In lieu of an abstract, here is a brief excerpt of the content:diacritics 35.1 (2005) 71-98MuseSearchJournalsThis JournalContents[Access article in PDF]Hospitality after the Death of GodTracy McNultyPierre Klossowski's fiction has been only sporadically published in English, and largely dismissed as perverse erotica or soft-core porn. When his 1965 trilogy Les lois de l'hospitalité was partially translated in English (under the title Roberte, ce soir & The Revocation of the Edict of Nantes), its Library of Congress classification characterized it simply as (...) "erotic fiction—French." Even in France, Klossowski has become the very signifier of perversion. His artwork graces the cover of Serge André's L'imposture perverse and of numerous erotic novels, he has been "diagnosed" as a pervert by writers on both sides of the Atlantic, and unironic readers of his Sade mon prochain hail him as Sade's disciple and heir.1Admittedly, the larger stakes of Klossowski's work are easily obscured by its free adaptation of the stock themes of libertine literature. His fictional works, like his visual compositions (essentially representations of rape scenes, often on historical themes—Diana and Actaeon, the Rape of Lucretia), explore the conflict between a woman's chaste moral attitude and her gradual surrender to an assailant's advances. The Laws of Hospitality concerns the erotic awakening of "hospitality" in a woman, which exposes a contradiction within her moral character and reveals her symbolic identity to be without foundation. Its protagonist Octave, who bears more than a passing resemblance to his creator, is a collector of artworks that eroticize the moment of moral hesitation experienced by women submitting to the sexual advances of a chance stranger—or even a "spiritual" apparition. His "laws of hospitality" are the fruit of his desire to experience this operation firsthand; they name a practice wherein the master of the house "offers" his wife to fortuitous guests, in order to savor the moment of her surrender.However, the stakes of Klossowski's "perverse" meditations are very different from the Sadeian project of uprooting religious morality. Sade challenges the patriarchal and religious authorities of his day by demonstrating that the paternal signifier on which their laws are based is without foundation. In proving that the law cannot hold [End Page 71] up against the repeated assaults of libertinage, he mounts a systematic deconstruction of the symbolic order of language by the real of jouissance. But although Klossowski may share Sade's perverse drive to "humiliate the law with the object,"2 his target is not the signifier as such, but rather the imaginary consistency afforded by what he calls the "grammatical fiction of the 'I,'" the illusion of autonomous personhood. The "object" he confronts it with is not the natural "truth" of jouissance, but rather the feminine object who disrupts the identity of the "master" who offers her.Klossowski's reflections on the special status of femininity in Enlightenment culture—at once marginal and singularly "extimate"—have never been fully appreciated, despite their enormous interest for the study of culture. In a way unique among contemporary authors, Klossowski sheds light on Jacques Lacan's enigmatic insight that the cultural importance of the feminine object consists in its sublimated status as an "object raised to the dignity of the Thing" [Lacan 112]. His fiction underscores the close ties between the feminine and what Freud called das Ding, the Thing uncannily internal to subjectivity that Lacan later identified with the function of the Nebenmensch, as the apotheosis of the Christian idea of the prochain, or neighbor [Lacan 151–52].Although Klossowski's erotic scenario invites comparisons with Sade's and Fourier's utopian calls to dissolve the privative boundaries between subjects, what he understands by "hospitality" is not the abolition of personal identity, but rather the staging of its internal contradiction.Hospitality, at the Limits of the LawThe act of hospitality—whose theological and philosophical origins this former Dominican novice and Latin scholar was intimately acquainted with—concerns a very particular tension. Etymologically, the host is the "master," the one who "eminently personifies" identity: not only his own identity, but also that of the group in whose... (shrink)

ABSTRACTBrazil has not yet approved legislation on assisted reproduction. For this reason, clinics, hospitals and semen banks active in the area follow Resolution 1358/92 of the Conselho Federal de Medicina, dated 30 September 1992. In respect to semen donation, the object of this article, the Resolution sets out that gamete donation shall be anonymous, that is, that the donor and recipients shall not be informed of each other's identity. Thus, since recipients are unaware of the donor's identity, semen banks and (...) the medical teams involved in assisted reproduction become the intermediaries in the process. The objective of this article is to show that, in practice, this represents disrespect for the ethical principles of autonomy, privacy and equality. The article also stresses that the problem is compounded by the racial question. In a country like Brazil, where racial classification is so flexible and goes side by side with racist attitudes, the intermediary role played by semen banks and medical teams is conditioned by their own criteria of racial classification, which are not always the same as those of donors and semen recipients. The data presented in this paper were taken from two semen banks located in the city of São Paulo . At the time of my research, they were the only semen banks in the state of São Paulo and supplied semen to the capital , the state of São Paulo, and to cities in other Brazilian states where semen banks were not available. (shrink)

Brazil has not yet approved legislation on assisted reproduction. For this reason, clinics, hospitals and semen banks active in the area follow Resolution 1358/92 of the Conselho Federal de Medicina, dated 30 September 1992. In respect to semen donation, the object of this article, the Resolution sets out that gamete donation shall be anonymous, that is, that the donor and recipients (and the children who might subsequently be born) shall not be informed of each other's identity. Thus, since recipients are (...) unaware of the donor's identity, semen banks and the medical teams involved in assisted reproduction become the intermediaries in the process. The objective of this article is to show that, in practice, this represents disrespect for the ethical principles of autonomy, privacy and equality. The article also stresses that the problem is compounded by the racial question. In a country like Brazil, where racial classification is so flexible and goes side by side with racist attitudes, the intermediary role played by semen banks and medical teams is conditioned by their own criteria of racial classification, which are not always the same as those of donors and semen recipients. The data presented in this paper were taken from two semen banks located in the city of São Paulo (Brazil). At the time of my research, they were the only semen banks in the state of São Paulo and supplied semen to the capital (São Paulo city), the state of São Paulo, and to cities in other Brazilian states where semen banks were not available. (shrink)

This article examines three films made during the 1950s by Elwyn James Anthony at the psychotic clinic for children at the Maudsley Hospital that marked an important transition in the purpose and practice of visual documentation in a clinical setting: film as a research tool was transitioning from the recording of external signs as indicators of internal subjective states, to the capture of the visual flow of communication between subjects. It is a shift that had a particular impact on (...) the emergent classification of autism, a modality not yet properly separated from the broader term of psychosis, as a non-relational condition whose visual capture demonstrated a void of inter-human communicational exchange. Film was significant not only as a recording apparatus, but as a method of cutting and crafting sequences of movements into brief repetitive motifs. The filmed behaviour of children remained opaque to interpretation, a ‘finding’ that facilitated the modelling of an emergent autism as subjects who were isolated, alienated and automaton-like, inhabiting a separate temporality. The article situates this ‘second’, affectless autism, within a broader context of post-war research into gestures as a language of the body, developed largely through an intellectual network of German émigré psychoanalysts who had fled to the US and UK in the 1930s. (shrink)

