The experience of pain is subjective, yet many people have their pain invalidated or not believed. Pain invalidation is associated with poor mental health, including depression and lower well-being. Qualitative investigations of invalidating experiences identify themes of depression, but also social withdrawal, self-criticism, and lower self-worth, all of which are core components of shame. Despite this, no studies have quantitatively assessed the interrelationship between pain invalidation, shame, and depression. To explore this relationship, participants recounted the frequency of experienced pain invalidation (...) from family, friends, and medical professionals, as well as their feelings of internalized shame and depressive symptoms. As shame has been shown to be a precursor for depression, we further explored the role of shame as a mediator between pain invalidation and depressive symptoms. All sources of pain invalidation were positively associated with shame and depressive symptoms, and shame fully mediated the relationship between each source of pain invalidation and depression. Relative to other sources, pain invalidation from family was most closely tied to shame and depression. Overall, findings indicate that one mechanism by which pain invalidation may facilitate depression is via the experience of shame. Future research may explore shame as a potential upstream precursor to depression in the context of pain. Findings provide more insight into the harmful influence of pain invalidation on mental health and highlight the impact of interpersonal treatment on the experiences of people in pain. (shrink)

Nanotechnologies and nanoscience have generated an unprecedented global research and development race involving dozens of countries. The understanding of associated environmental, ethical, and societal implications lags far behind the science and technology. Consequently, it is critical to consider both what is known and what is unknown to offer a kernel that future work can be added to. The challenges presented by nanotechnologies are discussed. Some initial solutions such as self-regulation and borrowing techniques and tools from other fields are accompanied by (...) a call for further research. (shrink)

In line with the British Psychological Society's recent recommendations for teaching the history of psychology, this comprehensive undergraduate textbook emphasizes the philosophical, cultural and social elements that influenced psychology's development. The authors demonstrate that psychology is both a human (e.g. psychoanalytic or phenomenological) and natural (e.g. cognitive) science, exploring broad social-historical and philosophical themes such as the role of diverse cultures and women in psychology and the complex relationship between objectivity and subjectivity in the development of psychological knowledge. The result (...) is a fresh and balanced perspective on what has traditionally been viewed as the collected achievements of a few 'great men'. With a variety of learning features, including case studies, study questions, thought experiments and a glossary, this new textbook encourages students to critically engage with chapter material and analyze themes and topics within a social, historical and philosophical framework. (shrink)

It is generally not recognized that Whewell's conception of necessary truth evolved only gradually; his early statements are misleading. For this reason, and because of certain peculiarities in his expository style over his publishing history, he is commonly thought to have used the term "necessary" in the sense of "absolutely necessary". I argue that, on the contrary, the term is essentially relational in his mature view. This conclusion leads, in turn, to a re-interpretation of his doctrine of "fundamental ideas". Here (...) I argue that the crux of his position is that cognitive principles which are initially regulative become, through invention, repeated employment, and stipulative definition, constitutive ones. (shrink)

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances of intentional wrongdoing, by males in nonacademic medical settings, with oversight problems and a selfish motive such as financial gain or sex. More than half of cases involved a wrongdoer with a suspected (...) personality disorder or substance use disorder. Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. (shrink)

Irrelevant emotional stimuli often capture attention, disrupting ongoing cognitive processes. In two experiments, we examined whether availability of rewards can prevent...

