This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)

While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences (...) of the proposed moral obligation to actively reinterpret variant classifications that carry a higher risk of being false positives. Such reclassification is likely to result in ‘downgrades’: previously pathogenic variants (pathogenic/likely pathogenic, P/LP) reclassified to benign (likely benign/benign, LB/B) or uncertain variants (variant of uncertain significance, VUS). Any laboratory policy to actively reinterpret (specific sets of) classifications will confront the clinician with the question whether the person tested should be recontacted on a reinterpretation of previously reported results. As others have pointed out, recontacting in general comes with challenges, since patients may not want to be recontacted or have forgotten about their genetic test.2 3 Recontacting in case of a downgrade, however, is particularly impactful. Previous studies on the psychosocial impact of reclassification on patients …. (shrink)

ABSTRACTThis is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task, an Emotional Visual Search Task, and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: (...) evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying... (shrink)

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This article examines the relation between the critical theory of Moishe Postone and the philosophy of Theodor Adorno. While the former is clearly influenced by the latter, these influences mostly stay implicit. When explicit, he does not so easily put his own thought in line with Adorno’s and is highly critical of him. I will investigate the ways in which ideas from Adorno made their way into Postone’s work, but also where the latter diverts from them. As will be shown, (...) Postone’s critical theory runs into a problem when one examines the immanent ground of his critical norm, freedom. Adorno, on the contrary, does succeed in employing the same norm in his own immanent critique. I will conclude that the problem Postone encounters can be avoided by being more of an ‘Adornian’, and that his theory allows this. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders has elicited numerous criticisms throughout its history. Its particularly controversial status has not been resolved by the recent release of the DSM-5 ; rather, the new edition has amplified debates in psychiatry as well as philosophy and the wider public. To a certain extent, such controversies are to be expected because of the influential role the DSM plays in science and health care. Researchers have often been required to use the DSM classification (...) to get funded and published, clinicians need to use it for diagnosis, and patients need a DSM code to get reimbursed for treatment.1 Classification in psychiatry shapes the course of research... (shrink)

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

This article gives an overview of the influence of the work of Michel Foucault on the philosophy of Agamben. Discussed are Foucault’s influence on the Homo Sacer cycle, on (the development) of Agamben’s notion of power (and on his closely related notion of freedom and art of life), as well as on Agamben’s philosophy of language and methodology. While most commentaries focus on Agamben’s interpretation of Foucault’s concept of biopower, his work also contains many interesting references to Foucault on freedom (...) and possibilities—and I think that it is here that Foucault’s influence on Agamben is most deeply felt. This article focuses on the shifts Agamben takes while looking for the Entwicklungsfähigkeit in the work of Foucault. (shrink)

This article discusses African feminist approaches to decolonization and social transformation. In recent years, there has been a significant shift in African feminist scholarship towards African concerns and Africa-centered solutions. Today’s turn to Indigenous knowledge, social structures, and gender relations is no longer just about shedding light on the precolonial past, but about fundamentally changing the epistemic framework in the sense of developing alternative epistemologies beyond the dominant ‘Western’ framework. But what is meant by ‘alternative epistemologies’? How do African feminist (...) thinkers conceptualize social change today? And how do they relate epistemic and social change in their thinking? These questions are explored in this article, focusing on work by Sylvia Tamale (Uganda), Wangari Maathai (Kenya), and Anthonia Kalu (Nigeria) and drawing on the discourse of ecofeminism and Ubuntu as two models of alternative epistemologies. (shrink)

BackgroundTranscranial direct current stimulation targeting the primary motor hand area may induce lasting shifts in corticospinal excitability, but after-effects show substantial inter-individual variability. Functional magnetic resonance imaging can probe after-effects of TDCS on regional neural activity on a whole-brain level.ObjectiveUsing a double-blinded cross-over design, we investigated whether the individual change in corticospinal excitability after TDCS of M1-HAND is associated with changes in task-related regional activity in cortical motor areas.MethodsSeventeen healthy volunteers received 20 min of real or sham TDCS on separate (...) days in randomized order. Real and sham TDCS used the classic bipolar set-up with the anode placed over right M1-HAND. Before and after each TDCS session, we recorded motor evoked potentials from the relaxed left first dorsal interosseus muscle after single-pulse transcranial magnetic stimulation of left M1-HAND and performed whole-brain fMRI at 3 Tesla while participants completed a visuomotor tracking task with their left hand. We also assessed the difference in MEP latency when applying anterior-posterior and latero-medial TMS pulses to the precentral hand knob.ResultsReal TDCS had no consistent aftereffects on mean MEP amplitude, task-related activity or motor performance. Individual changes in MEP amplitude, measured directly after real TDCS showed a positive linear relationship with individual changes in task-related activity in the supplementary motor area and AP-LM MEP latency.ConclusionFunctional aftereffects of classical bipolar anodal TDCS of M1-HAND on the motor system vary substantially across individuals. Physiological features upstream from the primary motor cortex may determine how anodal TDCS changes corticospinal excitability. (shrink)

Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)

This study examines the theory of planned behavior and the multidimensional ethics scale. Variables from both are included to determine which ones significantly correlate with student ethical behavioral intention in an academic setting. Using a survey, responses are collected from undergraduate business students from two southwestern universities in the United States using a scenario-based approach, looking at individual situations and group situations. SmartPLS was used to assess the results for four scenarios. From the theory of planned behavior, attitude was a (...) significant predictor of behavioral intention across all four scenarios while subjective norm was significant in one scenario. From the multidimensional ethics scale, moral equity and relativism were significant in one group scenario while moral equity and utilitarianism were each significant in an individual scenario. The findings indicate support for the use of the TPB and the MES when exploring ethics in an academic setting and for the need to study both individual and group situations. A discussion of the findings and implications is given. (shrink)

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

This collection features eleven original essays, divided into three thematic sections, which explore the work of Wilfrid Sellars in relation to other twentieth-century thinkers. Section I analyzes Sellars’s thought in light of some of his influential predecessors, specifically Ludwig Wittgenstein, Rudolf Carnap, John Cook Wilson, and Kazimierz Ajdukiewicz. The second group of essays explores from different perspectives Sellars’s place within the analytic tradition, including his relation with analytic Kantianism and analytic pragmatism. The book’s final section extracts some of the most (...) significant lessons Sellars’s work has to offer for contemporary philosophy. These chapters address his views on inference, his views on truth and its connection to recent discussions about truth-relativism and truth-pluralism, his conception of self-knowledge, and his theory of perceptual experience. (shrink)

This paper explores some ideas of Wilfrid Sellars to raise two difficulties for a naturalistic approach to the mind. The first difficulty, which is methodological, is a corollary of Sellars’s distinction between two images of man-in-the-world, the manifest and the scientific image. For Sellars, taking science seriously requires that we think of it as constructing a unified image of man-in-the-world of its own. I argue that it is the rivalry between the manifest and the scientific image which gives rise to (...) the mind-body-problem. The challenge for a naturalistic solution to the mind-body-problem is that it is not legitimate to isolate single scientific results from their theoretical context in order to integrate them piecemeal into the manifest image. According to Sellars, a satisfactory solution to the mind-body-problem must attempt nothing less than a fusion of both images which somehow respects and preserves the unity of each. The second, substantial difficulty for a naturalistic approach to the mind is that of coming to terms with the normativity of the mental. Many interpreters take Sellars to hold that normativity sets the mental apart from the rest of nature. Against this I argue that according to Sellars the living is governed by norms of its own. It follows that normativity cannot serve as the mark of the mental. I argue that according to Sellars the distinguishing feature of the mental lies elsewhere, namely in the way in which normative force comes about. Unlike biological norms, the norms of thought owe their force to a common practice of mutual evaluation. However, the assumption that there are norms in animate nature should make it easier for naturalists to accept that the mental is characterized by norms of its own. (shrink)

The need for a shift toward healthier and more sustainable diets is evident and is supported by universalized standards for a “planetary health diet” as recommended in the recent EAT-Lancet report. At the same time, differences exist in tastes, preferences and food practices among diverse ethnic groups, which becomes progressively relevant in light of Europe’s increasingly multi-ethnic cities. There is a growing tension between current sustainable diets standards and how diverse ethnic resident groups relate to it within their ‘culturally appropriate’ (...) foodways, raising questions around inclusion. What are dynamics of inclusiveness in migrant food practices? And what does this mean towards the transition to healthy and sustainable food? We study this question among Syrian migrants with different lengths of stay in the Netherlands. Our theoretical framework is based on practice theories, which emphasize the importance of socio-material context and of bodily routines and competences. We use qualitative methods, combining in-depth semi-structured life-history interviews with participant observation. Our findings indicate that inclusiveness takes different forms as migrants’ food practices and the food environment change. Regarding health and sustainability in food practices, understandings and competences around particularly fresh food change over time among both short- and long-term migrants, replacing making things from scratch with seasonal products with buying more processed products and out-of-season vegetables and fruits. We conclude that the performances of food practices and their configurations in food environments and lifestyles are dynamic and cannot unequivocally be interpreted as in- or exclusive, but that a more nuanced understanding is required. (shrink)