The series friends, rivals, enemies is a seemingly ‘natural’ classification for the relations of states, while the parallel series kin, neighbors, strangers functions as an informal classification system for social relations in general. That we may owe foreigners the hospitality due to strangers has become a matter of discussion among normative theorists, thanks to Kant's Perpetual Peace. Thus the conjunction of friendship and hospitality calls for a conceptual assessment. This assessment uses Aristotle's treatment of friendship (and Derrida's treatment (...) of Aristotle's ‘familial schema’) to establish three primary models of social relations (father to sons, husband to wife, brother to brother). Only ‘brothers’ (agents modeled as brothers) can be friends, rivals, or enemies. Only ‘fathers’ can be hosts who offer strangers the hospitality of the household. By the same token, only ‘fathers’ can be guests or take hostages. Such an assessment brings the conceptual concerns of two fields — international relations and political theory — closer together. In so doing, it rejects anarchy's conceptual hegemony in the field of international relations. (shrink)

Church asylum, a practice aimed at assisting migrants with precarious residence statuses, has been enacted in Finland particularly since the 2010s. As a result of migrants’ insecure residency, their capacities of action are often restricted. They have been deprived of access to health and social services and schooling, and their movements limited due to fear of the police and deportation. This article analyses the autonomy and capacities of action of those in church asylum and the congregations assisting them, following Albert (...) Bandura’s classification of individual, proxy and collective agency. The data consists of interviews with employees of congregations and people who have been in church asylum. According to the results, the agency of people in church asylum was often drastically limited, which led to a need for proxy and collective agencies. Immigration regulation created a structure controlling the autonomy and capacities of both migrants and congregations. All modes of agency were inventively applied. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There (...) is little systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

Electrotherapy is a dynamically developing method of treatment of sinus node dysfunction and atrioventricular conduction disturbances. It is an extremely important method used in the treatment of heart failure. The aim of this paper was to use classification trees for the differentiation between patients implanted with one of the three electrotherapy devices, i.e. SC-VVI/aai, DC-DDD, ICD/crt. The analysed data concerned 2071 patients who underwent implantation or device replacement procedures in the years 2010–2018, hospitalized in a coronary care unit. CART-type (...) classification trees with 5-fold cross-validation were used for the analysis. The decision concerning the choice of a particular electrotherapy device is always made based on the latest guidelines and the patient’s clinical condition. The used classification trees may enable verification of the state of implementation of guidelines in real-life therapeutic decisions. (shrink)

ObjectiveTo investigate post-traumatic stress disorder, perceived professional benefits and post-traumatic growth status among Chinese nurses in the context of the COVID-19 pandemic and to compare the differences between nurses working inside and outside Hubei.MethodsFrom February 18 to February 25, 2020, the authors constructed the questionnaire using the Questionnaire Star platform, and convenience sampling was used to distribute the questionnaire via WeChat. Nurses who worked at the hospital during the COVID-19 pandemic were the research subjects.ResultsA total of 3,419 questionnaires were (...) received, of which 2,860 nurses were working outside Hubei Province and 559 nurses were working inside Hubei Province. Both groups were exposed to COVID-19. The results indicated that gender, job title, department, average monthly income, the number of night shifts per month, hospital classification, specialization, and previous experience with assisting during disasters were statistically significant. The t-test results showed that the difference in perceived professional benefits scores between the two groups was not statistically significant, and the differences in PTG scores and PTSD scores between the two groups were statistically significant. The chi-square test indicated that the difference in PTSD prevalence between nurses working outside and inside Hubei Province was statistically significant and that the PTSD prevalence of nurses working outside Hubei Province was higher than that of nurses working inside Hubei Province. One-way ANOVA and independent sample t-test results showed that age, job title, job assignment, length of service, average monthly income, number of night shifts per month, number of children, and the Nurses’ Perceived Professional Benefits Scale and post-traumatic growth inventory scores influenced the prevalence of PTSD. Logistic regression showed that the occurrence of PTSD was associated with average monthly income, length of service, number of children, and the PTGI and NPPBS scores.ConclusionDuring the COVID-19 pandemic, nurses working outside Hubei Province reported greater PTSD than those working inside Hubei Province. The occurrence of PTSD was related to average monthly income, length of service, number of children, and the PTGI and NPPBS scores. (shrink)

Character strengths profiles in the specific setting of medical professionals are widely unchartered territory. This paper focused on an overview of character strengths profiles of medical professionals (medical students and physicians) based on literature research and available empirical data illustrating their impact on well-being and work engagement. A literature research was conducted and the majority of peer-reviewed considered articles dealt with theoretical or conceptually driven ‘virtues’ associated with medical specialties or questions of ethics in patient care (e.g., professionalism, or what (...) makes a good physician). The virtues of compassion, courage, altruism, and benevolence were described most often. Only a limited number of papers addressed character strengths of medical students or physicians according to the VIA-classification. Those articles showed that the VIA-character strengthsfairness, honesty,kindness, andteamworkwere considered most often by respondents to be particularly important for the medical profession. Available cross-sectional (time span: six years) and longitudinal (time span: three years) data regarding VIA-character strengths profiles of medical professionals were analyzed (N= 584 medical students, 274 physicians). These profiles were quite homogenous among both groups. The character strengthsfairness,honesty,judgment,kindness, andlovehad the highest means in both samples. Noteworthy differences appeared when comparing medical specialties, in particular concerning general surgeons and psychiatrists, with the former reporting clearly higher levels of e.g.,honesty(d= 1.02) orprudence(d= 1.19). Long-term results revealed significant positive effects of character strengths on well-being and work engagement (e.g.,perseveranceon physicians’ work engagement) but also significant negative effects (e.g.,appreciation of beauty and excellenceon students’ well-being). Further,hopewas significantly associated both positively with physicians’ well-being and negatively with students’ work engagement, possibly indicating specific issues concerning medical education or hospital working conditions. According to the modern-day physician’s pledge, medical professionals should pay attention to their own well-being and health. Therefore, promoting self-awareness and character building among medical professionals could be a beneficial strategy. (shrink)

We have made huge progress in understanding the biology of mental illnesses, but comparatively little in interpreting them at the psychological level. The eminent philosopher Jonathan Glover believes that there is real hope of progress in the human interpretation of disordered minds. -/- The challenge is that the inner worlds of people with psychiatric disorders can seem strange, like alien landscapes, and this strangeness can deter attempts at understanding. Do people with disorders share enough psychology with other people to make (...) interpretation possible? To explore this question, Glover tackles the hard cases—the inner worlds of hospitalized violent criminals, of people with delusions, and of those diagnosed with autism or schizophrenia. Their first-person accounts offer glimpses of inner worlds behind apparently bizarre psychiatric conditions and allow us to begin to learn the “language” used to express psychiatric disturbance. Art by psychiatric patients, or by such complex figures as van Gogh and William Blake, give insight when interpreted from Glover’s unique perspective. He also draws on dark chapters in psychiatry’s past to show the importance of not medicalizing behavior that merely transgresses social norms. And finally, Glover suggests values, especially those linked with agency and identity, to guide how the boundaries of psychiatry should be drawn. -/- Seamlessly blending philosophy, science, literature, and art, Alien Landscapes? is both a sustained defense of humanistic psychological interpretation and a compelling example of the rich and generous approach to mental life for which it argues. (shrink)