Much of the Mill-Whewell dispute was purely verbal, but much was not. Mill did not understand Whewell; the true character of the non-verbal aspect of the controversy emerges only upon adequate analysis of Whewell's actual position. Such analysis shows that Mill's objections to Whewell were misdirected, although suggestive of other which might, if prosecuted, carry. Ultimately, the dispute has to do with the given; neither man gives an adequate account of it. For this reason, the controversy cannot be resolved definitively (...) in favor of either of them. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Why are natural theories pre-well-ordered by consistency strength? In previous work, an approach to this question was proposed. This approach was inspired by Martin's Conjecture, one of the most prominent conjectures in recursion theory. Fixing a reasonable subsystem $T$ of arithmetic, the goal was to classify the recursive functions that are monotone with respect to the Lindenbaum algebra of $T$. According to an optimistic conjecture, roughly, every such function must be equivalent to an iterate $\mathsf{Con}_T^\alpha$ of the consistency operator ``in (...) the limit'' within the ultrafilter of sentences that are true in the standard model. In previous work the author established the first case of this optimistic conjecture; roughly, every recursive monotone function is either as weak as the identity operator in the limit or as strong as $\mathsf{Con}_T$ in the limit. Yet in this note we prove that this optimistic conjecture fails already at the next step; there are recursive monotone functions that are neither as weak as $\mathsf{Con}_T$ in the limit nor as strong as $\mathsf{Con}_T^2$ in the limit. In fact, for every $\alpha$, we produce a function that is cofinally equivalent to $\mathsf{Con}^\alpha_T$ yet cofinally equivalent to $\mathsf{Con}_T$. (shrink)

Does national success with an emerging technology require ethical sacrifices? This question is considered through the simultaneous consideration of ethics, investment, and outcomes in the nine jurisdictions that are making the largest investments in nanotechnologies—an important emerging technology. It is found that while ethical environment has no notable effect on pure and applied research, a more positive ethical environment is associated with measures associated with invention and commercialization. In summary, a race-to-the-top supports invention and commercialization of emerging technologies. A critical (...) finding as it suggests that issues such as corruption and regulation could be critical in limiting the extraction of social and economic benefit from emerging technologies (like nanotechnologies). (shrink)

If you're a Nietzsche scholar and you haven't heard of Mark Alfano's book, you're not paying attention. Published in 2019, Nietzsche's Moral Psychology has already been reviewed by leading Nietzsche scholars in numerous venues, dissected in a book symposium published in this very journal, and featured on a popular philosophy blog's book review forum. Its broad influence is already evidenced by the extensive scholarly debate it has provoked and the predominantly positive evaluations it has received, and its impact is particularly (...) noteworthy because of its... (shrink)

Though the claims they make about temporality are markedly different, Henri Bergson and Martin Heidegger agree that time is a philosophically foundational phenomenon; indeed, they agree that time is, in certain respects, the basis for all discursively representable beings. This paper focuses not so much on their theories of temporality (i.e., their respective answers to the question what is time? and their justifications for these answers) but rather on the challenges involved in talking about this phenomenon at all. Both thinkers (...) are highly sensitive to these challenges and to the problems involved in any attempt to represent time in a discursively straightforward manner. I will show that: (1) Bergson’s and Heidegger’s respective claims about time can be fully understood only if we keep this sensitivity in view and carefully note what they are—and aren’t—doing in talking about time ; and (2) what is ultimately at stake in their analyses is not just the phenomenon of time but what it means to engage in rigorous philosophical praxis. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Normalizing” Intersex Didn’t Feel Normal or Honest to Me.Karen A. WalshI am an intersex woman with Complete Androgen Insensitivity Syndrome (CAIS). My 57–year history with this has its own trajectory—mostly driven by medical events, and how I and my parents reacted. Most of my treatment by physicians has not been positive. It didn’t make me “normal” at all. I was born normal and didn’t require medical interventions. And by (...) the way, I’ve never been confused about who or what I am.Truthful disclosure didn’t come to me about my biology and what was done to me as an infant until I was 33, when I forced the issue by removing my medical records from my endocrinologist’s office. I learned that there was never full disclosure to my [End Page 119] parents either, and therefore there was no informed consent for the “corrective” surgeries performed on me as an infant. My parents were only told that their little girl would get cancer and would not have a normal development as a girl unless her “deformed ovaries” were removed, and that they should never discuss these problems with me. Thus, after having presented with an inguinal hernia and having exploratory surgery at age 16 months, my intra–abdominal testes were removed in a second surgery two months later. I was pronounced a “male pseudohermaphrodite,” a diagnosis that was shared neither with my parents nor with me.Years later, I discovered an article my surgeon published in 1960 in the Delaware Medical Journal about me and another intersex person he operated on (whom he labeled a “true hermaphrodite”). The article gives a very detailed pathology report of my gonads, but only two sentences regarding my welfare and the rationale for performing those surgeries. Dr. J. F. Kustrup wrote in this article, “These [two cases] emphasize the need for early diagnosis and treatment in order to avoid the possibility of malignant change and to permit these individuals to follow a normal psychosexual pattern.” And: “Hermaphroditism and pseudohermaphroditism are conditions in which early diagnosis and treatment are essential to avoid malignant degeneration and to allow the child some chance toward normal pyschic [sic] development.” I was grateful to find this article because it revealed the unfounded assumptions underpinning the recommendations for treatment, much of which continues today. Worse even than the sort of social prejudice that shapes treatment is the absence of evidence for what doctors treat as “necessary” interventions. For my syndrome, CAIS, there never was—and still is not—data to support the cancer scare, or the opinion that I’d be confused and not have a normal life.From about the age of four, I can remember being different and being stonewalled by my doctor and prevented by my parents from talking about it. The feelings and fears I tried to express were shushed away, and I could tell that my questions were upsetting everyone. Even if I had wanted to be complicit with their lame diversions and nonsensical explanations, the massive abdominal scars were there as a daily reminder and hinted at a very different story.The Road to Hell is Paved with Good IntentionsGrowing up, I was treated like a fascinoma and a lab rat at a major teaching hospital on the East Coast. All I learned from those doctors as a young kid was what it feels like to be ogled, photographed and probed by a roomful of white–coated male doctors. Dissociation made itself my friend, and helped me to cope through the annual genital and anal exams and probing. I thought I was a freak and I felt completely powerless to protect myself from them and their “care”.At my annual appointment at age 12, with my mom present, three doctors told me I was infertile. Learning that I couldn’t have kids really saddened and shocked me, but there was no opportunity to talk about my feelings—either that day, or any time afterward. I was told to stop crying. I remember them telling me that there was no one else like me and that this was a random genetic anomaly, thereby reinforcing the freakishness... (shrink)

