkeit, Zeitlichkeit u. a.) für den Umgang von Arzt und Krankem als zentral. Sie ist offen für die leiblich-seelische Betroffenheit, für die mögliche Stellvertretung des Physischen und Psychischen und sieht den Kranken als Subjekt und Objekt, das sich selbst zugleich Subjekt und Objekt ist. „Umgangslehre“ kennzeichnet AM als Handlungswissenschaft, die der „Doppelstruktur sachlicher und personaler Entsprechung von Mensch in Not und Mensch als Helfer bzw. Krankheit und Medizin“ (...) folgt. Sie unterscheidet Krankheit und Kranksein sowie klinische und (natur-)wissenschaftliche Objektivität. Lebensweltliche und psychosoziale Faktoren beeinflussen das Kranksein. Als Umgangslehre setzt anthropologisch-klinische Wissenschaft „an die Stelle der Objektivitätslehre der Erkenntnis eine personalistische […] Erkenntnislehre“, die auch ihre methodischen, handlungslogischen Sach- und Wertbegründungen reflektiert. Brücken zwischen AM und dem gegenwärtigen Ethikdiskurs werden skizziert. (shrink)

​The motivation for this volume is simple. For a variety of reasons, clinical psychologists have long shown considerable interest in the philosophy of science. When logical positivism gained currency in the 1930s, psychologists were among the most avid readers of what these philosophers had to say about science. Part of the critique of Skinner’s radical behaviorism and thus behavior therapy was that it relied on, and thus was logically dependent on, the truth of logical positivism—a claim decisively refuted both (...) historically and logically by L.D. Smith (1986) in his important Behaviorism and Logical Positivism: A Reassessment of the Alliance. ​. (shrink)

Fully interpreted, Lewis's dynamic systems modeling of emotion encompasses psychological-adaptation thinking and individual and group differences in normal and abnormal behavior. It weakens the categorical perspective in evolutionary psychology and the clinical sciences; and suggests continuity between or behavior in whatever way this is self and culturally constituted, although culture/linguistic factors and selfhood are neglected. Application of a dynamic systems model could improve formulation of clinical problems.

Fully interpreted, Lewis's dynamic systems modeling of emotion encompasses psychological-adaptation thinking and individual and group differences in normal and abnormal behavior. It weakens the categorical perspective in evolutionary psychology and the clinical sciences; and suggests continuity between “normal” or “abnormal” behavior in whatever way this is self and culturally constituted, although culture/linguistic factors and selfhood are neglected. Application of a dynamic systems model could improve formulation of clinical problems.

Uncertainty is the name of the game in philosopher Kenneth W Goodman’s attempt to apply ethics to evidence based medicine . Indeed, the book is as much about epistemology, or the study of how we learn and know about the world, as it is about ethics. Goodman’s desire is to understand what constitutes proof, or evidence, that a particular treatment is better than others. One of the ethical connections is that a failure to use such treatments is blameworthy.EBM is a (...) concept that is getting a great deal of attention these days. At least two factors drive this …. (shrink)

In recent years, society has come to recognize that the work performed by scientists, like that of journalists and politicians, may be influenced by the interests they serve. As a result, scientists' research is increasingly contested as a source of reliable knowledge. Such has been the case in issues concerning the climate debate, for example, where research results are at times perceived to comfortably fit in with the viewpoints of interested parties outside science. In medicine, governmental as well as commercial (...) organizations influence the public health research agenda (McGarity and Wagner 2008). Also, studies sponsored by pharmaceutical companies, for example, often yield biased, favorable results for .. (shrink)

