Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

BackgroundDeep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies hav...

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

Learning and memory are inextricably intertwined. The capacity for learning presupposes an ability to retain the knowledge acquired through experience, while memory stores the background knowledge against which new learning takes place. During the dark years of radical behaviorism, when the concept of memory was deemed too mentalistic to be a proper subject of scientific study, research on human memory took the form of research on verbal learning (Anderson, 2000; Schwartz & Reisberg, 1991).

Conscious recollection appears to be governed by seven principles: elaboration, organization, time‐dependency, cue‐dependency, encoding specificity, schematic processing, and reconstruction. However, these same principles may not apply to unconscious, or implicit, memory. Implicit memory is most commonly reflected in priming effects which occur in the absence of conscious recollection. Dissociations between explicit and implicit memory have been observed in patients suffering various sorts of brain damage, in other forms of amnesia, in behavioral performance of neurologically intact subjects, and in brain‐imaging studies (...) of memory. The most popular interpretation of these dissociations holds that explicit and implicit memory are mediated by separate and independent brain systems. However, there are also compelling interpretations in terms of dual processes operating on the contents of a single memory system. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

Contemporary literature in philosophy of action seems to be divided overthe place of action in the natural causal world. I think that a disagreementabout ontology underlies the division. I argue here that human action isproperly understood only by reference to a category of process or activity,where this is not a category of particulars.

In this book we attempted to gather together a set of chapters that describe new ways of approaching questions about aesthetics and innovation. Rather than going over old ground, the chapters describe attempts to break out in new directions. The book begins with a description of von Ehrenfels development of a Gestalt theory of aesthetics so evocative of the Vienna of 1900 that readers will wish that they had been there to experience the intellectual excitement and ends with a survey (...) the very latest research on brain scan research on perception of art. In between, we encounter chapters as diverse as a description of cognitive effects on art perception and on the analogies between oscillations in art history and waves in the physical world. About half of the book contains chapters by well known western psychological aestheticians and half chapters by Russian scholars many of whom will be new to western readers. As well as describing new methods and results, the chapters by Russian scholars will be novel to most western readers, because the Russian perspective on aesthetics and innovation is rather different than the traditional western perspectives. Looking at phenomena from new viewpoints never hurts and very often helps in science. (shrink)

The question that will be the focus of this paper is this: what is the significance of disagreement between those who are epistemic peers? There are two answers to this question found in the recent literature. On the one hand, there are those who hold that one can continue to rationally believe that p despite the fact that one’s epistemic peer explicitly believes that not-p. I shall call those who hold this view nonconformists. In contrast, there are those who hold (...) that one cannot continue to rationally believe that p when one is faced with an epistemic peer who explicitly believes that not-p. I shall call those who hold this view conformists. Inthis paper, I shall argue that neither nonconformism nor conformism provides a plausible account of the epistemic significance of peer disagreement. I shall then develop my justificationist account of peer disagreement’s epistemic significance. Whereas current views maintain that disagreement, by itself, either simply does or does not possess epistemic power, my account holds that its epistemic power, or lack thereof, is explainable in terms of its interaction with other features,particularly the degree of justified confidence with which the belief in question is held and the presence of information that one possesses about one’s own epistemic situation. (shrink)

One of Edmund Husserl's theoretical priorities throughout his philosophical career was to understand the nature of perceptual experience. His analyses of perceptual experience had a profound impact on subsequent thinkers in the phenomenological tradition, such as Aron Gurwitsch and Maurice Merleau-Ponty. Naturally, his account of perception remains a topic of discussion among Husserl scholars. Despite the attention it has received over many decades, Husserl interpreters diverge considerably in how they understand his views and their relation to current debates in the (...) philosophy of perception. A case in point is Husserl's view on the relation between veridical perceptual experience and hallucination, which I will... (shrink)

