In the context of the long-lasting coronavirus crisis, this study examines the occurrence, causes, and consequences of issue fatigue – a phenomenon that refers to a feeling of annoyance with an issue that is repeated continually in the news. Using data obtained from a representative two-wave panel survey conducted online in April and May 2020 (n = 1,232) in Germany, the study employed a cross-lagged panel model to examine longitudinal relations. First, the results indicate that a considerable (...) share of the German population already felt fatigued with the coronavirus issue in April, and that this proportion increased by May. Second, in terms of causes, the results show that perceptions of low news credibility and perceived “victimization” of other topics caused high levels of issue fatigue. However, effects of the reverse direction were also present, pointing to a mutual reinforcement of issue fatigue and media perceptions. Third, regarding consequences, the results reveal that recipients experiencing issue fatigue increasingly avoided coronavirus news, and also tended to disregard coronavirus hygiene rules. (shrink)

In this paper, we introduce the concept of policy malaise, which refers to citizens’ dissatisfaction with the way political institutions and processes handle specific problems such as the refugee issue in Germany. Based on a representative online panel survey with two waves conducted in 2016 and 2017 (N = 836), we explore the occurrence of policy malaise among the German population and its relation to issue-specific media use, trust in news media, and issue fatigue. First, the (...) results indicate that policy malaise toward the refugee issue is widespread in Germany. Second, we found that media use relates differentially to policy malaise: While high exposure to public broadcasting was negatively associated with policy malaise, we found the opposite for private broadcasting. Third, policy malaise is higher for people who experience issue fatigue and lower for people who trust the news media. Finally, trust in media reinforces the negative and positive relations between media use and policy malaise. Implications concerning the associations between policy malaise and political alienation in its broader sense are discussed. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of (...) treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

We develop a new perspective on various forms of psychological suffering – including attachment issues, burn-out, and fatigue complaints – by drawing on the construct of learned helplessness. We conceptualise learned helplessness in operant terms as the behavioural effects of a lack of reinforcement and in goal-directed terms as the dysregulation of goal-directed behaviour. Our central claim is that if one fails to reach a goal (e.g. the goal to secure a job), then not only this goal but also (...) other related goals (e.g. the goal to maintain social relationships) may lose their motivating effects. The similarity relation between goal stimuli can therefore shed light on how failure in one life domain can come to affect various other life domains. We detail the relation between our proposal and existing theories and discuss new research and clinical directions. (shrink)

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (shrink)

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (shrink)

Considerable research evidence has accumulated indicating that there is an increased likelihood for illness and injury among employees working in long-hour schedules and schedules involving unconventional shift work. In addition, studies show that fatigue-related errors made by employees working in these kind of demanding schedules can have serious and adverse repercussions for public safety. As the result of these concerns, new protective legislation is being advocated in the United States, for instance, to restrict the hours of work among nurses (...) and other healthcare professionals. This article reviews the history of concerns about long working hours and the current scientific evidence regarding their effects on workers' health. The ethical implications of unconventional shift work and long work-hour schedules are considered. Relevant ethical considerations involve mandatory or unpaid overtime and the possibility of employer coercion, the political basis for government regulation of working hours, potential limits on voluntary assumption of risk, societal benefits accruing from the equitable distribution of available working hours, gender-based inequities related to working hours, and employer responsibilities for protecting individuals who are not employees from the spillover effects of demanding work schedules. (shrink)

BackgroundThe COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for (...) a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa.MethodsWe conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60–125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data.ResultsFive main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme.ConclusionsNumerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:It’s a Human Rights Issue!Daniela TrufferI was born in 1965 in Switzerland with a severe heart defect and ambiguous genitalia. The doctors couldn‘t tell if I was a girl or a boy. First they diagnosed me with CAH and an enlarged clitoris, and cut me between my legs looking for a vagina.Because of my heart condition, the doctors assumed I would die soon. After an emergency baptism, I (...) stayed in the hospital for three months. My mother would travel to the city as often as possible, though she was only allowed to see me through a glass window.When I was two months old, and still in the hospital, doctors opened my abdomen and found healthy testes, which they threw in the garbage bin. According to my medical records, my parents had not provided consent. Further tests showed I am chromosomally male.Later the “castration” was declared a “mistake”: one doctor said I was a boy with hypospadias. As they had already removed the testes, however, they would have “to continue this way and the small patient must be made a girl.”After three months, my parents were finally allowed to take me home.During my childhood, I spent a lot of time in doctor’s offices and hospitals, suffering countless examinations of my genitals and urethral opening. When I was two, our family doctor stuck his finger into my urethral opening; I was screaming very loud, my father says. My mother had to put me into warm water because every time I had to pee I screamed in pain. Later I was hurried to the hospital with a bad infection. Still today my urethra often hurts after going to the toilet.I knew early in my life that I was different.I learned fragments of the truth only after decades of ignorance and denial. I was lucky to obtain my medical records. The hospital initially told me they no longer existed. When I insisted, they eventually sent me some recent files pertaining only to care I received after I was an adult. I kept calling. Once I was put through directly to the archive, where I was told that indeed there were “lots of files on microfilm.” However, it was only when I threatened to return with a lawyer that the hospital sent me a large pile of printouts.Finally I had it in black and white: The doctors had systematically lied to my parents, instructing them to “raise me as a girl” and never talk to me or to anyone else about “the gender issue.” Asked if I could have children, the doctors told them it was “doubtful.” At seven, the doctors still claimed it had been necessary to “remove the ovaries,” and at fourteen told me that I didn‘t menstruate because my “uterus was very small.”Because of the castration, my bone growth was reduced. To this day, I have to deal with health problems like a ruined metabolism, recurring fatigue and vertigo, and osteopenia.I would eventually grow older than doctors had originally predicted. At seven, they decided to operate on my heart septum and valve. I went to the hospital for preparatory cardiac catheterization. However, because of an infection, doctors put off the procedure. Since I had already been admitted, they decided to “use the opportunity to conduct the genital correction already planned in 1965,” and shortened my micropenis to the size of a “very small clitoris,” allegedly with my consent.Fortunately they didn‘t amputate the glans, and I still have sexual feelings left. But I remember the pain and unease, and how I often ran home from [End Page 111] school crying. Today I have a lot of scar tissue, which often hurts and itches.After a few days I was brought back to the cardiologist for the catheterization, and a few months later heart surgery. The doctors saved my life and destroyed it in the same year.I spent my childhood in fear, isolation, and shame. When I had to see a doctor, I was always scared stiff, but I never cried, and endured everything without any protest. I felt sick days in advance, and in... (shrink)

In pediatric emergency rooms (ERs), social workers must navigate diverse responsibilities including acting as advocates and liaisons between families and multidisciplinary treatment teams, providing compassionate support to families in crisis, and assessing for and reporting any suspicions of child abuse or neglect. These potentially contrasting roles can place social workers at the center of dealing with ethical dilemmas and advocating against ethical violations, such as bias and discrimination toward families. This qualitative study seeks to gain insight into ethical issues commonly (...) encountered in pediatric ERs by exploring the perspectives of 23 social workers at Level 1 trauma centers in the United States. Thematic analysis was used to develop major themes and subthemes related to ethical violations, dilemmas, and best practices in pediatric ERs. Major themes emerged related to unfair treatment of families (with subthemes of bias, discrimination, and compassion fatigue), ethical dilemmas (with subthemes of cultural issues, safety and system issues), and promoting ethical practices (with subthemes of self-awareness, advocacy, and efforts to change the system). This study provides important insights into ethical issues in pediatric ERs as experienced by social workers and can inform efforts to improve the quality and equity of care for all families in pediatric ERs. (shrink)

This paper deals with new pharmacological and technological developments in the manipulation and curtailment of our sleep needs. While humans have used various methods throughout history to lengthen diurnal wakefulness, recent advances have been achieved in manipulating the architecture of the brain states involved in sleep. The progress suggests that we will gradually become able to drastically manipulate our natural sleep-wake cycle. Our goal here is to promote discussion on the desirability and acceptability of enhancing our control over biological sleep, (...) by illustrating various potential attendant ethical problems. We draw attention to the risks involved, possible conflicts of interests underlying the development of wake enhancement, and the potential impact on accountability for fatigue related errors. (shrink)

For healthcare professionals and organizations, there is an emphasis on addressing moral distress and compassion fatigue among clinicians. While addressing these issues is vital, this paper suggests that the philosophical concept of agent-regret is a relevant but overlooked issue in healthcare. To experience agent-regret is to regret your harmful but not wrongful actions. This person’s action results in someone being killed or significantly injured, but it was ethically faultless. Despite being faultless, agent-regret is an emotional response concerning one’s (...) agency in a situation that results in death or significant harm. In healthcare, many clinicians are likely to experience regret for faultless actions that significantly harm or cause the death of a patient. The recognition of agent-regret in healthcare is significant because it differs, conceptually and practically, from moral distress and compassion fatigue. Building on the work of Wojtowicz (Citation2022), we should strive to understand clinicians’ agent-regret by recognizing their agency in the situation, not lessening or removing it. (shrink)

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care for sick (...) people can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems. (shrink)

Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country. In this article, the authors report findings from (...) an empirically grounded study that examines the experience of IENs who entered Ontario’s workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as ‘different’ from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice and the role of patients and families in decision‐making. In addition, problems with English language fluency cause work‐related stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides important insights as policy and management decision‐makers balance the tension between increasing the IEN workforce and the delivery of safe patient care. (shrink)

Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically (...) unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Seeing the Best of MeJohn ScheumannHi I am John, I am 21 and live in Northern California. I was diagnosed with a brain tumor in March 2005. When I was diagnosed I was 13–year–old, in 7th grade, the school year was nearing its end. I was just starting to hit my stride with my youthful independence. Skipping forward to post surgery: right after, the effects from the surgery were (...) severe. My whole body was weak, I was temporarily paralyzed on the left side of my of my body, I could hardly speak or see. My recovery has been hard, relearning how to do many things again.Now eight years after, I have recovered very well (although it doesn’t always seem like that to me). My “disabilities” are physical and cognitive. My physical issues are that I have very poor balance. My coordination is also poor (especially on my left side). I get fatigued more easily, then that triggers the issues with my balance and coordination even more. Also when I’m fatigued my left arm, leg, and hand can get shaky (which is also know as ataxia). My cognitive issues are that I process information slower, have a bad memory, have trouble finding the right words to say, organizing thoughts, etc.To me I am disabled, I have things that happened to me that effected my body and impaired me in different ways. I am disabled but that’s not all I am, I am still a young growing adult who does things that most people my age do.There are times though were the term disability does not do me justice. The things that happened to me affect me everyday but I act and do things that most people my age do, I go to the gym, walk my dog, hang out with friend, watch sports, etc..... On the surface I appear to be an average able bodied person, my “disabilities” aren’t always visible sometimes till someone gets to know me or see me interact for a while. So people will sometimes not treat me in the way I would like to be treated because of their unknowing. People sometimes expect me or want me to do things I’m not capable of and that can be awkward and upsetting.Other times people see me as your average person my age and I’ll tell them I have a disability they don’t understand the complexity of it and that certain things are difficult for me and only in certain situations, not all the time. They don’t understand the disability is individual to me and one issue is not the same for everyone across the board. This can also be awkward and upsetting at times.Saying all this I understand people will misjudge me and most often people are not being ignorant they are acting the best way they know how and that given the chance they can see the best of me and truly understand who I am and forget the label “disabled.” [End Page E8]Copyright © 2013 The Johns Hopkins University Press... (shrink)