Of all the problems facing science none are more challenging yet fascinating than those posed by consciousness. In The Science of Consciousness leading researchers examine how consciousness is being investigated in the key areas of cognitive psychology, neuropsychology and clinical psychology. Within cognitive psychology, special focus is given to the function of consciousness, and to the relation of conscious processing to nonconscious processing in perception, learning, memory and information dissemination. Neuropsychology includes examination of the neural conditions for consciousness and (...) the effects of brain damage. Finally, mind/body interactions in clinical and experimental settings are considered, including the somatic effects of imagery, biofeedback and placebo effects. Every chapter is written by an expert in the field. They each provide a clear overview of existing research along with an exciting new synthesis of consciousness studies. The The Science of Consciousness will be invaluable for students, researchers and clinicians interested in the developments and directions of this rapidly growing field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 1-7 [Access article in PDF] Clinical Practice, Science, and the Unconscious Douglas McConnell Neil Pickering Keywords psychotherapy, cognitive science, neuroscience, computational view of mind. This volume of Philosophy, Psychiatry, & Psychology is devoted to questions about the unconscious mind. The philosophical complexities and difficulties associated with the unconscious are many and, despite widespread confusion and disagreement as to the nature of the (...) unconscious mind, it is used as a concept informing psychotherapy. It is therefore not surprising that papers in a special edition on the unconscious might be weighted heavily toward uncovering a justifiable conceptual niche for the unconscious and elaborating on some of the main conceptual connections. Although this makes for a slightly more philosophical edition of PPP than usual, those perhaps less interested in philosophy and more interested in actual psychiatric practice can incorporate the concepts and insights developed in these papers into their practice as they see fit.The three main articles take three quite distinct approaches to the unconscious. Schechtman (2005) addresses the need for a theory of personal identity to incorporate the unconscious and presents one that does so by developing some central Lockian intuitions. Church (2005) investigates whether the kinds of things happening in the unconscious can be explained by cognitive operations not normally associated with consciousness, specifically, spatial structuring of experience. McConnell and Gillett (2005) clarify some of Lacan's ontology of the mind where the language encountered and used by the subject provides the structure for their unconscious.The aim of this introduction is to ask and try to answer a question that logically precedes those raised in the articles in the light of the therapeutic use of the unconscious. When dealing with psychoanalysis or psychoanalytic concepts in an Anglo-American context, the struggle that psychoanalysis has had and continues to have in a psychiatric domain ruled by science is never far from the spotlight. Indeed Hinshelwood (2005) also picks up the importance of this conflict when replying to McConnell and Gillett. It seems to be historically true that the unconscious has fallen out of favor in scientific and psychiatric circles (it is no surprise that psychiatric training is largely based in "hard," that is, biological and biochemical science) particularly over the last 50 years or so. But is the scientific skepticism to be found about the use of the unconscious well-founded? And how does the continued utilization [End Page 1] of the unconscious by the therapist fit into current practice given this skepticism? Psychotherapy and the Unconscious In psychotherapy, the therapist and the client together construct a story that explains why the client is having some form of difficulty in his or her life. The stated aim is to enable the client to overcome this difficulty by gaining an understanding of what has generated it. Doing so may be a first step to dealing with that conflict. For example, an office worker who is scared of the boss and whose life at work is a misery as result may come to think that the boss is a reminder of some threatening figure from childhood and that the reaction is a regression to infantile behavior. Knowing this, the fear of the boss can be revisited—perhaps reconfigured, perhaps overcome—and life may improve. In the process of therapy, the relation of the figure from childhood to the boss is made conscious. But it was still operative before it was made explicit, even though the client did not realize it and some would say that the client's unconscious had somehow buried the memory from childhood or hidden from the client the relation of this memory of a threatening figure to the boss.A description of the content of the unconscious is, then, an intentional description involving the client's thought life, one made to help an individual understand otherwise unintelligible (to that individual) feelings, beliefs, desires, actions, and so on. Subjects' intentions are their normatively structured mental representations of, and attitudes toward, the world (e.g., "He is my boss"; "I am afraid of him"). An intentional unconscious description then takes an intentional form... (shrink)

How to improve clinical practice and, in particular, that of physical therapy? Currently, several strategies are used which all fit the label scientification. These scientific strategies have to make physical therapy''s clinical practice more homogeneous. Sometimes this homogenization is thought to be necessary for other strategies of innovation including effectiveness research. But it has also been suggested that more homogeneity in the clinic is already itself an improvement. In this article we comment on these strategies. More specifically, we (...) direct our attention at attempts in physical therapy to establish a uniform, generally adopted scientific language. We argue that these attempts fail to appreciate the specificity of therapeutic work. The effectiveness research that follows is therefore liable to take irrelevant variables into account. We illustrate this argument with examples taken from analyses of diverging therapies for stroke patients. (shrink)

Rationality in medicine is frequently construed as hypotheticodeductive. This article argues that such a model gives a distorted view of the rational character of an enterprise that makes judgments about individual human well-being. Medicine as a science is a practical human science. Seen as such, its rational orientation is one that applies general knowledge to particular situations. It is argued that such an orientation is not deductive but interpretative. The Aristotelian concept of practical wisdom (‘phron sis’) is used as a (...) model of the rational orientation of clinical judgment. Keywords: clinical judgment, rationality, human sciences CiteULike Connotea Del.icio.us What's this? (shrink)

Introduction : health humanities -- Patient as storyteller : determinants of health -- Unconscious bias -- Bearing witness to suffering -- Resilience and burnout -- Recognizing our interdependence -- The influence of time on meaning -- Uncertainty and decision making -- Professional identity : perspectives, roles, values, and attributes.

The epistemological status of health science, natural science, and clinical knowledge is explored. It is shown that ‘health science’, a term increasingly used in association with the clinical knowledge of the therapies, nursing, and other health occupations, is not fully a science in the sense of the natural sciences. It is rather a hybrid which relates applications of natural science, behavioral science, and the humanities to problems in health. The same may be said of clinical knowledge (...) which entails, as essentials, humanistic considerations involving the personal concerns of the patient, in addition to the more evident external aspects of diagnosis and treatment. The recent introduction of the term ‘health science’ reflects scientism in its approach to health issues. It also reflects confusion about the nature of clinical knowledge. Keywords: health science, clinical knowledge, natural science, behavioral science, humanism CiteULike Connotea Del.icio.us What's this? (shrink)

Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we (...) discuss how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)