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a "community" within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between "autonomy" and "community." The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part (...) II examines a clinical trial for the blood substitute PolyHeme® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of "community." The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment. (shrink)

Willingness and readiness of people to do their jobs are among the key factors of a successful enterprise. In XXI century intellectual human labour is gaining unprecedented value and is being developed actively. The demand for intellectual labour calls forth an increasing number of jobs and professions that require an extensive preparation, a large number of working places, high level of integration of joint human efforts, growth of social welfare. These trends are becoming ever more pervasive and are spreading widely (...) in service industries, and that explains the rapid development of the latter when compared to the traditional areas of human activity. In its turn, it heightens the need for staff in service companies, supported by significant personnel turnover and a certain shortage of skilled professionals. These circumstances determine the need for developing a new concept of fostering staff motivation at the enterprises in the sphere of services. In order to reach the stated purpose while conducting our research into tourism and hospitality industry, as well as retail chains, we have examined the problems that arise in the process of staff motivation, and studied the foreign practice of motivating staff in hotels. The obtained analysis results enabled us to work out practical recommendations on improvement of the mechanism of tangible and intangible rewards in service companies, which are based on external and internal motivational factors. Additional attention in the article is paid to the statement that financial incentives should be based on key performance indicators (KPI). We give a detailed consideration to the classification of internal motivation incentives of the staff according to the terms of their realization, and give a schematic representation of the performance dynamics of the internal motivation model in service businesses. (shrink)

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a ?community? within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between ?autonomy? and ?community.? The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part (...) II examines a clinical trial for the blood substitute PolyHeme? (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of ?community.? The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment. (shrink)

We present a study of the linguistic output of the German-speaking writer Robert Walser using Natural Language Processing (NLP). We curated a corpus comprising texts written by Walser during periods of sound health, and writings from the year before his hospitalization, and writings from the first year of his stay in a psychiatric clinic, all likely attributed to schizophrenia. Within this corpus, we identified and analyzed a total of 20 linguistic markers encompassing established metrics for lexical diversity, semantic similarity, and (...) syntactic complexity. Additionally, we explored lesser-known markers such as lexical innovation, concreteness, and imageability. Notably, we introduced two additional markers for phonological similarity for the first time within this context. Our findings reveal significant temporal dynamics in these markers closely associated with Walser’s contemporaneous diagnosis of schizophrenia. Furthermore, we investigated the relationship between these markers, leveraging them for classification of the schizophrenic episode. (shrink)

Multiple studies have been performed to identify the most common ethical dilemmas encountered by ethics consultation services. However, limited data exists comparing the content of ethics consultations requested by specific hospital specialties. It remains unclear whether the scope of ethical dilemmas prompting an ethics consultation differ between specialties and if there are types of ethics consultations that are more or less frequently called based on the specialty initiating the ethics consult. This study retrospectively assessed the incidence and content of (...) ethics consultations called by surgical vs. non-surgical specialties between January 1, 2013 to December 31, 2018 using our RedCap Database and information collected through the EMR via our Clinical and Translational Science Center. 548 total ethics consultations were analyzed. Our results demonstrate that more surgical consults originated from the ICU, as opposed to lower acuity units, and surgical patients were more likely to have a DNR in place. Surgical specialties were more likely to call about issues relating to withholding/withdrawing life-sustaining treatment, while non-surgical specialties were more likely to call about issues related to discharge planning. There appear to be morally relevant differences between consults classified as the “same” that are not entirely captured by the usual ethics consultations classification system. In conclusion, this study highlights the unique ethical issues experienced by surgical vs. non-surgical specialties. Ultimately, our data can help ethics consultation services determine how best to educate various hospital specialties to approach ethical issues commonly experienced within their field. (shrink)

Introduction: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. Aim: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. Method: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with advanced (...) cancer. Results: Four domains of vulnerability derived from Kipnis’s taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others—for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (shrink)

The aim of this review is to identify and provide a structured overview of quantitative models in the pharmaceutical supply chain, a subject not exhaustively studied in the previous reviews on healthcare logistics related mostly to quantitative models in healthcare or logistics studies in hospitals. The models are classified into three categories of classification: network design, inventory models, and optimization of a pharmaceutical supply chain. A taxonomy for each category is shown describing the principal features of each echelon included (...) in the review; this taxonomy allows the readers to identify easily a paper based on the actors of the pharmaceutical supply chain. The search process included research articles published in the databases between 1984 and November 2016. In total 46 studies were included. In the review process we found that in the three fields the most common source of uncertainty used is the demand in the 56% of the cases. Within the review process we can conclude that most of the articles in the literature are focused on the optimization of the pharmaceutical supply chain and inventory models but the field on supply chain network design is not deeply studied. (shrink)

This paper proposes a novel method for identifying the public evaluative standards that contribute to the classification of certain conditions as mental disabilities. Public evaluative standards could contribute to ascertaining disabilities by outlining characteristics whose presence beyond a threshold is fundamentally important for the life of a person and whose absence or reduced occurrence constitutes a disability. Additionally, they can participate in determining disabilities by delineating particularly grave difficulties, impairments, or incapacities. Our method relies on a model of public (...) justification of evaluative standards that is inspired by Gerald Gaus’s theory of public reason. Thus, our approach recommends the justification of evaluative standards through sound deliberative routes from reasons accessible to all persons who participate in the process of justification and the convergence of what is justified in this way to each of them. We deem that disabilities could be caused both by problems in the internal characteristics of a person as well as by unfairness or a lack of hospitality in external circumstances. This is why the method of justification is applied to the assessment of those circumstances as well. If social or environmental circumstances cannot be justified through the convergence of reasons accessible to all persons involved in the process of justification, we have reasons to exclude the presence of a disability and ascertain the presence of inadequate external conditions. (shrink)