continent. 1.3 (2011): 201-207. “Poetry is experience, linked to a vital approach, to a movement which is accomplished in the serious, purposeful course of life. In order to write a single line, one must have exhausted life.” —Maurice Blanchot (1982, 89) Nikos Karouzos had a communist teacher for a father and an orthodox priest for a grandfather. From his four years up to his high school graduation he was incessantly educated, reading the entire private library of his granddad, comprising mainly (...) the Orthodox Church Fathers and the ancient classics. Later on in his life he sold the library for money, only to buy a little more time before he went broke again: “I carry sorrow like a cage/ I got no birds/ as I come back from her hair/ I see the profit emptied/ cool from terror.” (1993, Ι, 101) Nowadays—and ridiculously recently—we are more than apt to speak of a certain insouciance pertaining to the Greek form of expenditure: expenditure without any type of investment, sometimes not (even) symbolic. In the vaults of the European unconscious, this imprudent stance still conjures a “capital punishment” in the form of de-capitation, reflecting back the fear of excess and the terror of its consequences.1 Thus the Greek way of living is very close to what a stranger could have termed as “the Greek way of dying.” Yet, what is not often understood is that the Greek esprit , the same one that invented the maxim μηδ?ν ?γαν (“nothing in excess”), does not experience death solely as an imminent fear of bankruptcy. For it miraculously combines its unconditional acceptance with the promise of a resurrection that is always there in the scents of Spring, from Dionysus to the orthodox Christ: “Everyone resurrects himself through dying [….] Resurrection is the switching of mortalities.” (2002, 94) Hence, if an entire library was imprudently traded for a plate with seven olives, a sliced tomato and some fresh goat cheese, let us not be fooled: this is not the meal of the pauper, but that of “an aristocrat from God” (1993, II, 491) feeding his eloquent loudmouth, ridiculously cut open in an otherwise rock-solid caput . *** To speak of the Greek experience is to speak about a half-dead language that still utters in life what is seemingly excluded from it and thus forbidden to be talked about: death. Death as anything that is out of this world, as something that will never return . Still, along with an experience of death that recently waned as a worn-out academic fashion, the Greek experience is dead too. Nearly 2300 years of written words separating Homer from the fall of Byzantium equal 500 books on a library traded for money: “I am with the killed. Hence my deepest solitude. I do not feel this tremendous macho society, beyond from the fact that it is a ruthlessly consuming one. It is me who pays all the time .” (2002, 57) Let us do the math and see how much this dealing with the Greek experience is costing the poet and how much dealing with the Greek experience might cost us today. *** “I do not guarantee a single word.” (Karouzos, 1993, II, 454) Through its various dialects and forms, the Greek language speaks through an incessant historical dissemination. Anyone who is aware of this terrifying polymorphy and still calls himself a poet, must stand against a white sheet of paper, pen-in-hand, with a very particular duty: to be as fully inconsistent as possible. In the formally ironic uniqueness of the poem, the poet functions as “a band-aid for lesser and greater antinomies.” (1993, I, 251) Of course these antinomies are not exhausted in language—they are historical, political and, alas, existential. Yet, beyond appearances , it is language that ruthlessly encodes them through history, submitting the poet to the temptation of placing them one next to the other on a single white sheet. The closer their neighboring, the greater the scattering of the writer in the ironic uniqueness of the paper. In a work where poetic license is described as a “freedom-impasse” (2002, 51), this task is undertaken in full conscience of its personal consequences: “what I am interested in is to escape my individuality (envisioning the non-ego) […] Nevertheless, my dissociations never achieve duration.” (2002, 74-75) Hence, though poetry is the “deserted direction of will,” (1998, 62) the stance of the poet is not that of a Nietzschean “great man.”2 Whereas drunkenness provides a thread between the poem and the excess it both presupposes and infuses (“Poetry always enlarges. ‘Drunkenness’ is nothing more than that,” (2002, 85)), whereas language flashes in loudmouth spurts of déraison (“When I am alone I do something else. I utter words. For example, while having my ouzo and listening to music I am most likely capable of randomly shouting ‘Electricity!’” (2002, 138)), the poet never gives in to the double affirmation that would eventually risk the “element of pleasure in discourse.” (2002, 80)” It is exactly because the gap of the antinomies is so vast that poetry is not meant to be written with a hammer. Neither does writing consist in a reevaluation of those elements. In short, poetry is not an affirmation of difference, but the surprising beauty of chiming antinomies. We might never transcend them, but it is up to us to put them together. Yet again, this voisinage is not to be identified with the necessity of chance as an eternal return.4 On the contrary it is a return from that very return : Let us treat Yes as a No to No and No as a Yes […] And let us not forget that this pissed affirmation crumbled down Nietzsche’s intellect in the dark paths of this world. (2002, 88) This return from the “vicious circle” should in no way be taken as a form of artistic prudence. Rather it can be seen as a dribble of demonic inconsistency as Dionysus transforms himself into a Christ that is in turn de-theologized: “Who can forbid that? Every man is capable of his own theology, nothing can stop him.” (2002, 73-74) This is a turn towards an existential vision of the world, historically coinciding with a particular political defeat of the Left, to which the poet devoted all his life: after the defeat of the popular front I raised the question “why do we exist?” while others were asking “why we failed.” (2002, 57)5 But most of all it is a return to poetry that exceeds the existential question itself, going beyond the issue of faith. Poetry comes in as a question of return after a defeat that is confessed in full profanity. Though it accepts the necessity of the defeat, it does not affirm it. Though it negates it, the negation is not in the name of a promise to be delivered in the kingdom of heavens. Following a historical and existential defeat, poetry is born post mortem . It signals a return to Christ as “groundless religiousness in the surprise of the real as such” (2002, 72) which is at once a return to the refuge of childhood. It is not a question of endurance towards an eternal return. Rather it is a question on the possibility of an existential return. Returning in a world as someone who cannot enjoy any returns exactly because he is averse to guarantees. A return without returns. *** PHOTOCOPY OF HAPPINESS When I was young I used to pin down cicadas and step on ant nests. I used to stand there silent for hours. With threads I decapitated bees. Now I am a dead man breathing. (Karouzos, 1993, II, 336.) The return to the “paradise of childhood” (2002, 68) constitutes the devouring refuge of its own memory when defeat becomes the synonym of adulthood. The political struggles of a young communist in a country torn up by a civil war right after World War II fraught with incarcerations and exiles. Historically they resulted in the defeat of the communist movement in Greece and opened up a long turbulent road that would peak in the dictatorship of 1967. Existentially they led to a series of disillusionments: mental breakdown, divorce, abandonment of studies in law school. To the question “why do we exist” the answer was poetry. Still this exposé should not be read as a sweeping chronography of a man. For it actually happens to coincide with the historical fate of a nation that after its modern constitution never stopped dreaming of the glories of its past youth, in a present that was (and is) sweepingly disappointing. But isn’t this return to youth finally a way of compensating for a loss of youth that necessarily results in a losing adulthood? Will Greeks, the eternal children of Plato and Nietzsche, ever learn? How to return without dying, how to remember without wasting time? WE ARE IN THE OPEN MEANING Living the coldest mauve night right across Parthenon I went to take a piss on some foliage and I was enjoying the foliage as it was steaming. (Karouzos, 1993, II, 340) Beyond the historical tragedies of modern Greece and away from any personal disappointments, the relation that this land holds with language and history is mediated through the Greek light—whose omnipresence is the very condition of its transcendence. All historical contradictions from Dionysus to Christ took place under this light; all those disseminated dialects were spoken beneath its warmth. To paraphrase Lévinas,6 light is both the condition of the world and of our withdrawal from it—a withdrawal towards the invisibility of God, of the dead, of meta-physics, resulting from the temptation that all is still here, behind this light the visibility of which they once evaded: “birds, the allurement of God.” (1993, I, 17) Under that luminous sky, if Greeks can do anything at all, it is to envision a return that will never come. All they can do is write poetry—which is doing nothing; other than lending an ear to a disseminated language whispering a unity that cannot be promised, as an adulthood in defeat is ready to recognize. Trying “to trap the invisible in visibility” (1993, II, 483) they forget that they have grown up and one day they die—with the promise of return. Hence an additional meaning must be given to this return to childhood. It does not signal salvation but rather its promise. To the ears of an aged continent it means that the return to/of poetry is a losing game, a return without returns. “Europe, Europe… you are nothing more than the continuation of Barabbas.” (1993, I, 295) *** “Life is not there to verify theories.”7 The records show that Karouzos was finally given a second-class pension from the Greek government, at the time when he was being recognized by the literary press as one of Greece’s major contemporary poets. Being neither a bourgeois nor a nobelist, he proclaimed himself to be an anarcho-communist, unconditionally faithful to the utopia of a classless society. He also drank, heavily. “Capitalism made an animal out of man/ Marxism made an animal out of truth/ Shut up.” (1993, II, 369) Perhaps one of the most scandalous divides of our times has been the one between the living and the dead, the latent prohibition that the living should not be concerned with the dead based on the mere impossibility of the dead to be concerned with the living in the first place. What adds to this scandal is that this divide abuses anything that cannot return to us by subsuming it under the same futility. Hence death is no longer “loss” in the usual sense. It no more refers to the things we lost but to our “loss” (of time, money and well-being) as we insist to dwell on them. Death is a waste —of time. It is this waste that we find in the insouciance of Greek expenditure; the waste in dealing with a language that most of its historical part is no longer spoken (a dead language); the waste in translating a poet who is ex definitio untranslatable; the waste of his vision, his money, his life. The waste of dealing with anything that cannot return and that cannot bring in any returns . But it is also the waste of life that poetry itself presupposes, the waste of dealing with invisibility, with anything that is out of this world and thus invokes the fear of death that is in turn—and surprisingly— nowhere to be found. Instead of death, what is there, beyond the light, is the being without us (to recall the Lévinasian il y a ), the mumble of our own nothingness which constitutes the price to be paid for writing poetry under an evergreek light. To understand this to-and-fro, is to realize that poetry is something out of this world that nevertheless takes place in this world, by virtue of this world. But to ridiculously equate this to-and-fro with death as non-existence, is to exile poetry along with its own possibility from this same old world: I do not believe that poetry will ever disappear from this world. […] But I am also sure that it does not have many chances of playing, as you say, a redemptive role in our vertiginous technological future. Without being endangered as a creative need, it will be placed on the side of history. (2002, 32) It is mainly there that we would like to locate the meaning of Nikos Karouzos’s poetry today. If we are willing to include the Greek original it is because we consider that it will be both a waste of time for us to do so (since most of you cannot read Greek) and because it might induce you to the even larger waste of learning it. We would additionally be glad if this small introduction served as an equally wasteful, academically useless piece of reading, gesturing towards a taboo of investing in anything Greek—that is in anything dead among the living, in anything that will never come back and maybe was never here in the first place. This is the only way to reserve for ourselves the possibility of poetry and preserve the light of its promise. “To return: that is the miracle.” (1993, I, 17) Athens, Greece July 10, 2011 NOTES 1 “ Capitale (a Late Latin word based on caput “head”) emerged in the twelfth to thirteenth centuries in the sense of funds, stock of merchandise, sum of money or money carrying interest.