In this essay, I argue that the Commodification Objection, locates a phenomenon of real moral significance. In defending the Commodification Objection, I review three common criticisms of it, which claim firstly, that commodification doesn’t always lead to instrumentalization; secondly, that commodification isn’t the only route to such an outcome; and finally, that the Commodification Objection applies only to persons, and human organs are not persons. In response, I conclude that moral significance does not require that an undesirable outcome be a (...) necessary consequence of the phenomenon under examination; the relative likelihood of an undesirable mode of regard arising provides a morally-relevant distinguishing marker for assessing the comparative moral status of social institutions and arrangements; and sales in blood products are sufficiently distinct from sales of everyday artefacts and sufficiently close to personhood to provide genuine grounds for concern. Accordingly, criticisms of the Commodification Objection do not provide grounds for rejecting the claim that human organ sales in general and compensation for blood plasma donation in particular can have morally pernicious ‘commodificatory effects’ upon our attitudes, for what human organ sales provide is a distinctive ethical hazard. (shrink)

This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss (...) their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision. (shrink)

Ordinal analysis is a research program wherein recursive ordinals are assigned to axiomatic theories. According to conventional wisdom, ordinal analysis measures the strength of theories. Yet what is the attendant notion of strength? In this paper we present abstract characterizations of ordinal analysis that address this question. -/- First, we characterize ordinal analysis as a partition of $\Sigma^1_1$-definable and $\Pi^1_1$-sound theories, namely, the partition whereby two theories are equivalent if they have the same proof-theoretic ordinal. We show that no equivalence (...) relation $\equiv$ is finer than the ordinal analysis partition if both: (1) $T\equiv U$ whenever $T$ and $U$ prove the same $\Pi^1_1$ sentences; (2) $T\equiv T+U$ for every set $U$ of true $\Sigma^1_1$ sentences. In fact, no such equivalence relation makes a single distinction that the ordinal analysis partition does not make. -/- Second, we characterize ordinal analysis as an ordering on arithmetically-definable and $\Pi^1_1$-sound theories, namely, the ordering wherein $T\leq U$ if the proof-theoretic ordinal of $T$ is less than or equal to the proof-theoretic ordinal of $U$. The standard ways of measuring the strength of theories are consistency strength and inclusion of $\Pi^0_1$ theorems. We introduce analogues of these notions---$\Pi^1_1$-reflection strength and inclusion of $\Pi^1_1$ theorems---in the presence of an oracle for $\Sigma^1_1$ truths, and prove that they coincide with the ordering induced by ordinal analysis. (shrink)