The DSM-III, DSM-IV, DSM-IV-TR and ICD-10 have judiciously minimized discussion of etiologies to distance clinical psychiatry from Freudian psychoanalysis. With this goal mostly achieved, discussion of etiological factors should be reintroduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A research agenda for the DSM-V advocated the "development of a pathophysiologically based classification system". The author critically reviews the neuroevolutionary literature on stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in (...) adult humans. Over 30 empirically testable/falsifiable predictions are presented. It is noted that in DSM-IV-TR and ICD-10, the classification of stress and fear circuitry disorders is neither mode-of-acquisition-based nor brain-evolution-based. For example, snake phobia and dog phobia are clustered together. Similarly, research on blood-injection-injury-type-specific phobia clusters two fears different in their innateness: 1) an arguably ontogenetic memory-trace-overconsolidation-based fear and 2) a hardwired fear of the sight of one's blood or a sharp object penetrating one's skin. Genetic architecture-charting of fear-circuitry-related traits has been challenging. Various, non-phenotype-based architectures can serve as targets for research. In this article, the author will propose one such alternative genetic architecture. This article was inspired by the following: A) Nesse's "Smoke-Detector Principle", B) the increasing suspicion that the "smooth" rather than "lumpy" distribution of complex psychiatric phenotypes may in some cases be accounted for by oligogenic transmission, and C) insights from the initial sequence of the chimpanzee genome and comparison with the human genome by the Chimpanzee Sequencing and Analysis Consortium published in late 2005. Neuroevolutionary insights relevant to fear circuitry symptoms that primarily emerge overconsolidationally are presented. Also introduced is a human-evolution-based principle for clustering innate fear traits. The "Neuroevolutionary Time-depth Principle" of innate fears proposed in this article may be useful in the development of a neuroevolution-based taxonomic re-clustering of stress-triggered and fear-circuitry disorders in DSM-V. Four broad clusters of evolved fear circuits are proposed based on their time-depths: 1) Mesozoic circuits hardwired by wild-type alleles driven to fixation by Mesozoic selective sweeps; 2) Cenozoic circuits relevant to many specific phobias; 3) mid Paleolithic and upper Paleolithic circuits ; 4) Neolithic circuits. More importantly, the author presents evolutionary perspectives on warzone-related PTSD, Combat-Stress Reaction, Combat-related Stress, Operational-Stress, and other deployment-stress-induced symptoms. The Neuroevolutionary Time-depth Principle presented in this article may help explain the dissimilar stress-resilience levels following different types of acute threat to survival of oneself or one's progency. PTSD rates following exposure to lethal inter-group violence are usually 5-10 times higher than rates following large-scale natural disasters such as forest fires, floods, hurricanes, volcanic eruptions, and earthquakes. The author predicts that both intentionally-caused large-scale bioevent-disasters, as well as natural bioevents such as SARS and avian flu pandemics will be an exception and are likely to be followed by PTSD rates approaching those that follow warzone exposure. During bioevents, Amygdala-driven and locus-coeruleus-driven epidemic pseudosomatic symptoms may be an order of magnitude more common than infection-caused cytokine-driven symptoms. Implications for the red cross and FEMA are discussed. It is also argued that hospital phobia as well as dog phobia, bird phobia and bat phobia require re-taxonomization in DSM-V in a new "overconsolidational disorders" category anchored around PTSD. The overconsolidational spectrum category may be conceptualized as straddling the fear circuitry spectrum disorders and the affective spectrum disorders categories, and may be a category for which Pitman's secondary prevention propranolol regimen may be specifically indicated as a "morning after pill" intervention. Predictions are presented regarding obsessive-compulsive disorder and "culture-bound" acute anxiety symptoms. Also discussed are insights relevant to pseudoneurological symptoms and to the forthcoming Dissociative-Conversive disorders category in DSM-V, including what the author terms fright-triggered acute pseudo-localized symptoms. Speculations based on studies of the human abnormal-spindle-like, microcephaly-associated gene, the microcephaly primary autosomal recessive gene, and the forkhead box p2 gene are made and incorporated into what is termed "The pre-FOXP2 Hypothesis of Blood-Injection-Injury Phobia." Finally, the author argues for a non-reductionistic fusion of "distal neurobiology" with clinical "proximal neurobiology," utilizing neurological heuristics. It is noted that the value of re-clustering fear traits based on behavioral ethology, human-phylogenomics-derived endophenotypes and on ontogenomics can be confirmed or disconfirmed using epidemiological or twin studies and psychiatric genomics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I am Not Obese. I am Just Fat.Sarah BrambletteMy body mass index classifies me as super morbidly obese, however my overall vital health statistics would indicate otherwise. I celebrated the American Medical Association’s classification of obesity as a disease for several reasons. First, obesity as a disease involves other medical complications of which I have none, so finally perhaps I can say I am not obese, I am (...) just fat. I am fat, as in my weight is caused by Lipedema and Lymphedema. Lipedema is a congenital condition, which causes my body to produce and accumulate abnormal amounts of adipose tissue in my legs, hips, thighs, and arms. There is not much known about Lipedema in the medical profession, even though it was identified in 1940 by doctors at the Mayo Clinic, and not many treatment options exist. Abnormal Lipedema tissue does not respond to restrictive caloric diet or exercise. Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. The second reason I celebrated obesity being classified as a disease was the hope that more research would be conducted on the actual causes and treatment of obesity and that research might include adipose tissue disorders. My vital health statistics are all normal, yet I still face challenges getting proper treatment in healthcare.My StoryAs I sat staring at the metal beast, I decided to make one final attempt to mount it. I placed my right foot on the step and used both hands to boost myself up, my lower legs were so large there was no room for my left foot. Immediately the exam table began to tip towards me, then slammed loudly against the tile floor as I quickly stepped off. It was a game of exam table teeter–totter I had played many times before and lost more often than won. I gave up, placed the sheet meant to cover my legs on the chair in the corner and squeezed myself down between its arms. The exam gown pinched my arms, barely covering the front of me and draped over my legs.My LegsOne of the main reasons I was seeing a new doctor, my first doctor visit in several years. My previous family doctor had retired. I was not ill, I was concerned. My weight had reached a point to where I was scared for my health and I wanted to get help and answers. I wanted answers about why my legs were so large and leaked fluid.The answer I got was one I had heard before “It’s your weight”.To the doctor’s credit, she did explain it a bit more, she said the fluid in my legs was due to my excess weight putting pressure on my legs. However, she did not actually know how much I weighed. The scale in her office only went to 350lbs, and even with the add–on weight it could not register a weight for me, so we only knew I weighed more than 400lbs. I asked her if she knew if the hospital or another office had a scale that could weigh me. She did not. She may have sent me home with a prescription for a diuretic, I do not remember. I know I was not sent home with any help for my weight or my legs, just a follow–up appointment. It was during that follow up appointment that I advocated for myself and asked if she would refer me for physical therapy, so that I could do some safe and monitored exercise. She agreed, and I began physical therapy in the pool.At the pool I met other people who looked similar to my size. I noticed their legs were normal size and wondered why? Then I thought about sumo wrestlers. Sumo wrestlers weigh hundreds of pounds and their legs are normal too. What was wrong with my legs? One day I heard a man in the pool tell another [End Page 85] patient that he had lost weight. I wondered where he was able to weigh himself, and hoped it was not rude to ask him. He told me... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recent and Classic References at the Interface of Philosophy, Psychiatry, and Abnormal PsychologyArticlesAggernaes, A. 1972. The expanded reality of hallucinations and other psychological phenomena. Acta Psychiatrica Scandinavica 48: 220–238.Anonymous. 1991. Child sexual abuse and the limits of responsibility. Lancet 337: 890.Anonymous. 1993. Mental incapacity and medical treatment. Lancet 341: 1123–1124.Appelbaum, M. D., and A. Creer. 1993. Confidentiality in group therapy. Hospital and Community Psychiatry 44: 311–312.Beatson, J. A. (...) 1993. The psychiatrist and peer review—a psychodynamic review of the literature. Australia and New Zealand Journal of Psychiatry 27: 311–318.Berrios, G. E. 1987. Dementia during the seventeenth and eighteenth centuries: a conceptual history. Psychological Medicine 17: 829–837.Blackburn, R. 1988. On moral judgments and personality disorders: the myth of psychopathic personality revisited. British Journal of Psychiatry 153: 505–512.Blackmon, W. D. 1993. Are psychoanalytic billing practices ethical? American Journal of Psychotherapy 47: 613–620.Blashfield, R. K., and J. G. Draguns. 1976. Evaluative criteria for psychiatric classification. Journal of Abnormal Psychology 85, no. 2: 140–150.Blashfield, R. K., J. Sprock, and A. K. Fuller. 1990. Suggested guidelines for including or excluding categories in the DSM-IV. Comprehensive Psychiatry 31, no. 1: 15–19.Blashfield, R. K., J. Sprock, D. Haymaker et al. 1989. The family resemblance hypothesis applied to psychiatric classification. Journal of Nervous and Mental Disease 177: 492–497.Borys, D. S. 1994. Maintaining therapeutic boundaries: the motive is therapeutic effectiveness not defensive practice. Ethics and Behavior 4, no. 3: 267–273.Brown, W. M. 1985. On defining disease. Journal of Medicine and Philosophy 10: 311–328.Bub, J. 1994a. Is cognitive neuropsychology possible? Proceedings of the Biennial Meetings of the Philosophy of Science Association 1: 417–427.Bub, J. 1994b. Testing models of cognition through the analysis of brain-damaged performance. British Journal of Philosophy of Science 45, no. 3: 837–855.Buck, C. 1989. Problems with the Popperian approach: A response to Pearce and Crawford-Brown. Journal of Clinical Epidemiology 42: 185–187.Buck, R. 1994. The neuropsychology of communication: spontaneous and symbolic aspects. Journal of Pragmatics 22, no. 3-4: 265–278.Camp, N. M. 1993. The Vietnam war and the ethics of combat psychiatry. American Journal of Psychiatry 150: 1000–1009.Crockett, C. 1961. Ethics, metaphysics, and psychoanalysis. Inquiry 4: 37–52.Dalton, E., K. Hopper, and S. Reiner. 1976. Ethical issues in behavior control. Values and Ethics in Health Care 2: 1–40.Faust, D. 1993a. Use and then prove, or prove and then use? Some thoughts on the ethics of mental health professionals’ courtroom involvement. Ethics and Behavior 3, no. 3-4: 359–380.Fodor, J., and E. Lepore. 1994. What is the connection principle? Philosophy and Phenomenological Research 54: 4.Foss, L. 1994. Putting the mind back into the body: a successor scientific medical model. Theoretical Medicine 15, no. 3: 291–313.Galletly, C. A. 1993. Psychiatrist-patient sexual relationships: the ethical dilemmas. Australia and New Zealand Journal of Psychiatry 27: 133–139.Glymour, C. 1994. On the methods of cognitive neuropsychology. British Journal of Philosophy of Science 45, no. 3: 815–835.Gottlieb, M. C. 1994. Ethical decision making, boundaries, and treatment effectiveness: a reprise. Ethics and Behavior 4, no. 3: 287–293.Gutheil, T. G. 1994. Discussion of Lazarus’s “How certain boundaries and ethics diminish therapeutic effectiveness”. Ethics and Behavior 4, no. 3: 295–298.Helme, T. 1993. A special defence—a psychiatric approach to formalising euthanasia. British Journal of Psychiatry 163: 456–466.Kovel, J. 1976–77. Therapy in late capitalism. Telos 30: 73–92.Lazarus, A. A. 1994a. How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior 4, no. 3: 255–261.Lazarus, A. A. 1994b. The illusion of the therapist’s power and the patient’s fragility: my rejoinder. Ethics and Behavior 4, no. 3: 299–306.Lehrman, N. S. 1980. Psychiatric power and responsibility: Abuse and abdication, a proposed corrective conference. The Humanist 40: 9–13.Lockhart, T. 1992. Professions, confidentiality, and moral uncertainty. Professional Ethics: A Multidisciplinary Journal 1, no. 3-4: 33–52.Margolin, S. G. 1964. The scientific status of psychoanalytic clinical evidence (II). Inquiry 7: 37... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Third Way: Social Disability and Person-Centered AssessmentChristopher Heginbotham (bio)Keywordsimpaired functioning, psychopathic, personality disorder, neurological damage, psychotherapyJohn Sadler’s Fascinating Paper identifies a significant problem with existing diagnostic classifications. But in doing so he raises further unresolved philosophical, nosological, and practical problems. Although he is undoubtedly right in showing that the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (and International Classification of Diseases [ICD]-10) do not provide an (...) adequate categorization, he is I believe wrong to use the term “vice” to describe the cluster of wrongful acts.“Vice” conjures up images of Miami, drugbusting police, prostitution, and other activities that are characterized by one thing—by and large, these are actions undertaken knowingly, usually for financial gain. These are not the actions of people with impaired mental functioning as a result of mental disorder or neurological damage. It is of course true that human trafficking and enforced prostitution may mean women forced into prostitution against their will, but rarely are these women considered mentally disordered solely as a result of their prostitution. Yet it is capacitated, premeditated wrongdoing that is normally considered to be “vice.”By contrast, all the cases cited in the paper describe conditions that are almost certainly the result of some form of impaired functioning, either owing to early childhood experiences (Case A), familial culture and conditioning (Case B), or neurological damage (Case C). The common thread in these cases is impaired capacity—in Case A this could be described as due to psychopathic or personality disorder (I distinguish the two separately rather than describe the phenomenon as “psychopathic personality disorder”) as a result of multiple childhood traumas. Their presentation is not unexpected given the person’s history and, although the condition may have become refractory, it might be amenable to treatment with psychoanalytically oriented psychotherapy, given sufficient time and a nurturing environment (Bateman and Fonagy 2006, 2008; Cordess and Cox 1996; Levy 2008).The description of Case B leaves a lot of room for doubt and uncertainties. Did Ms A really try to smother her child? She confessed to one occasion, but was this under duress? Did she feel that if she agreed she would be treated more leniently? And if she was guilty, does it suggest “vice,” a premeditated act, or is there another explanation—attention [End Page 31] seeking because of low self-esteem or a personality disorder as a result of some abuse that had not been identified? Almost certainly from the description given this would not count, for me at any rate, as vice. Her actions may be odd, bizarre, or dangerous, but did they demonstrate a mens rea? Was Ms A making adequate evaluative judgments of her situation and that of her child? We know from clinical work with very damaged women in forensic mental health services that early physical, emotional, or sexual abuse leads in turn to women harming both themselves and their children (Bland et al. 1999; Cordess and Cox 1996; see also for example, Jeffcote and Watson 2004). Or perhaps, speculatively, her condition was Munchausen’s by proxy?Case C is horrendous but does not lend itself readily to the forms of psychiatric classification available. Indeed there is no easy way to describe such actions other than those of someone who is either incapable of understanding the nature and consequence of the actions that he has undertaken, or is simply “mad” in a folk sense. Prima facie this seems to be the result of permanent and little understood neurological damage. However, this case comes closest to the evil that is implied in the term “vice”; and might be diagnosed similarly to a celebrated English murderer, that of Peter Sutcliffe, the so-called Yorkshire Ripper. Sutcliffe was diagnosed as suffering from paranoid schizophrenia, although the jury at his trial found that he was fit to plead, and he was initially sent to prison, where he deteriorated. He is now, and has for some time, been in Broadmoor high secure hospital.The result of these comments is that I agree fully with John Sadler’s conclusions, but for rather different reasons. DSM-IV categories try and fail to offer a symptomatology for... (shrink)