[…] The word and the reality it stood for appear in the sermons of St. Bernardino of Siena (1380-1444) ‘… quamdam seminalem rationem lucrosi quam communiter capitale vocamus ’, ‘that prolific cause of wealth that we commonly call capital’” (Braudel, 1992, 232-233). 2 “A great man – a man whom nature has constructed and invented in the grand style – what is he? First : there is a long logic in all of his activity, hard to survey because of its length, and consequently misleading; he has the ability to extend his will across great stretches of his life and to despise and reject everything petty about him, including even the fairest, ‘divinest’ things in the world.” (Nietzsche, 1968, 505, §962) 3 Cf. Deleuze, 1986, 186-9. 4 “Return is the being of becoming, the unity of multiplicity, the necessity of chance: the being of difference as such or the eternal return.” (Deleuze, 189)5 In this 1982 interview Karouzos refers to the defeat of the communist movement in Greece after the civil war of 1946-1949 between the Governmental Army and the Democratic Army of Greece, the military division of the Greek communist party. Karouzos’s father was a member of the communist National Liberation front (EAM) members of which formed the mainl resistance movement (ELAS) in Greece during WWII. The poet was a member of the United Panhellenic Organization of Youth (EPON), which was a youth division of EAM. After the end of the war, ELAS was called to disarmament in view of the formation of a National Army. The members of EAM resigned from the government of national unity and a series of protests led to a 3 year civil war between ELAS and the Government Army. After the defeat of ELAS the Communist party was outlawed and many communists were exiled in deserted Greek islands. Karouzos, who took action in the Greek resistance and was active during the Greek civil war, was exiled in Icaria on 1947 and in Makronisos on 1953 where he was called two years earlier to do his military service. 6 “Existence in the world qua light, which makes desire possible, is then, in the midst of being, the possibility of detaching oneself from being. To enter into being is to link up with objects; it is in effect a bond that is already tainted with nullity. It is already to escape anonymity. In this world where everything seems to affirm our solidarity with the totality of existence, where we are caught up in the gears of a universal mechanism, our first feeling, our ineradicable illusion, is a feeling or illusion of freedom. To be in the world is this hesitation, this interval in existing, which we have seen in the analyses of fatigue and the present.” (Lévinas, 1988,43-4) 7from a TV interview. THE POETRY OF NIKOS KAROUZOS From Redwriter [ Ερυθρογρ?φος ], in Collected Works, Vol . II, Athens: Ikaros. 1993, 463-4. [Athens: Apopeira, 1990, 9-10.] JESUS ANTI-OEDIPUS* Why were we once saving till the fifth day the Paschal lamb? The scriptures say: with this victim’s meat we ought to cleanse all of our senses. To give life to the whitest wave miraculous odors in the extension of the chest. Ideals to death. For us to witness the illustrious dawns of Absinthe and for the soul to be a deeply carved ornament on the fore we named will. Then many deer running amidst the evergreen growth with watery hymns, then, the unintended angels descending with heights spiraling in their momentum offer themselves to the luminous Adventure. Whence the need for speech and our sufferings covered with flags like the glorified dead. An incorporeal finger pointing at the flamboyant and fragrant holocausts within the tired horizons and the exhausted breadths with joys of the mistletoe on fire and shivering all of the green-leaved love. Something would have chirped again had we not driven it away— maybe the ewe’s grass. Something would have called us to the eternal resurrection— maybe the grace of spring. But now our heart is fiercely blinded, withdrawn to the appearances of Hades. Silence and ice incessantly cover the Infant Spirit in thatched times. While the cherry trees are dreaming faintly glowing in absolute darkness there’s nothing the Babylonians can contemplate in labs with automatic colored lights. How to rejoice now in the fifth day of the lamb? We have forked the stars. We’ve gradually become supposedly sublime with plucked chimeras in our hands. Avenged relentlessly by science. *Though the poem appears in a 1990 collection, it was actually written in 1968. Hence the reader must be aware in not associating Karouzos’ Anti-Oedipus with the famous 1972 work of Deleuze and Guattari, given that the former precedes the latter. ΙΗΣΟΥΣ ΑΝΤΙ-ΟΙΔΙΠΟΥΣ Γιατ? κρατο?σαμε κ?ποτε ?ς την π?μπτη μ?ρα το πασχαλιν? πρ?βατο; Τα κε?μενα λ?νε: μ’ αυτο? του θ?ματος το κρ?ας ?πρεπε να καθαρ?σουμε ?λες τις αισθ?σεις. Για να δ?σουμε κ?μα στη ζω? λευκ?τατο θαυμ?σιες ευωδι?ς στην ?κταση του στ?θους. Ιδανικ? στο χ?ρο. Για να βλ?πουμε τα λαμπρ? χαρ?ματα του ?ψινθου και να ’ναι η ψυχ? στ?λισμα βαθυχ?ρακτο της πλ?ρης που την ε?παμε θ?ληση. Τ?τε πολλ?ς δορκ?δες τρ?χοντας αν?μεσα στην καταπρ?σινη φ?ση με τους υδ?τινους ?μνους, τ?τε, κατεβα?νοντας οι αθ?λητοι ?γγελοι με κυλινδο?μενο το ?ψος στην ορμ? τους χαρ?ζονται της αστραφτερ?ς Περιπ?τειας. ?θεν η μιλι? γι’ αυτ? χρει?ζεται και τα δειν? σκεπ?ζονται ωσ?ν τους τιμημ?νους νεκρο?ς με σημα?ες. Ασ?ματο δ?χτυλο δε?χνει τα φλογ?δη και μοσχοβ?λα ολοκαυτ?ματα στους κουρασμ?νους ορ?ζοντες στα εξουθενωμ?να πλ?τη καθ?ς αν?βουν οι χαρ?ς του νερα?δ?ξυλου και τρ?μει ολ?κληρη η πρασιν?φυλλη αγ?πη. Κ?τι θα κελαηδο?σε π?λι αν δεν το δι?χναμε— μπορε? της προβατ?νας το χορτ?ρι. Κ?τι θα μας καλο?σε στην απ?ραντη αν?σταση— μπορε? του ?αρος η χ?ρη. Μα η καρδι? μας ?γρια τυφλ?θηκε π?ρασε στα φαιν?μενα του ?δη. Σιγ? και π?γος αδι?κοπα σκεπ?ζει στους αχυρ?νιους καιρο?ς το Ν?πιο Πνε?μα. Την ?ρα που ονειρε?ονται οι βυσσινι?ς και λ?μπουν αμυδρ? μεσ’ στο απλ?τατο σκοτ?δι τ?ποτα δε στοχ?ζονται οι βαβυλ?νιοι στα εργαστ?ρια με τ’ αυτ?ματα χρωματιστ? φ?τα. Π?ς να χαρο?με πια την π?μπτη μ?ρα του προβ?του; Φουρκ?σαμε τ’ αστ?ρια. Γ?ναμε σιγ?-σιγ? δ?θεν υπ?ροχοι με μαδημ?νες χ?μαιρες στα χ?ρια. Μας ν?μεται σκληρ? η επιστ?μη. From: Redwriter [Ερυθρογρ?φος], in Collected Works, Vol. II, Athens: Ikaros. 1993, 472. [Athens: Apopeira, 1990, 18.] DIALECTΙCS OF SPRING Christ the straight angle; Christ the Pythagorean theorem. Christ the infinitesimal calculus from above the blessed Sets Christ. Christ the tessellation of massive particles Christ the zero mass. Hence we spray numbers and fields of lust. We are carabineers of diseased logic plus something— Observed means observer and Hekate The darkness luminous and light in the dark Astarte banqueters demons from today. ΔΙΑΛΕΚΤΙΚΗ ΤΟΥ ΕΑΡΟΣ Χριστ?ς η ορθ? γων?α· Χριστ?ς το πυθαγ?ριο θε?ρημα. Χριστ?ς ο απειροστικ?ς λογισμ?ς ?νωθεν ?λβια Χριστ?ς τα Σ?νολα. Χριστ?ς η ψηφιδογραφ?α στα μαζικ? σωμ?τια Χριστ?ς η μ?ζα μηδ?ν. ?ρα ψεκ?ζουμε αριθμο?ς και πεδ?α λαγνε?ας. Ε?μαστε τυφεκιοφ?ροι νοσο?σης λογικ?ς και κ?τι-- παρατηρο?μενο σημα?νει παρατηρητ?ς και Εκ?τη σκ?τος το π?μφωτο και φως εν τ? σκοτ?? η Αστ?ρτη συνδαιτημ?νες δα?μονες απ’ ?ρτι. From: Redwriter [Ερυθρογρ?φος], Athens: Apopeira, 1990, 18. [1993, II, 472]. CREDO (as we are used to say in Latin) Α I believe in one Poet expelled from heavens / fugitive from the god and vagabond, Empedocles / and here on earth / exile on the earth etc. of Baudelaire /. Β I believe in one Computer inside thunder and through matter. Γ Suffering undefiled / substantive / the Poet uplifts himself slow-burning suicidal implying lengthy sleeps. Δ Cutting down on prospective mistakes. Ε Of all things visible and invisible officiating the onion-peelings. Ζ The Poet has nothing / see the departed /. Η I believe in one Poet that says: madness I enjoy; he ridicules existence; let me light up from my mana. Θ Syntax he doesn’t care about when musicality commands him. Along with still more licenses, and Ts are played according to the concept sound anywhere. E.g. the winters here, he winters there; it will not come—I will not rest, etc. etc. Ι The Poet exercises thought until it’s stripped down. Κ And if he’s Greek he must always study the fineness of Attica, in light, mountains, fields and sea. For this fineness teaches language. Λ And if he’s deeply destined the Poet expresses the unexplainable of the explained; he happens to be a rightful heir to the scientist and his predecessor. Μ On the froth he does not last; the Poet blusters at the bottom of the pot. Ν Flamebred and never redeemed. Ξ The Poet must sometimes say: what a consumption of presence — be a bit lonely for a change! Ο The Poet is twilit. Π He is susceptible of deaths and resurrections. Ρ He looks from the corner of his eye and exists in a glance. Σ He follows behind the mother. Τ Eveningless when it comes to age. Υ I believe in one Poet who says: let the purities coincide. Until the Corinth of the Universe or even further. Φ In a higher despair. Χ In a brighter quintessence. Ψ In one sensation that lifts off. Ω Forgiving everyone. CREDO (ως ε?θισται να λ?με λατινιστ?) Α Πιστε?ω εις ?να Ποιητ?ν εκτ?ς ουρανο? / φυγ?ς θε?θεν και αλ?της, Εμπεδοκλ?ς / και επ? της γης / εξ?ριστος π?νω στη γη κ.λπ. του Βωδελα?ρου /. Β Πιστε?ω εις ?να Υπολογιστ?ν εντ?ς κεραυνο? και δια της ?λης. Γ Υποφ?ροντας ?χραντα / ουσιαστικ?ν / ο Ποιητ?ς ανατε?νεται βραδυφλεγ?ς αυτ?χειρας εξυπακο?οντας πολ?ωρους ?πνους. Δ Τα υποψ?φια λ?θη λιγοστε?οντας. Ε Ορατ?ν τε π?ντων και αορ?των ιερουργ?ντας την αποκρομμ?ωση. Ζ Ο Ποιτ?ς ?χει τ?ποτα / βλ?πε τους αναχωρ?σαντες /. Η Πιστε?ω εις ?να Ποιητ?ν που λ?ει: η τρ?λα μ’ αρ?σει· γελοιοποιε? την ?παρξη· ας αν?ψω απ’ τη μ?να μου. Θ Συνταχτικ? δεν το γνοι?ζεται στην προσταγ? της μουσικ?τητας. Μαζ? και μ’ ?λλες ακ?μη λευτερι?ς, και τα νυ πα?ζονται κατ? την ?ννοια ?χος οπουδ?ποτε. Π.χ. τον χειμ?να εδ?, το χειμ?να εκε?· δε θ? ’ρθει – δεν θα καταλαγι?σουμε, κ. λπ. κ.λπ. Ι Ο Ποιητ?ς γυμν?ζει τη σκ?ψη σε απογ?μνωση. Κ Κι αν ε?ναι ?λληνας οφε?λει να σπουδ?ζει π?ντοτε της Αττικ?ς τη λεπτ?τητα, σε φως, βουν?, χωρ?φια και θ?λασσα. Διδ?σκει γλ?σσα η λεπτ?τητα το?τη. Λ Κι αν ε?ναι βαθι? πεπρωμ?νος ο Ποιητ?ς εκφρ?ζει το ανεξ?γητο του εξηγητο?· τυγχ?νει ν?μιμος δι?δοχος του επιστ?μονα και προκ?τοχ?ς του. Μ Στον αφρ? δεν ?χει δι?ρκεια· στο πατοκ?ζανο μα?νεται ο Ποιητ?ς. Ν Φλογοδ?αιτος και ποτ? ξελυτρωμ?νος. Ξ Ο Ποιητ?ς κ?ποτε πρ?πει να λ?ει: μεγ?λη καταν?λωση παρουσ?ας – γενε?τε και λ?γο μοναξι?ρηδες! Ο Ο Ποιητ?ς ε?ναι αμφ?φλοξ. Π Επιδ?χεται θαν?τους και αναστ?σεις. Ρ Ακροθωρ?ζει και υπ?ρχει σε ξαφνοκο?ταγμα. Σ Ε?ναι ουραγ?ς της μητ?ρας. Τ Αν?σπερος απ? ηλικ?α. Υ Πιστε?ω εις ?να Ποιητ?ν που λ?ει: να συμπ?σουν οι αγν?τητες. Μ?χρι την Κ?ρινθο του Σ?μπαντος ? μακρ?τερα. Φ Σε αν?τερη απελπισ?α. Χ Σε φαειν?τερη πεμπτουσ?α. Ψ Σε μια α?σθηση που πτηνο?ται. Ω Συγχωρ?ντας τους π?ντες. From Large Sized Logic [ Λογικ? μεγ?λου σχ?ματος ], Athens: Erato, 1989, n.p. [1993, II, 521-3]. (shrink)