Philosophy of history is not a subject which has hitherto attracted much attention in this country. Preoccupation with the methods and achievements of the natural sciences, and distaste for the sort of rationale of history as a whole which Hegel and others offered under the title in the early nineteenth century, have served to make most British philosophers accord its problems only the most casual recognition. It is therefore all the more interesting to find an English writer of unusual powers (...) both of argument and expression, who was himself an historian of distinction in his special field, devoting a large part of his philosophical thinking to the problems of historical knowledge and their wider implications. Unfortunately, R. G. Collingwood was not able to begin the major work on philosophy of history, to writing which, as we are told in the introduction to the present book, he had looked forward for twenty-five years, until his powers were seriously affected by bad health, and he did not live to complete it. But though the full results of his thinking on the subject are lost, we are now able, thanks to the skilful work of his friend Professor T. M. Knox, to study what is in effect an extensive interim report on it. Professor Knox has produced The Idea of History largely on the basis of lectures which Collingwood prepared in 1936, supplemented by two essays already published which date from the same period and a certain amount of material from the unfinished Principles of History written in 1939. (shrink)

It is a well known empirical observation that natural axiomatic theories are pre-well-ordered by consistency strength. For any natural theory $T$, the next strongest natural theory is $T+\mathsf{Con}_T$. We formulate and prove a statement to the effect that the consistency operator is the weakest natural way to uniformly extend axiomatic theories.

We inhabit a world in which the market is a dominant institutional form of social organization. This influence is not without its critics, and there is considerable debate amongst political philosophers and policy-makers about whether the range of the market should expand or contract and, further, about the extent to which the market should be subject to constraints and government regulation. The expansion of the market into realms hitherto unknown is the theme of a number of recent books, including Michael (...) Sandel's What Money Can't Buy and Debra Satz's Why Some Things Should Not Be for Sale, which build on earlier work by, amongst others, Elizabeth Anderson, Margaret Jane Radin, and Michael Walzer. (shrink)

Newton described his Principia as a work of ‘experimental philosophy’, where theories were deduced from phenomena. He introduced six ‘phenomena’: propositions describing patterns of motion, generalised from astronomical observations. However, these don’t fit Newton’s contemporaries’ definitions of ‘phenomenon’. Drawing on Bogen and Woodward’s distinction between data, phenomena and theories, I argue that Newton’s ‘phenomena’ were explanatory targets drawn from raw data. Viewed in this way, the phenomena of the Principia and the experiments from the Opticks were different routes to the (...) same end: isolating explananda. (shrink)

The question I want to discuss is that of the sense and respects in which morality is strictly a matter for the individual. To hear some people talk you would think that it is wholly so. Not only do I have to make my own moral decisions; I have in a way to make them on my own terms, in so far as the rules I take to govern my actions are rules I have freely accepted, or at the least (...) not positively repudiated. In law I can be bound by statutes which I regard as abhorrent or even of whose content I am ignorant ; that a similar situation should obtain in morals is commonly treated as absurd. If I see nothing wrong with a certain practice, such as premarital sex or drug-taking, I can’t be brought morally to book for indulging in it. Morals is not solely a matter of personal taste, for the nature of moral judgment is such that the moral agent legislates not just for himself but for all who are similarly situated; equally, however, it is not something which can be externally enforced. There are no objective moral principles, plain for all to see, against which to measure moral error, and though there is fairly widespread agreement among the respectable that some forms of conduct are morally admirable and others morally deplorable, we are under no obligation to respect these “conventions.” A man’s only true obligation here is to follow his conscience and thus do what he takes to be right, in the light of the best information about the situation he can get. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)