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a “community” within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between “autonomy” and “community.” The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part (...) II examines a clinical trial for the blood substitute PolyHeme® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of “community.” The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Bad, the Ugly, and the Need for a Position by PsychiatryLloyd A. Wells (bio)Keywordsvice, psychiatric education, psychiatry-law interface, medicalizationSadler’s paper is thought provoking and will resonate with many psychiatrists who deal with the interface of vice and psychiatric syndromes. This interface and the dilemmas it poses are perhaps most discussed by residents, who are dealing with the issue for the first time and who often debate what is (...) “psychiatric” about these cases. Many residents have their own informal systems of classifying vice, often with a divide between the criminal population and those perceived as avoiding work and responsibility. These unofficial classifications are usually judgmental and often pejorative, but the residents rarely get much help from faculty in this area. Indeed, many of the faculty have equally judgmental and pejorative views, which are neither systematized nor subject to systematic analysis.By clarifying the importance of the issue of the vice–mental disorder relationship (VMDR) to psychiatry, Sadler may move this topic to one that receives Socratic discourse in our training programs and serious consideration in the training of psychiatrists rather than an idiosyncratic lumping of these patients into the broad category of “patients I don’t like.”Sadler asks for comments in several categories: historical intractability, goals of psychiatry, taxonomy, implications for the criminal justice system, implications for the law, and ethical/political implications.Issues of historical intractability are long standing. In A Tour of the Whole Island of Great Britain, written in the early eighteenth century, Daniel Defoe (1724–1727) describes many asylums, often with the comment, “as it is a madhouse, so is it also a house of correction.” Some of the great public hospitals of the seventeenth and eighteenth centuries were built at least as much to get antisocial and homeless people off the streets as to provide care for the mentally ill. The moral treatment of France and Great Britain, which added much to the practice of psychiatry, clearly had punitive “treatments” for patients with vice-laden behaviors, and this was very explicit in the American moral model of treatment of the late nineteenth century with its obsessive need to prevent patients from masturbating. In the nineteenth and early twentieth centuries, there was great debate about the inclusion of Pritchard’s “moral insanity”—now sanitized into “personality disorders”—into the psychiatric domain, and Kraepelin referred to this group as “enemies of society.”Sadler next asks us to consider the goals of psychiatry in regard to “a proper VMDR.” He wonders [End Page 43] whether a strict medicalization account can be defended. I think it is clear from a large literature and from clinical experience that it cannot be defended —now. But it may become defensible in this century, which will pose enormous challenges to psychiatry, lawmakers, and the courts (vide infra). A strict moralization model is defended by many in society, including some psychiatrists, but has severe limitations and seems illogical. It is hard to make a case (though juries have done so) that, for example, a very delusional young woman with postpartum psychosis who murders her children because of the belief that far worse things than death will happen to them imminently if they live, fits the moralization approach. The Dahmer case is especially instructive. Although there was enormous “vice” (and perhaps “evil”), it is hard to make a case that a sane man would make temples out of the body parts of victims and would attempt to commune with the dead through them.He wonders whether a “mixed” version of medicalization/moralization can be developed and defended. I would argue for both a mixed approach and a “shared” approach. A middle adolescent with bipolar disorder burned his house to the ground. (Fortunately, he and family members were injured but not killed.) He was wildly manic at the time and set the fire because he wanted to prove that he was immortal and totally impervious to flames. He was delusional, extraordinarily impulsive, and completely without judgment, and it would be extraordinarily difficult to exclude the medical frame in any consideration of the vice involved. The vice, indeed, may be more involved in his decision while euthymic to stop taking... (shrink)