As inpatient nurses spend the majority of their work time caring for patients at the bedside, they are often firsthand witnesses to the devastating outcomes of inadequate preventive healthcare and structural injustices within current social systems. This experience should obligate inpatient nurses to be involved in meeting the social justice needs of their patients. Many nursing codes of ethics mandate some degree of involvement in the social justice needs of society, though how this is to be achieved is not detailed (...) in these general guidelines. Acknowledging an explicit obligation for inpatient nurses to address the social justice issues of their patients would facilitate better overall understanding of social justice issues and reduce preventable admissions. If implementation of such an obligation is done with care, having inpatient nurses participate in justice projects could also mitigate compassion fatigue, allow for better job satisfaction among these nurses, and provide a sense of revitalization in nurses’ role as health promoters. (shrink)

The suspension system is referred to as the set of springs, shock absorbers, and linkages that connect the car to the wheel system. The main purpose of the suspension system is to provide comfort for the passengers, which is created by reducing the effects of road bumpiness. It is worth noting that reducing the effects of such vibrations also diminishes the noise and undesirable sound as well as the effects of fatigue on mechanical parts of the vehicle. Due to (...) the importance of the abovementioned issues, the objective of this article is to reduce such vibrations on the car by implementing an active control method on the suspension system. For this purpose, a conventional first-order sliding mode controller has been designed for stochastic control of the quarter-car model. It is noteworthy that this controller has a significant ability to overcome the stochastic effects, uncertainty, and deal with nonlinear factors. To design a controller, the governing dynamical equation of the quarter-car system has been presented by considering the nonlinear terms in the springs and shock absorber, as well as taking into account the uncertainty factors in the system and the actuator. The design process of the sliding mode controller has been presented and its stability has been investigated in terms of the Lyapunov stability. In the current research, road surface variations are considered as Gaussian white noise. The dynamical system behavior for controlled and uncontrolled situations has been simulated and the extracted results have been presented. Besides, the effects of existing uncertainty in the suspension system and actuator have been evaluated and controller robustness has been checked. Also, the obtained quantitative and qualitative compressions have been presented. Moreover, the effect of controller parameters on the basin of attraction set and its extensiveness has been assessed. The achieved results have indicated the good performance and significant robustness of the designed controller to stabilize the suspension system and mitigate the effects of road bumpiness in the presence of uncertainty and noise factors. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.1 (2002) 84-106 [Access article in PDF] Irony in the Platonic Dialogues Charles L. Griswold, Jr. I INTERPRETERS OF PLATO have arrived at a general consensus to the effect that there exists a problem of interpretation when we read Plato, and that the solution to the problem must in some way incorporate what has tendentiously been called the "literary" and the "philosophical" sides of Plato's writing. (...) The problem is created by the fact that Plato wrote in dialogue form, indeed a specific type of dialogue form. The solution must somehow combine into a coherent theory of the "meaning" of the dialogues, the ways in which these texts work (such as the use of imagery, metaphor, myth, allusion, irony, as well as argument). At the same time, there exists enormous disagreement about how one ought to move from these general observations to interpretation of a particular text. 1The problem of interpretation lies not merely in the fact that Plato wrote dialogues. That alone would not necessarily present any hermeneutical issues of unusual difficulty. Plato's distinctive use of the dialogue form creates the difficulties. The genre that we might call "the Platonic dialogue" is distinguished by several relevant characteristics.First, there is no character called "Plato" who speaks in any of the dialogues; indeed, "Plato" is mentioned twice in the entire corpus, once as being absent (Pho. 59b10), and once as being present (Apol. 38b6). Authorial anonymity is thus an important feature of the dialogues. 2 At least ab initio, we are not justified in identifying Plato with any one of his characters. Indeed, there are positive reasons why he cannot be identified even with Socrates, as I will discuss below. 3 Plato is absent from his own texts; no simple act of reading them will allow us to ascertain what his views are. 4 It does not follow that Plato's views are [End Page 84] entirely absent from the dialogues—say, in the form of some mysterious "esoteric teaching"—and that they cannot be elicited by a complex act of reading. Just how Plato's views are to be extracted has been, again, the subject of a very long debate. 5 I myself think that Plato's views can be so elicited. 6 But the fact of his anonymity as author means that "Plato's meaning" is not ascertainable in the way that, say, "Kant's meaning" may be ascertainable in the Critique of Pure Reason.A second feature of Plato's dialogues contributes to the interpretive puzzle. The dialogues are clearly fictional in character. They are not—they could not be—transcriptions of conversations which took place. Some dialogues could not have taken place even when the interlocutors were historical figures (for example, at the Phaedrus' ostensible dramatic date the real Phaedrus was not in Athens). Not only are many of the characters entirely fictional, there is clear evidence that even "Socrates" is very much a fictionalized version of the historical character. I am referring not just to the famous statement in the (possibly inauthentic) Second Letter, 7 but to the fact that the Socrates of Plato's dialogues is presented as being a super-human character. This is evident from Alcibiades' description of him in the Symposium as well as from a number of subtle fictions. For example, Plato has Socrates narrate the entirety of the Republic from memory, without a single moment of hesitation or (so far as the reader can tell) any lapse of memory. This fantastic feat is complemented by Socrates' equally fantastic stamina in conversation. The lengthy Protagoras, for example, is narrated in its entirety by Socrates immediately after the dialogue itself has occurred. Socrates never shows any fatigue of any sort. It is not just hyperbole to say that Plato's Socrates is heroic; he is carefully compared, in passages I cannot examine here, to both Achilles and Odysseus. Socrates' absolute calm and self-control before death also evidence his superhuman character. The relation between the historical Socrates and the Platonic Socrates is the source of much fruitful controversy. It suffices for... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Comorbidity:More Than a Kuhnian AnomalyPeter Zachar (bio)Keywordscomorbidity, classification, epidemiology, differential diagnosis, personality disorderDr. Aragona's article in this issue of Philosophy, Psychiatry, & Psychology makes some important points regarding the relationship between comorbidity rates and the classification system currently used in psychiatry. Particularly persuasive is his claim that observed patterns of comorbidity are, in important respects, consequences of the structure of the classification system. I am not convinced, (...) however, that comorbidity is best conceptualized as an artifact of the taxonic structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Instead, I suggest that the use of dichotomies such as true versus artifactual should be used with caution when psychiatric classification is being discussed.In contrast with the artifact hypothesis, I argue that the phenomena covered by the term "comorbidity" are real, expectable features of the psychiatric domain. They are not the phlogiston and luminiferous ether of psychiatry. I am skeptical of the notion that high comorbidity rates as a whole can be understood as Kuhnian anomalies, or that there is a crisis, or that after a period of revolutionary science a new paradigm would eliminate these 'anomalies.' In short, high rates of comorbidity in psychiatry will not simply disappear once scientists develop a better nosological paradigm. High levels of comorbidity can, however, be both lowered and provided a better, evidence-based conceptual framework.Many Conditions, One OrganIn general medicine, comorbidity conventionally refers to the simultaneous occurrence of two independent disease processes or distinct clinical entities, such as heart disease and liver cancer (Feinstein, 1970; Jablensky 2004). The presence of one disease is supposed to affect the other in such a way that the co-occurrence of the two has implications for prognosis and treatment.Comorbidity in psychiatry is a broader concept, referring to a variety of conditions that overlap in multiple ways. The different kinds of overlap are amenable to detailed empirical analysis (e. g., Klein and Riso 1993; Neale and Kendler 1995). Depressive reactions to primary disorders, attention deficit symptoms associated with mania, panic attacks in the context of severe borderline personality disorder, substance abuse disorders among psychopaths, histrionic dynamics combined [End Page 13] with narcissistic personality traits, and emergent conditions such as schizoaffective disorder are all distinct types of comorbidity. The kinds of overlapping conditions just listed are sometimes termed psychiatric comorbidity. Also important is comorbidity between psychiatric disorders and general medical conditions as is studied in behavioral medicine and health psychology. The crisis, if there is one, is a crisis of comorbidities.The heart disease and liver cancer type of comorbidity as independent organ systems being affected is ruled out a priori in psychiatric comorbidity proper. In psychiatry, "psychopathological disease processes" can all be expected to affect a single organ, namely the brain or, more likely, affect the different systems that are tightly integrated in the brain. The tight integration can make putative comorbid psychiatric disorders difficult to disentangle.It is a widely held consensus that causes, not organ systems, are what matter in comorbidity. In this tradition, Dr. Aragona claims that in general medicine shared symptoms between two diseases (such as fever and fatigue) are not a problem because the diseases are differentiated with respect to etiology; in psychiatry, however, where syndromes are differentiated by a description of symptoms only, symptomatic overlap is a problem.Is descriptive psychopathology, therefore, a root cause of the "crisis of comorbidity" and should it be abandoned in favor of etiological classification? Unfortunately, forcing psychiatric nosology to conform to an etiological paradigm is unlikely to resolve the problem of psychiatric comorbidity. As noted, the problem is one of distinguishing between the different etiological disease processes that are affecting tightly integrated systems in the brain. The brain as a whole is a multilevel, dynamic, and open system, which has an ecology (Zachar 2000). As argued by Kendler (2005) and Schaffner (2002, 2008), it has not thus far, and may never be fully possible to segregate causes and their associated psychiatric disorders into parsimonious etiological packages. In the ecology of neuroscience, causes and effects tend to merge in a continuous series of common pathways.It would be foolish... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Family, Friends, and Cancer:The Overwhelming Effects of Brain Cancer on a Child’s LifeLynne ScheumannOur son was diagnosed with a medulloblastoma at the old age of 13. The “lucky” part for him was his brain was almost fully developed at this age as opposed to most “medullo” patients. While this was a benefit to him it was also one of the hardest things for him.He went into surgery a highly (...) intelligent, active, and left handed boy and came out unable to move his left side, could barely speak, and very much aware of what he just lost. We, as a family, were totally unprepared for how globally this would [End Page 23] affect the rest of his life. As we spent time in the hospital I would look at the children with other types of cancer and see them walking and talking and doing their schoolwork and God forgive me I would be jealous. The fact that the cancer was in his brain, the part of his body that makes him who he is changed everything forever.He lost all of his friends because 13–year–old boys communicate best through physical activity and that was not an option for him. He still has the same personality and sense of humor, but he will not be the architect or engineer he once dreamed of being. Math, that was once so easy for him was now like a foreign language, never to be mastered again. He was able to graduate from High School and takes classes at our local Junior College in Computer Assisted Drafting, but he can only manage one or two classes a semester due to the fatigue he still suffers from.What I most worry about and wish I had been forewarned about is his long–term quality of life. Physically he has come such a long way from how he was after the resection. It was a very slow process in which the first year of rehab was slowed by the fact that one of the chemo agents causes peripheral neuropathy. He developed contractures in his ankles and needed serial casting and ankle–foot orthotics (AFO) not just on the left leg, but now the right. He was able to switch his handedness fairly easily and his left hand will always be of limited usefulness because of ataxia. I would get angry at him that he gave up on his left side so quickly until it was finally explained to me years later that the ataxia would never get better.As far as his walking ability goes he has come a long way. At first he was unable to walk and once he started rehab he went back to learning to crawl and progressed to a walker. The first time I saw him walk with the walker brought tears to my eyes. It was so much more of an event for me than when he took his first steps as a toddler. This was so much more hard fought. He never complained, just always did what was asked of him. It had to have been such hard work and also somewhat embarrassing, as he needed help to literally do everything for months. He progressed to a cane and about two years ago decided not to use that or his AFO’s. He now wears high top boots that substitute for the AFO’s but don’t make him appear disabled. Recently he decided there are times when he would be safer if he had his cane and purchased one that looks more like a hiking stick than a cane. I think he has come to terms with the fact that physically he is as good as he is going to get and works hard to maintain what he did regain. He has a trainer and goes to the gym on a regular basis with no prompting from us. I do not know if he realizes that as he ages things will be harder for him than the average person. I think in some way he is aware of that because he did decided to use the cane if safety is an issue.His... (shrink)