People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction, because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis’s work (...) offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people’s agency can also result in people losing belief in their self-efficacy. Lewis’s strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent’s values and to available techniques of self-control. However, the agent can overcome this stage by developing new techniques of self-control, by building on their self-concept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, (...) where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (shrink)

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and (...) an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)

While Vilém Flusser’s writings on (media) philosophy and communication have found a wide readership across the globe, another ‘Flusser’ has been present all along, interwoven perhaps, namely that of the ‘obsessive futurologist’. Flusser, the futurologist, does not only imagine or predict media-technological universes unfolding with, among, and for us, but he, in his insistence that ‘communication is anthropology’, also imagines scenarios of possible worlds to come. In his little-known book Angenommen: Eine Szenenfolge (1989), available in English translation as What If? (...) Twenty-Two Scenarios in Search of Images (2023), he designs sketches of an Anthropocene fraught with nightmares and wonders. What If? offers insight into the radical futures of a slipstream Anthropocene that have to do with speculative design, with Flusser’s concept of design as ‘crafty’ or slippery, and with art and the immense creative potential of failure versus reasonable, ‘good’ computing or calculability. (shrink)

This supplement serves a double purpose. It presents, on the one hand, a selection of papers devoted to the title question “How much philosophy in the philosophy of science?”. On the other hand, it signalizes the newly established cooperation between the German Society for the Philosophy of Science and the Journal for General Philosophy of Science .The GWP was founded in Hannover in 2011 and had its inaugural conference in March 2013 [for a report on the “GWP.2013” by H. Lyre (...) see EPSA Newsletter 2 2013]. The society was launched for several reasons. Albeit the German community of philosophers of science is quite large , it is at the same time a rather distributed and dispersed community. This has to do with the university landscape in Germany, which is dispersed rather t .. (shrink)

Odera Oruka’s Sage philosophy project, his definition of philosophy, the method of interviewing sages, and the differentiation between folk and philosophic sages, have been discussed and criticised at length. Unfortunately, less known is Odera Oruka’s work on Ethics. This is especially regrettable, as his philosophical work had two main objectives:· The liberation of philosophy in Africa from ethnological and racist prejudices (Sage philosophy).· The reconstruction of the dimension of sagacity in philosophy which got lost in technical and analytic language during (...) the last decades. Philosophy becamea kind of expert knowledge with specialized terminology, thereby losing its holistic outlook and practical relevance.For Odera Oruka, who situates himself in the Socratic tradition of philosophy, philosophy is not a science in the ivory tower, but has to contribute to the bettermentof the life of the people - it has to be made practical. Philosophers have to deploy the results of their thinking to the well-being of their communities. This is what he considers, following Socrates, the sagacious dimension of philosophy.The aim of the present article is to highlight the ethical dimension of Odera Oruka's work, and to show the inseparable relationship of the Sage Philosophy project and his works on ethics, with a special focus on his concept of global justice. At the same time, the article attempts to show the relevance of Odera Oruka's work to the world philosophical discourse. (shrink)

Excerpt: How does subjective well-being change over the life course and what concepts do people draw upon when they answer questions about their well-being? Does well-being indeed change or are people endowed with a set level of happiness around which their well-being fluctuates? These are some of the questions this paper will address with a focus on three domains of life: family, work, and health.

This paper gives insight into the Islamic bioethical discussion on harvesting and using human embryonic and adult stem cells. It describes some of the Islamic legal mechanisms involved in the bioethical discourse among Muslims. As the contemporary Islamic bioethical discourse is very diverse, the paper focuses on the critical discussion of related resolutions of the Saudi-based Islamic Fiqh Academy due to the esteem in which the IFA is held in the Islamic world and the pertinence of their rulings on this (...) issue. This study discusses the different sources of human adult and embryonic stem cells and their use from an Islamic perspective, while questioning some directions the Islamic bioethical discourse has taken. The paper invites interested parties to deliberate the use of some of the legal means resorted to in the ongoing Islamic bioethical discourse. (shrink)