We construct by diagonalization a non-well-founded primitive recursive tree, which is well-founded for co-r.e. sets, provable in Σ1 0. It follows that the supremum of order-types of primitive recursive well-orderings, whose well-foundedness on co-r.e. sets is provable in Σ1 0, equals the limit of all recursive ordinals ω1 ck . RID=""ID="" Mathematics Subject Classification (2000): 03B30, 03F15 RID=""ID="" Supported by the Deutschen Akademie der Naturforscher Leopoldina grant #BMBF-LPD 9801-7 with funds from the Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie. (...) RID=""ID="" I would like to thank A. SETZER for his hospitality during my stay in Uppsala in December 1998 – these investigations are inspired by a discussion with him; S. BUSS for his hospitality during my stay at UCSD and for valuable remarks on a previous version of this paper; and M. MÖLLERFELD for remarks on a previous title. (shrink)

PURPOSE/OBJECTIVES: To examine differences in nursing care received by patients with breast cancer enrolled in clinical trials and those not enrolled in clinical trials. DESIGN: Retrospective review of clinic charts. SETTING: Oncology outpatient department of a tertiary-care hospital. SAMPLE: 90 women with early stage breast cancer. The mean age of the women was 53 years. More than half of the women (51 of 90) were treated in a clinical trial. METHODS: Retrospective chart review of all the nurse-patient clinic encounters (...) for a six-month period from date of cancer diagnosis. The content of each encounter was coded using a modified version of the Nursing Action Classification System. MAIN RESEARCH VARIABLES: Nursing interventions (i.e., assessment, medical scheduling, psychosocial scheduling, reassurance, and teaching) and phone calls. FINDINGS: Women enrolled in clinical trials had more phone interactions with nursing staff (p = 0.003) and received teaching (p < 0.001) and reassurance (p = 0.005) from nursing staff more often than women not enrolled in clinical trials. Controlling for age and stage of disease, teaching (p < 0.001), and reassurance (p = 0.10) were the primary differences in nursing care between the patients enrolled in clinical trials and those not enrolled. CONCLUSION: Differences in nursing care received exist between patients with breast cancer enrolled in clinical trials and those not enrolled. IMPLICATIONS FOR NURSING PRACTICE: Both teaching and reassurance are important components of caring for patients with cancer and are associated with treatment compliance. If the results of this study are confirmed, measures must be employed to ensure that all patients receive optimal care. (shrink)