Nursing theories are typically anthropocentric and emphasize caring for a person as a unitary whole. They maintain the dualisms of human–nonhuman, natural–social and material–ideal. Recent developments in nonhuman ontology question the utility of that approach. One important philosopher in this new materialism is political theorist Jane Bennett. In this paper, I explore Bennett's vital materialism and enchantment as two concepts arising from the nonhuman turn that should inform nursing philosophy. Vital materialism considers the lively power of matter to affect the (...) world and be affected in relations. Enchantment refers to a sense of wonder and captivation with matter. While summarizing her important contributions, I also describe common criticisms and responses. I consider the human as an assemblage of matter as well as the agency or “thing power” of matter external to humans. This has implications for nursing thought and practice, and it can inform a more capacious research methodology. I also discuss how compassion fatigue or burnout and other professional issues may be seen as a form of disenchantment with the material world. I argue that embracing these and other elements of Bennett's new materialist philosophy can help nurses and other health professionals enrich their theories and practice to advance their disciplines and improve care for persons and populations. (shrink)

The realities of the coronavirus crisis caused by the COVID-19 pandemic, in many cases, become decisive for adjusting the prospects for socio-economic development. The article presents the main results of studying the social aspect of the pandemic in the context of social heterogeneity and specific regional differences. The main points of the study are focused on analyzing the dynamics of the pandemic spreading in Russia’s regions, the specifics and effectiveness of social restrictions, and the transformation of social space. The analysis (...) of the pandemic dynamics was carried out taking into account the information from four large industrial regions in the center of Russia and the Urals. As part of the analysis, a number of problematic issues of the social constraints effectiveness are considered, among which there are the following ones: specificity of the pandemic dynamics by regions in the context of various options for self-isolation, factors of «Path Dependence» of the social space, the consequences of redundant restrictions, social «fatigue» and «erosion» of requirements for isolation. From the viewpoint of updating the transformation priorities - spatial transformations during a pandemic, the following aspects are considered: background for moving from isolation restrictions to spatial transformations, regional employment specificity, socio-economic priorities of spatial transformation, problem-oriented zoning of a heterogeneous socio-economic space. The study is aimed at developing an adequate authorities’ and society’s response to the problems of coronacrisis, forming a regionally adapted set of measures and strategies of socio-economic transformations during the pandemic, creating a basis for solving interdisciplinary issues in the subsequent situation of «normality 2020». (shrink)

This paper clarifies the notion of "contact with reality" by investigating one way in which lack of such contact can be expressed: the interrogative attitude. The case of a socially withdrawn, seventeen-year-old schoolboy is examined. Paul C. had long been overly logical and precise in his style of thinking. An acute disturbance began with mental fatigue along with apparent obsessive symptoms (e.g., extreme monitoring of his own actions) to the point that simple, everyday actions became very time-consuming; he also (...) developed a tendency to ask endless questions even about trivial phenomena. However, unlike those of the true obsessive, Paul's monitoring, doubting, and querying seemed to lack any emotional or personal element; he was not anxious but, rather, apathetic. Also, Paul lacked real curiosity: To him, everything had the same level of importance, and his attention was not directed by any precise or personal goal. This paper argues that Paul's interrogative attitude was actually a form of autistic-schizophrenic thinking characterized by "pragmatic weakening" and a loss of vital contact with reality, which are consequences of a weakening of the "élan vital" with its "vital propulsion toward the future." Such patients retain their intellectual powers but do not use these powers in accord with the requirements of reality. The interrogative attitude can be seen as a compensation mechanism—a way to maintain some minimal contact with the world. The paper ends with psychotherapeutic recommendations. (Abstract written by special issue editor: L.A.S.). (shrink)

Middle- and upper-middle-class students continue to outpace those from less privileged backgrounds. Most attempts to redress this inequality focus on the issue of access to financial resources, but as _Producing Success_ makes clear, the problem goes beyond mere economics. In this eye-opening study, Peter Demerath examines a typical suburban American high school to explain how some students get ahead. Demerath undertook four years of research at a Midwestern high school to examine the mercilessly competitive culture that drives students to (...) advance. _Producing Success_ reveals the many ways the community’s ideology of achievement plays out: students hone their work ethics and employ various strategies to succeed, from negotiating with teachers to cheating; parents relentlessly push their children while manipulating school policies to help them get ahead; and administrators aid high performers in myriad ways, even naming over forty students “valedictorians.” Yet, as Demerath shows, this unswerving commitment to individual advancement takes its toll, leading to student stress and fatigue, incivility and vandalism, and the alienation of the less successful. Insightful and candid, _Producing Success_ is an often troubling account of the educationally and morally questionable results of the American culture of success. (shrink)

Boddez, Van Dessel, and De Houwer in their paper “Learned helplessness and its relevance for psychological suffering: A new perspective illustrated with attachment problems, burn-out, and fatigue complaints” advance the idea that failing to reach a goal of personal importance unleashes detrimental processes (i.e. learned helplessness) which spill over to other (similar) goals, in the long run resulting in passivity and psychological suffering. As the authors conceptualise learned helplessness in motivational terms (lack of reinforcement, dysregulation of goal-directed response) and (...) attach great weight to the concept of goal failure, I will comment on three issues inherent in their line of argument from a motivational perspective, that is, from the perspective of persistence and disengagement in personal goals. More specifically, first, I will address the distinction between motivational and functional helplessness, then elaborate on goal-related failure and its consequences, and finally cover the issue of generalising failure experience due to the similarity of goals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:André Cadieux THE JUNGLE OF DIONYSUS: THE SELF IN MANN AND NIETZSCHE "nphe self," wrote Kierkegaard, "is a relation which relates itself to A its own self." From this cryptic saying we may at least infer that to be a self is to be self-conscious. But the human self has always resisted its reflexive scrutiny, and thus remains mysterious to itself. "What—on the assumption that it has one—is its (...) essence?" "Of what moral nature is that essence?" "What possibilities of self-transcendence does the self contain?" These questions are, or ought to be insofar as we pride ourselves on being reflective, central questions for us all. They were surely central to Friedrich Nietzsche and Thomas Mann, but it is the burden of this article to argue that these men were united, at least at a certain point in the career of each, in their answers as well as in their questions. If we accept this claim, then we must either find dubious Mann's assertion about Nietzsche, "I took nothing literally, I believed him hardly at all,"1 or accept it on pain of believing in the occurrence of an extraordinary coincidence. For (I submit) a full understanding of Aschenbach's fate in Death in Venice yields a vision of human life and the self that is identical to that of Nietzsche in The Birth of Tragedy. Mann's central symbol is thejungle; it is, in fact, thejungle of Nietzsche's Dionysus. I When death, in the person of the gaunt stranger with the vertical furrows in his brow (pp. 4-5),3 comes to lead Aschenbach on his last journey, our sense of symmetry disposes us to find in the story some symbol of life as well. And initially it looks as if, in Aschenbach's vision of the jungle "thick with incredible bloom" (pp. 5-6), we have it. But if we follow Mann into the psyche of Gustave Aschenbach, we shall see that the matter is not so simple. Aschenbach, at the height of 53 54Philosophy and Literature his powers—a nobleman at fifty, whose prose is by now a textbook paradigm (p. 14)—is declining, suffering from a "growing fatigue, which no one must suspect," and longs to travel because travel will remove him from "the spot which was the daily theatre of a rigid, cold, and passionate service" (p. 7), a service which he finds it increasingly difficult to maintain. But why the difficulty? He was not naturally robust—which made his efforts of will "the more morally valiant" (p. 9); but what is there in the writer's art that should demand such stamina? Aschenbach had himself said "that almost everything conspicuously great is great in despite," and of the truth of that saying his own life was an exemplar (p. 1 1). But in despite of what? The text mentions mundane obstructions and afflictions, but these are superficial. We must look for our answer in that force against which Aschenbach has most strenuously set himself. That force, it emerges, is knowledge. The conspicuously great is great in despite of its temptation by knowledge. Knowledge is for Aschenbach, strangely, a "sharp and bitter irritant" which blunts the mind, and because it had for him this property he "turned his back on the realm of knowledge, and passed it by with averted face" (pp. 12-13). He renounces sympathy with this "abyss," and in its place achieves "the miracle of regained detachment," which issues in a style of "lofty purity, symmetry, and simplicity, which gave his productions a stamp of the classic" (p. 13). But what is this dread knowledge, why is it dreaded, and what is the detachment sought in its stead? It is knowledge, we must conclude, of the human soul. Aschenbach's great novel, The Abject, is to be interpreted as "a rebuke to the excesses of a psychology-ridden age," excesses which stand condemned because they issue in "the flabby humanitarianism" expressed in Madame de StaëPs maxim that to understand all is to forgive all (p. 13). Aschenbach, in short, rejects knowledge of the true self because it leads to the self's acceptance of the self... (shrink)