The 21st century has been revolutionary for the field of clinical genomics, with major advancements and breakthroughs over the years. It is now considered an instrumental tool in clinical and preventive medicine and has been used on a day-to-day basis to complement current clinical practice. However, with advancements in genomics comes greater bioethical concerns, which becomes increasingly complex with more cutting-edge technology. Some of the major ethical concerns include obtaining informed consent, possibility for genetic enhancements and eugenics, (...) genomic equity and potential discrimination and cloning. It is imperative that we appreciate the benefits of genomic medicine in complementing traditional practices, identify and address the ethical concerns with relation to the practice of genomic medicine, and to ensure a common goal of improving human lives. With these in mind, the practice of genomics can have maximum impact in the collective health of the population, with greater benefit to all. (shrink)

Research ethics is often said to have been born of scandal. Whether or not this is true of the field in general, it does seem to be the case for much of the literature on the ethics of international research. But in When Experiments Travel: Clinical Trials and the Global Search for Human Subjects, the anthropologist Adriana Petryna sets out to portray not scandal, but the routine offshoring of clinical trials. Through gripping interviews and detailed case studies, she (...) follows the lifecycle of international research, tracing its connections to health systems, legal systems, and entitlement programs. She also provides a glimpse into the complex social relations on which the research process depends, allowing her reader to see the way the labor is divided, the responsibilities delegated, the risks shifted, and decisions with far-reaching social consequences shaped by a spectrum of market, regulatory, and cultural influences. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the (...) policy of separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

In his memorandum, “The Role of Applied Social Science in the Formation of Policy,” Professor Merton has stated that “… all applied social science involves advice.” While this statement obviously does not mean that the social scientist is limited solely to giving advice, it does imply a frame of reference in which the primary function of the social scientist appears to be obtaining information, analyzing it, and presenting the results to the policy-maker.

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically-engineered (...) pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation. (shrink)

Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate “social facts” in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes (...) of thinking by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment. (shrink)

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms (...) of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future. (shrink)

Sociologists of science have argued that due to the institutional reward system negative research results, such as failed experiments, may harm scientific careers. We know little, however, of how scientists themselves make sense of negative research findings. Drawing from the sociology of work, the author discusses how researchers involved in a double-blind, placebo, controlled randomized clinical trial for methamphetamine dependency informally and formally interpret the emerging research results. Because the drug tested in the trial was not an effective treatment, (...) the staff considered the trial a failure. In spite of the disappointing results, the staff involved in the daily work with research subjects still reframed the trial as meaningful because they were able to treat people for their drug dependency. The authors of the major publication also framed the results as worthwhile by linking their study to a previously published study in a post hoc analysis. The author concludes that negative research findings offer a collective opportunity to define what scientific work is about and that the effects of failed experiments depend on individual biography and institutional context. (shrink)

In _The Biology of Clinical Encounters_, Gedo utilizes recent findings in neuroscience and cognitive psychology to elaborate his conception of psychobiology and to consider its implications in clinical analysis. He pursues this challenging undertaking in several directions. He illuminates the way in which psychobiology enters into his hierarchical model of mental functioning, and goes on to examine three clinical syndromes - phobias, obsessions, and affective disturbances - in which biological considerations are particularly important. Of special note are (...) chapters examining the implications of a biological approach for clinical psychoanalysis. Gedo explores the notion of transference that grows out of attentiveness to psychobiological factors, elaborates the concept of therapeutics that follows from looking beyond mental contents, and discusses the problem of assessing clinical evidence produced by analyses informed by a psychobiological orientation. Drawing on his own analytic work of over three decades, he compares analyses conducted with a psychobiological orientation with the outcome of analyses conducted earlier in his career with a more traditional psychological approach. A stimulating introduction to the interpenetration of the biological and the psychological in clinical work, _The Biology of Clinical Encounters_ is quintessential Gedo: scholarly in conception, elegant in tone, provocative in import, and illuminating, always, of fundamental issues about the status of psychoanalysis as a science of mind. (shrink)

In _The Biology of Clinical Encounters_, Gedo utilizes recent findings in neuroscience and cognitive psychology to elaborate his conception of psychobiology and to consider its implications in clinical analysis. He pursues this challenging undertaking in several directions. He illuminates the way in which psychobiology enters into his hierarchical model of mental functioning, and goes on to examine three clinical syndromes - phobias, obsessions, and affective disturbances - in which biological considerations are particularly important. Of special note are (...) chapters examining the implications of a biological approach for clinical psychoanalysis. Gedo explores the notion of transference that grows out of attentiveness to psychobiological factors, elaborates the concept of therapeutics that follows from looking beyond mental contents, and discusses the problem of assessing clinical evidence produced by analyses informed by a psychobiological orientation. Drawing on his own analytic work of over three decades, he compares analyses conducted with a psychobiological orientation with the outcome of analyses conducted earlier in his career with a more traditional psychological approach. A stimulating introduction to the interpenetration of the biological and the psychological in clinical work, _The Biology of Clinical Encounters_ is quintessential Gedo: scholarly in conception, elegant in tone, provocative in import, and illuminating, always, of fundamental issues about the status of psychoanalysis as a science of mind. (shrink)