During the mid 1980s, the renowned American documentary filmmaker Fred Wiseman produced a four-part series of films that sought to record the operations of institutions in Talladega, Alabama, devoted to the care and training of people with disabilities. These films—designated as the Multi-handicapped Series—have received much less attention than Wiseman's earlier work, as if films about disability mark a drastic departure from his previous award-winning productions, such as Titicut Follies (1965) and Hospital (1970). The Multi-handicapped Series takes up general (...) categories of disabled populations as discrete documentary topics, Deaf (1986), Blind (1986), Multi-handicapped (1986) and Adjustment & Work (1986) as opposed to a specific location as in his earlier films. As a result, the latter series of films identify social and interpersonal structures developed in the name of specific conditions. Like Foucault's research on disciplinary tactics, Wiseman's films seek out many of the segregated social spaces typically occupied by persons classified as deviant: prisons, hospitals, charity networks, sheltered workshops, resident facilities, and vocational training structures. The Multi-handicapped Series focuses on the activities of professions and practitioners in education, administration, and therapy, as well as the institutional roles designed for bodies marked as disabled. Unlike its 19th century predecessor classification, feebleminded, the latter twentieth century U.S. policy answer has been waged as a matter of dividing disabilities into a binary structure of orthopedic or cognitive categories. Such a development has left many crossover bodies in a diagnostic no-body's-land. To analyze the history of these developments, this essay recognizes the formation of today's disability category as an effect of new regimes of power; a form of domination based upon the application of particularized diagnostic pathologies that provide the basis for cordoning off bodies which fail to fit neatly within the cognitive/orthopedic binary. As documents of the social spaces that are occupied by disabled people, Wiseman's films offer a rare contemplation of institutional practices and their application to populations viewed as nonnormative. (shrink)

HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they (...) prefer to use ‘SGOT’, ‘ELISA’ and ‘spot test’ to represent the HIV test, while ‘immunosuppression’, ‘↓ CD4 disease’ and ‘ARC’ are preferred instead of ‘AIDS’. It is possible that health professionals’ belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article on (...) the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy... (shrink)

In Holding Health Care Accountable , E. Haavi Morreim differentiates between duties of expertise and resource duties, arguing for tort liability respecting the former and contract liability respecting the latter. Though Morreim's book addresses ordinary clinical medicine, her liability scheme may also be relevant elsewhere. Focusing on disaster medicine, and especially the medical management of violent mass disasters (e.g., where terrorists have deployed weapons of mass destruction), I argue in this essay that Morreim's classification of duties still fits, but (...) that it is difficult to hold government powers accountable for their many resource and expertise duties. This difficulty is compounded by political arrangements that foist under-funded mandates for disaster services on healthcare providers. As a result of such arrangements, hospitals and clinicians are prone to liability for expenditures and clinical interventions that are beyond their scope. This problem can be mitigated, I argue, by examining and clarifying the apparent social compact between society and healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and PsychologyArticlesAntonak, R. J., C. R. Fielder, and J. A. Mulick. 1993. A scale of attitudes toward the application of eugenics to the treatment of people with mental retardation. Journal of Intellect Disabilities Research 37:75–83.Arens, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:15–16.Bavidge, M. 1996. Commentary on “Minds, memes, and multiples.” Philosophy, Psychiatry, (...) & Psychology 3:29–30.Blashfield, R. K. 1973. Evaluation of the DSM-II classification of schizophrenia as a nomenclature. Journal of Abnormal Psychology 85(2):140–150.Braude, S. E. 1996. Multiple personality and moral responsibility. Philosophy, Psychiatry, & Psychology 3:37–54.Broverman, I. K., S. R. Vogel, D. M. Broverman et al. 1972. Sex-role stereotypes: a current appraisal. Journal of Social Issues 28:59–78.Broverman, I. K., D. M. Broverman, P. E. Clarkson et al. 1975. Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology 34:1–7.Checkland, D., and M. Silberfeld. 1996. Mental competence and the question of beneficient intervention. Theoretical Medicine 17(2):121–134.Clark, S. R. L. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:55–57.Clark, S. R. L. 1996. Minds, memes, and multiples. Philosophy, Psychiatry, & Psychology 3:21–28.Dickenson, D., and D. Jones. 1995. True wishes: The philosophy and developmental psychology of children’s informed consent. Philosophy, Psychiatry, & Psychology 2:287–303.Donaldson, T. 1978. Psychoanalyzing the practical inference model. Philosophical Research Archives 4:1215.Eekelaar, J. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:305–307.Fisher, S., and R. P. Greenberg. 1993. How sound is the double-blind design for evaluating psychotropic drugs? Journal of Nervous and Mental Disease 181:345–350.Fulwiler, C., and M. F. Folstein. 1995. Commentary on “Chris Walker’s interpretation of Karl Jaspers’ phenomenology.” Philosophy, Psychiatry, & Psychology 2:345–346.Heinze, M. 1995. Commentary on “Moralist or therapist?” Philosophy, Psychiatry, & Psychology 2:31–32.Iturrate, M. 1977. Man’s freedom: Freud’s therapeutic goal. Review of Existential Psychology and Psychiatry 15:32–45.Littlewood, R. 1991. From diseae to illness and back again. Lancet 337:1013–1015.Maddox, J. 1993. New genetics means no new ethics. Nature 364:97.McCormick, S. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:309–310.Murray, T. H. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:311–312.Muzika, E. G. 1989. Object relations theory, Buddhism, and the self-synthesis of eastern and western approaches. International Philosophical Quarterly 30(1):59–74.Parker, M. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:313–314.Phillips, J. 1996. Key concepts: Hermeneutics. Philosophy, Psychiatry, & Psychology 3:61–69.Pole, D. 1970. Self and personality. The Journal of the British Society for Phenomenology 1:30–36.Priebe, S. 1989. On the subjectivity of psychiatric diagnosis. Psychiatric Praxis 16:86–89.Radden, J. 1996. Lumps and bumps: Kantian faculty psychology, phrenology, and twentieth-century psychiatric classification. Philosophy, Psychiatry, & Psychology 3:1–14.Sampson, E. E. 1981. Cognitive psychology as ideology. American Psychologist 36:730–743.Sarbin, T. R. 1976. Contextualism: A worldview for modern psychology. Nebraska Symposium on Motivation 24:1–41.Senft, P. A. 1975. The self-contradictions (antinomies) of psychotherapy: Is a solution in social action possible? The Human Context 7:367–372.Shuman, D. W. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:59–60.Sprigge, T. 1996. Commentary on “Minds, memes, and multiples.” Philosophy, Psychiatry, & Psychology 3:31–36.Wallace, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:17–20.Wells, L. A. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:315–317.Wiggins, O. P., and M. A. Schwartz. 1995. Chris Walker’s interpretation of Karl Jaspers’ phenomenology: a critique. Philosophy, Psychiatry, & Psychology 2:319–343.BooksAmerican Hospital Association. 1994. Values in conflict: Resolving ethical issues in health care. 2nd ed. Chicago: American Hospital Association.American Medical Association. 1992. Code of medical ethics: Annotated current opinions of the council on ethical and judicial affairs. Chicago: American Medical Association.———. 1994. Council on ethical and judicial affairs... (shrink)