E. Levinas et M. Henry reconnaissent tous deux l’importance pour la philosophie occidentale de la pensée de Husserl, mais ils s’en démarquent car ils la trouvent trop intellectualiste. C’est pourquoi ils vont chercher respectivement dans l’autre et dans la vie auto-affective une issue radicale à toute représentation ou discours théorique. L’auteur de cette étude met dès lors en évidence le fait que la critique, par ces deux phénoménologues, des philosophies de la conscience les amène à décrire, dans le cadre (...) de ce qu’elle propose d’appeler une « méta-phénoménologie », des « attitudes » telles que le désir, la douleur et la fatigue. Il sera question dès lors de tâcher de répondre aux questions portant sur la possibilité d’une refondation de la phénoménologie qui irait « au-delà » ou « en deçà » de ce que cette démarche philosophique s’est donné elle-même comme horizon. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Holding Doctors Responsible at Guantánamo*Nancy Sherman (bio)I recently visited the Guantánamo Bay Detention Center with a small group of civilian psychiatrists, psychologists, top military doctors, and Department of Defense health affairs officials to discuss detainee medical and mental health care. The unspoken reason for the invitation to go on this unusual day trip was the bruising criticism the Bush administration has received for its use of psychiatrists and psychologists (...) in the interrogation of suspected terrorist detainees.1We disembarked from our Navy jet to find an island lush and green from recent storms. A small boat took us from the airfield to the naval hospital. From the boat there was no sign of Camp Delta, where the detainees are actually held. Nor was there a sign of prisons or barbed wire or the detention facility's 505 inmates.Our host was the commanding officer of Gitmo, Major General Jay W. Hood (an artillery officer by training), who had replaced Major General Geoffrey Miller, implicated in the "migration" of torture methods from Gitmo to Abu Ghraib. Dressed in fatigues, General Hood briefed us using PowerPoint. His intelligence director told us that interrogators have not used harsh "fear up" tactics—the ones designed to terrify—since 2003.We went by bus from the naval hospital to the 30-bed detainee hospital for quick briefings from a psychiatrist and a physician. Still, we were not permitted to see any detainees or hunger strikers, despite our requests. During our six hours on the ground, we had only a fleeting glimpse of a few detainees outside their cellblocks behind barbed wire and screened fences.Indeed, when I got home and saw the play "Guantánamo: Honor Bound to Defend Freedom," by Victoria Brittain and Gillian Slovo, I had the disquieting feeling that I had absorbed more about detainee life at the theater than I had from actually being at Gitmo. This only amplified my anxiety that what I had heard and seen during my VIP visit sidestepped the central moral issue of whether abuse is still occurring at Gitmo and whether health professionals are, or have been, a party to coercive interrogation. [End Page 199]The question that the Pentagon leadership has been focusing on, and which was a key subject of discussion during our day at Gitmo, is whether there is an ethical difference between using psychologists or psychiatrists on interrogation teams—what the Pentagon calls, "behavioral consultation teams," or BSCTs, pronounced "biscuit." Some in the Pentagon would like to have doctors and psychiatrists, who are bound by the Hippocratic teaching to "do no harm," be the clinicians treating detainees. Psychologists, who are not as bound by Hippocratic dicta, would consult with and advise interrogators. But this is a red herring. It is hair-splitting that detracts from the real issue of whether health professionals of any stripe can ethically be involved in interrogations that may involve coercive techniques or torture. The answer is clearly no. They should not be involved, directly or indirectly, in situations that may lead to the breach of confidential medical records; to torture or to cruel, inhumane, and degrading treatment; or to exploitation of fears or phobias. Mental health professionals simply should not be collaborating with interrogators in inflicting psychological torture.Hood said that "rapport building" was the preferred and an effective interrogation technique, but that is no guarantee that rougher tactics will not be used. The fact is that there is enormous pressure on the people at Guantánamo Bay to get good intelligence for the war on terror, and it is as easy for behavioral scientists as it is for interrogators to compromise their moral standards. Cunning and deception to extract information may be acceptable in some cases. But many people have been outraged to learn from media reports that methods developed by military psychologists to train our own troops to resist torture—the so-called "survival, evasion, resistance, and escape" methods taught at Ft. Bragg—have been "reverse engineered" at Guantánamo Bay to create coercive, psychologically manipulative interrogation techniques for use against detainees.Plato warned long ago that a doctor's skill, abstracted from good character and wisdom, is a neutral... (shrink)

ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss protocol on communication and wellbeing of older persons with DSL and their communication partners in the Netherlands and Belgium.MethodsParticipants and their communication partners were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication (...) strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired. Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843. (shrink)

BackgroundPhysician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians.MethodologyA scoping review was (...) conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review.Results31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice.ConclusionMindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation. (shrink)

According to the literature, the family is now considered to be the most important resource for the care and support of a sick family member. Families are being increasingly invited and trained to play a utilitarian role, not just as family caregivers, but as healthcare agents. Healthcare institutions, based on neoliberal health policies, are encouraging them to perform increasingly complex and professionalized tasks. The burden associated with this expanded healthcare function, however, is significant (fatigue, emotional distress and exhaustion). The (...) aim of this article was to present French sociologist Jacques Donzelot's theoretical perspective on governing through the family. According to Donzelot, such a government is exercised through various power techniques, including the instrumentalization of the family role and the transfer to families of the responsibility for health care. This author describes how healthcare institutions call on the family to perform hospital and biomedical practices within the home. A spin‐off of neoliberalism, the practices of governing through families specifically target women, who are considered to be the pillar of the family. Donzelot's perspective is very relevant to nursing, but is still rarely mobilized in the discipline. His critical perspective allows for a re‐reading of relations of power and mechanisms of surveillance and control of families, issues that are often overlooked in nursing research. (shrink)

The word ‘freedom’ leads a double life. As a rallying cry in the mouths of politicians and publicists, it features in speech acts which inspire men to brave endeavours. Freedom or death are the proffered alternatives, and they are generally linked with fatiguing dispositions such as vigilance. As a philosophical concept, on the other hand, freedom is a territory in which battles are fought about such issues as positivity and negativity, virtue, determinism and the character of the will. There is (...) remarkably little connection between these two lives. Philosophers do not seem to take much interest in courage, and politicians do not tarry to specify whether it is negative or positive liberty they are talking about. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Receiving the Gift of Life: My Kidney Transplant StoryJudith W. RyanAs one of three siblings who all inherited an unfortunate gene from our mother, I was born with polycystic kidney disease (PKD). None of us knew of this, however, until later middle age, and my mother not until she was 76. I was the last sibling diagnosed at the age of 56. My brothers had been diagnosed some years (...) before and jokingly started to look at me as a universal donor. Since I had a 50-50 chance of having PKD and with a mother who was one of eight children with none of her siblings known to have the disease, I had not felt an urgency to be tested. Besides, I had no signs or symptoms. But now there was a reason. I made an appointment for a renal ultrasound and while having the procedure, I tipped the screen so that I could see the results. Although the technician was not happy with this, I was repaid with the view of my kidneys looking full of bubbles. Yes, our family was three for three in the genetic game of roulette.I knew immediately how I was going to navigate this health issue. As an adult nurse practitioner I had a very good understanding of what was to come. I knew my blood type “O” was the most common and would mean the longest wait for a deceased donor transplant, at least five years if I were lucky and only after enduring several years of progressing renal failure. In addition, I had cared for dialysis patients and watched my mother endure with difficulty both peritoneal and hemodialysis prior to her death a year before my diagnosis. Knowing I would not choose dialysis left me hoping for a miracle of a living donor or, more realistically, managing my disease as best I could until I died.The next step was managing PKD symptoms and issues as my kidneys continued to fail. One of the errors in my thinking during this time turned out to be that because I had two brothers who had the same disease and were ahead of me in their disease progression, I could follow their lead. It turned out that we manifested our disease very differently. My younger brother, who was diagnosed first, had to deal with significant pain from persistent cyst ruptures, monthly, biweekly then weekly. This continued even after his transplant until he had his native kidneys removed. The other two of us did not have to deal with cyst ruptures. Additionally, anemia was no problem for my younger brother but was for us older siblings. Significant fatigue and weariness were a problem for both of my brothers but not for me.And so it went, as we compared our blood test results, that the idea of a living donor entered the conversation. I knew this would be a problem for me because how do you ask people to consider being a donor? I had difficulty asking friends for a ride to the airport. This is where the grace and kindness of others and divine intervention enter [End Page 107] our story—word about our medical dilemma spread through the visibility of my younger brother, a minister in New England.Fortunately for me, my much beloved younger brother had dozens of people who wanted to be his donor. About 12 of these potential donors were actually tested before finding a match. One of his unmatched donors became the donor for my older brother (our first family transplant). Two years later, my other brother received his transplant. Three years later, after being told he was not a good match for my brother, this dear man came forward to be a possible donor for me. Hence, I got my transplant from an unused donor from my younger brother’s group. Overall, we had living donors from three different churches located within an hour of each other in New England. I even lucked out and acquired the minister of one of the churches as my donor. All three of us received kidneys over five years from living donors who did not know my older brother... (shrink)

Fibromyalgia is characterised by chronic, continuous, widespread pain, often associated with a sense of fatigue, non-restorative sleep and physical exhaustion. Due to the nature of this condition and the absence of other neurological issues potentially able to induce disorders in body representations per se, it represents a perfect model since it provides an opportunity to study the relationship between pain and the bodily self. Corporeal illusions were investigated in 60 participants with or without a diagnosis of FM by means (...) of an ad hoc devised interview. In addition, motor imagery was investigated and illusions relating to body part movements and changes in body size, feelings of alienness, and sensations of body parts not belonging to one’s own body were found. Crucially, these symptoms do not correlate with any of the clinical measures of pain or functional deficits. The results showed that motor imagery was also impaired, and the severity of the deficits found correlated with the functional impairment of the participant. This indicates that disorders in body representations and motor imagery are part of the clinical expression of FM. However, while motor imagery seems to be linked to reduced autonomy and functional deficits, bodily illusions are independent and potentially represent a concurrent symptom. (shrink)

Community and patient stakeholder partners serve in many roles. One particularly important role of community and patient organizations and representatives is to serve as gatekeepers; in this role, they monitor, and in some cases even determine, what research does and does not get conducted with their communities. Such gatekeeping can prevent “helicopter” research and community research fatigue. Gatekeeping can also aid in identifying and mitigating harms that might occur not only to individual participants but to third parties (who do (...) not provide consent for participation) or to the community as a whole. Although individual informed consent and independent review both aim to protect against research risks, in research with identifiable communities these protections may be insufficient to protect from other types of harms. Given the gaps in protection, the gatekeeping role of community research partners is an important supplement to informed consent and independent IRB review, but it also raises its own set of ethical challenges. Here, we discuss the limitations of informed consent and independent review in research with identifiable communities, the benefits of gatekeeping for protecting third parties and groups, types of gatekeepers, and issues in the selection of gatekeepers. (shrink)

The COVID-19 pandemic is a health issue leading older adults to an increased vulnerability to unfavorable outcomes. Indeed, the presence of physical frailty has recently led to higher mortality due to SARS-CoV-2 infection. However, no longitudinal studies have investigated the role of neuropsychogeriatric factors associated with lockdown fatigue in healthy cognitive aging. Eighty-one healthy older adults were evaluated for their neuropsychological characteristics, including physical frailty, before the pandemic. Subsequently, 50 of them agreed to be interviewed and neuropsychologically re-assessed (...) during the lockdown and immediately after it. Moreover, during another home confinement, they performed a psychological screening to evaluate possible mood changes and fatigue. According to Fried's frailty criteria, at T0, 63% of the sample was robust, 34.5% pre-frail, and only 2.5% frail. Significantly, these subjects presented a decrease in handgrip strength and walking speed. Results from Principal Component Analyses and multiple regression models highlighted the contribution of “cognitive” and “psychological” factors in explaining handgrip strength and gait speed. At T3, lockdown fatigue was explained by higher scores on the Beck Depression Inventory and lower scores on the Trail Making Test part A. Results from a moderated-mediation model showed that the effect of psychomotor speed on lockdown fatigue was mediated by depression, with a moderating effect of gait speed. Our findings highlight the complex interrelationship between cognitive, psychological, and physical factors in the emergence of pandemic fatigue in a carefully selected older population. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

Social and political topics of public concern shift and reconfigure themselves with volatility as well as speed in contemporary life. Issues ignite and arouse constituencies of response, in alliance and opposition, with a quite uncertain degree of predictability, even if with periodicities and a detectable routing circuitry about which it is easy to become cynical, or at least fatigued. Something burns, now, among us; and we would prefer not to think much about the fact that it, or a close relative, (...) burned a year and a half before—sometimes even more recently—in other places more plausibly a fountain and fundament of currents of Western cultural life. The issues must feel real; they must be seen as urgent, abstract matters of right and wrong, shocking disclosure, heroic resistance, without reference to anywhere else than here and anyone else but us. (shrink)

This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during the COVID-19 (...) pandemic, reimagining situations of “unfreedoms” is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Taking Sides: Clashing Views in Death and Dying ed. by William J. Buckley and Karen S. FeldtZoe BernatskyTaking Sides: Clashing Views in Death and Dying Selected, edited, and with introduction by William J. Buckley and Karen S. Feldt new york: mcgraw-hill, 2013. 576 pp. $63.00If you are searching for a textbook that inspires students to think critically by examining diverse positions around contemporary bioethics issues related to death (...) and dying, Taking Sides: Clashing Views in Death and Dying is an engaging and effective learning tool that is well structured and a compelling read. As part of a series of Taking Sides textbooks, this volume examines eighteen issues clustered around seven themes: (1) end-of-life decision making; (2) caregiver end-of-life decision making; (3) treatment requests and decisions regarding pain and futility; (4) assisted suicide; (5) determining definitions of death; (6) hospice, policy, and costs of dying; and (7) dying and death as cultural performances. Units for each theme include an introduction, pro and con arguments, a summary, and a list of additional resources.The book offers a wealth of wisdom through thought-provoking scenarios, forward-looking themes, and scholarly articles. Readers are presented with real-life controversies, such as how depression or advanced directives influence the [End Page 214] end-of-life decision-making process, and how advocates affect the quality of end-of-life care. Other topics covered include the right to effective pain management, the use of palliative sedation for intractable symptoms, and withholding or withdrawing futile treatment including artificial nutrition and hydration. Also debated are concerns surrounding the provision of assisted suicide and the criteria for establishing brain death; issues regarding access to hospice; the impact of identifying with a specific religious orientation; and the reception of culturally competent care.Individuals are often forced abruptly into end-of-life decisions without time for extensive reflection about the meaning of life and death. The weightiness of the outcomes and the intensity of the experience, combined with the apprehension so many of us feel about death and dying, can overwhelm individuals and families. This book promotes thoughtful deliberation about such matters from both professional and personal perspectives. The inclusion of a section on caregiver decision making that highlights compassion fatigue is a unique and valuable contribution to the overall topic. Social, cultural, and religious influences that increase comfort (or pain) in dying patients and the unique experience of grief for those who remain are also given attention.The greatest strength of this text is the “Taking Sides” approach, which introduces the reader to divergent positions on ethical issues. The articles are well selected from recent scholarship and orient readers who may be unfamiliar with medical and ethical terminology and concepts. The presentation of contradictory positions demonstrates the true-to-nature complexity of ethical decisions and inspires the reader to further reflection, and the extensive list of resources provides a rich opportunity for further study. The book is an easy read, and the units and themes can be surveyed independently, making it a helpful resource for introductory courses on moral theology or ethics; a digital “Instructor’s Resources Guide” provides sample questions for academic purposes. Since death and dying is a universal issue, the anticipated audience is extensive.While this text provides an excellent introduction to the ethical dilemmas around death and dying, there are particular areas that are not addressed, such as decision-making in the case of neonates, children, or those with preexisting psychiatric disorders or other disabilities. A valuable addition to the book would have been the presentation of a framework for dealing with the complex challenges of death and dying, such as the virtue ethics framework offered by Lydia Dugdale in the 2015 publication Dying in the Twenty-First Century. But although the book does not add new material to existing debates, the clarity with which it presents each argument will help to orient those less familiar with bioethical issues. [End Page 215]Zoe BernatskyNewman Theological CollegeCopyright © 2016 Society of Christian Ethics... (shrink)

The relation between moral philosophy and moral practice is itself philosophically controversial. nor is there any one determinate formula through which to express the relations between the basic principles of morality and of rationality itself. the concepts of the moral and the political are both 'essentially contestable' and so too is the nature of their relations; that is, their analysis is itself of moral and political import. nevertheless, in periods of overall stability, this contestability may hardly be apparent. all this, (...) and its connection with philosophy's fundamental commitment to questioning and self-awareness has a deep significance for moral (and political) education. (shrink)

Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system (...) boundaries and on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries. (shrink)

It is commonly taken for granted that questions of feasibility are highly relevant to our normative thinking – and perhaps especially our normative thinking about politics. But what exactly does this preoccupation with feasibility amount to, and in what forms if any is it warranted? This article aims to provide a critical introduction to, and clearer characterization of, the feasibility issue. I begin by discussing the question of how feasibility is to be understood. I then turn to the question (...) of feasibility’s role, suggesting that there are two quite different kinds of role questions that may be at play, though they are often run together: a question about feasibility’s normative significance; and a question about its proper use in informing our normative thinking. Finally, I consider how the feasibility issue differs from certain other related issues: the demandingness issue; the issue of whether “ought” implies “can;” and the “ideal versus non-ideal theory” issue. (shrink)

The author argues that there is no such thing as a unique and general taxonomy of non-at-issue contents. Accordingly, we ought to shun large categories such as “conventional implicature”, “F-implicature”, “CI”, “Class B” or the like. As an alternative, we may, first, describe the “semantic profile” of linguistic devices as accurately as possible. Second, we may explicitly tailor our categories to particular theoretical purposes.