BackgroundBilateral cerebral palsy is the most common type of CP in children and is often accompanied by different degrees of communication impairment. Several studies have attempted to identify children at high risk for communication impairment. However, most prediction factors are qualitative and subjective and may be influenced by rater bias. Individualized objective diagnostic and/or prediction methods are still lacking, and an effective method is urgently needed to guide clinical diagnosis and treatment. The aim of this study is to develop and (...) validate an objective, individual-based model for the prediction of communication impairment in children with BCP by the time they enter school.MethodsA multicenter prospective cohort study will be conducted in four Chinese hospitals. A total of 178 children with BCP will undergo advanced brain magnetic resonance imaging at baseline. At school entry, communication performance will be assessed by a communication function classification system. Three-quarters of children with BCP will be allocated as a training cohort, whereas the remaining children will be allocated as a test cohort. Multivariate lesion- and connectome-based approaches, which have shown good predictive ability of language performance in stroke patients, will be applied to extract features from MR images for each child with BCP. Multiple machine learning models using extracted features to predict communication impairment for each child with BCP will be constructed using data from the training cohort and externally validated using data from the test cohort. Prediction accuracy across models in the test cohort will be statistically compared.DiscussionThe findings of the study may lead to the development of several translational tools that can individually predict communication impairment in children newly diagnosed with BCP to ensure that these children receive early, targeted therapeutic intervention before they begin school.Trial registrationThe study has been registered with the Chinese Clinical Trial Registry. (shrink)

Objective: To examine how research ethics boards review research projects in emerging disciplines such as functional neuroimaging.Design: To compare the criteria applied and the decisions reached by REBs that reviewed the same mock research protocol in functional neuroimaging.Participants: 44 Canadian biomedical REBs, mostly working in public university or hospital settings.Main measurements: The mock research protocol “The Neurobiology of Social Behavior” included several ethical issues operating at all three levels: personal, institutional and social. Data consisting of responses to closed questions (...) were analysed quantitatively. Qualitative analysis of open-question responses used mixed classification.Results: Similar criteria were used by most participating REBs. Yet the project was unconditionally approved by 3 REBs, approved conditionally by 10 and rejected by 30.Conclusions: The results point to the difficulty for REBs of reviewing all kinds of research projects, regardless of field, by relying on international and national norms framed in general terms and a possible variation between REBs in the interpretation of their mandate for the protection of research subjects. (shrink)

Abstract: Potatoes are edible tubers, available worldwide and all year long. They are relatively cheap to grow, rich in nutrients, and they can make a delicious treat. The humble potato has fallen in popularity in recent years, due to the interest in low-carb foods. However, the fiber, vitamins, minerals, and phytochemicals it provides can help ward off disease and benefit human health. They are an important staple food in many countries around the world. There are an estimated 200 varieties of (...) potatoes, which can be classified into a number of categories based on the cooked texture and ingredient functionality. Using a public dataset of 2400 images of potatoes, we trained a deep convolutional neural network to identify 4 types (Red, Red Washed, Sweet, and White).The trained model achieved an accuracy of 99.5% of test set, demonstrating the feasibility of this approach. (shrink)

These two lectures by Jacques Derrida, 'Foreigner Question: Come from Abroad' and 'Step of Hospitality/No Hospitality', derive from a series of seminars on 'hospitality' conducted by Derrida in Paris, January 1996. The book consists of two texts on facing pages. 'Invitation' by Anne Dufourmantelle appears on the left clarifying and inflecting Derrida's 'response' on the right. The interaction between them not only enacts the 'hospitality' under discussion, but preserves something of the rhythms of teaching. The book also characteristically combines careful (...) readings of canonical texts and philosophical topics with attention to the most salient events in the contemporary world, using 'hospitality' as a means of rethinking a range of political and ethical situations. For example, Antigone is revisited in light of the question of impossible mourning; the trial of Socrates is brought into conjunction with the televised funeral of François Mitterrand. (shrink)

In face of unprecedented awareness of religious diversity, as well as the dangers of conflict, interreligious dialogue has become vital. Yet, these authors maintain, it is the commitment to think together about religious faith and our inherited traditions that genuinely moves mutual understanding to new levels. Here is such a religious experiment, an interreligious theological quest, framed in the interests of peacemaking." -- Publisher.

Previously published: Paris: Ancienne librairie Germer Bailliaere, 1901.

In conversation with the ethical-theological-philosophical role of love in the Abrahamic traditions and U.S. immigration, personal testimonies of refugee families seeking asylum join the witness of the interfaith community of greater San Antonio to explain the gift received when love of God is expressed as radical hospitality.

Abstract : Background: Vegetable agriculture is very important to human continued existence and remains a key driver of many economies worldwide, especially in underdeveloped and developing economies. Objectives: There is an increasing demand for food and cash crops, due to the increasing in world population and the challenges enforced by climate modifications, there is an urgent need to increase plant production while reducing costs. Methods: In this paper, Lemon classification approach is presented with a dataset that contains approximately 2,000 (...) images belong to 3 species at a few developing phases. Convolutional Neural Network (CNN) algorithms, a deep learning technique extensively applied to image recognition was used, for this task. The results: found that CNN-driven lemon classification applications when used in farming automation have the latent to enhance crop harvest and improve output and productivity when designed properly. The trained model achieved an accuracy of 99.48% on a held-out test set, demonstrating the feasibility of this approach. (shrink)

In Hospitality, Volume I, Jacques Derrida continues a seminar series he inaugurated in 1991 under the general title of "Questions of Responsibility." Delivered at the École des Hautes Études en Sciences Sociales (EHESS) in Paris from November 1995 through June 1996, the seminar is guided by questions that focus on responsibility and "the foreigner": How is the foreigner welcomed and/or repressed? What does the notion of the foreigner reveal about kinship, ethnicity, the city, the state, and the nation? What are (...) the stakes of the opposition between friend and enemy? How should we think of this in relation to borders, citizenship, displaced populations, immigration, exile, asylum, integration, assimilation, xenophobia, and racism? Derrida approaches these questions through readings of several classical texts as well as more modern texts from Heidegger, Arendt, and Camus, among others. Central to his project is a rigorous distinction between conventional hospitality (always finite and conditional) and the idea of a hospitality open unconditionally to the newcomer. (shrink)