Testimony is an invaluable source of knowledge. We rely on the reports of those around us for everything from the ingredients in our food and medicine to the identity of our family members. Recent years have seen an explosion of interest in the epistemology of testimony. Despite the multitude of views offered, a single thesis is nearly universally accepted: testimonial knowledge is acquired through the process of transmission from speaker to hearer. In this book, Jennifer Lackey shows that this (...) thesis is false and, hence, that the literature on testimony has been shaped at its core by a view that is fundamentally misguided. She then defends a detailed alternative to this conception of testimony: whereas the views currently dominant focus on the epistemic status of what speakers believe, Lackey advances a theory that instead centers on what speakers say. The upshot is that, strictly speaking, we do not learn from one another's beliefs - we learn from one another's words. Once this shift in focus is in place, Lackey goes on to argue that, though positive reasons are necessary for testimonial knowledge, testimony itself is an irreducible epistemic source. This leads to the development of a theory that gives proper credence to testimony's epistemologically dual nature: both the speaker and the hearer must make a positive epistemic contribution to testimonial knowledge. The resulting view not only reveals that testimony has the capacity to generate knowledge, but it also gives appropriate weight to our nature as both socially indebted and individually rational creatures. The approach found in this book will, then, represent a radical departure from the views currently dominating the epistemology of testimony, and thus is intended to reshape our understanding of the deep and ubiquitous reliance we have on the testimony of those around us. (shrink)

This essay explores the speech act of dogwhistling (sometimes referred to as ‘using coded language’). Dogwhistles may be overt or covert, and within each of these categories may be intentional or unintentional. Dogwhistles are a powerful form of political speech, allowing people to be manipulated in ways they would resist if the manipulation was carried outmore openly—often drawing on racist attitudes that are consciously rejected. If philosophers focus only on content expressed or otherwise consciously conveyed they may miss what is (...) most powerful and pernicious in the speech of political culture. This essay is a call to start paying attention to these more covert speech acts, and a first attempt at beginning to theorize them. It argues that dogwhistles present a complex and interesting case for the philosopher of language, and explores their implications for democratic politics. (shrink)

Intuitively, there is a difference between knowledge and mere belief. Contemporary philosophical work on the nature of this difference has focused on scenarios known as “Gettier cases.” Designed as counterexamples to the classical theory that knowledge is justified true belief, these cases feature agents who arrive at true beliefs in ways which seem reasonable or justified, while nevertheless seeming to lack knowledge. Prior empirical investigation of these cases has raised questions about whether lay people generally share philosophers’ intuitions about these (...) cases, or whether lay intuitions vary depending on individual factors (e.g. ethnicity) or factors related to specific types of Gettier cases (e.g. cases that include apparent evidence). We report an experiment on lay attributions of knowledge and justification for a wide range of Gettier Cases and for a related class of controversial cases known as Skeptical Pressure cases, which are also thought by philosophers to elicit intuitive denials of knowledge. Although participants rated true beliefs in Gettier and Skeptical Pressure cases as being justified, they were significantly less likely to attribute knowledge for these cases than for matched true belief cases. This pattern of response was consistent across different variations of Gettier cases and did not vary by ethnicity or gender, although attributions of justification were found to be positively related to measures of empathy. These findings therefore suggest that across demographic groups, laypeople share similar epistemic concepts with philosophers, recognizing a difference between knowledge and justified true belief. (shrink)

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the globalHIVepidemic,CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders inHIVresearch. This study explored the perspectives ofCSOrepresentatives involved inHIVprevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents fromSouthAfrican and internationalCSOs representing activist and advocacy groups, community mobilisation initiatives, (...) and human and legal rights groups were purposively sampled based on involvement inHPTs. Interviews were conducted fromFebruary‐May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively.CSOrepresentatives largely described positive outcomes of recent microbicide andHIVvaccine trial terminations, particularly inSouthAfrica, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time‐points, as well as the need for legitimate alternatives toCABs as mechanisms for engagement. Key issues forCSOs in relation to research were also raised. (shrink)

Once symbolized by a burning armchair, experimental philosophy has in recent years shifted away from its original hostility to traditional methods. Starting with a brief historical review of the experimentalist challenge to traditional philosophical practice, this chapter looks at research undercutting that challenge, and at ways in which experimental work has evolved to complement and strengthen traditional approaches to philosophical questions.

Introduction -- Elucidating complexity theories -- Complexity in the natural sciences -- Complexity in social theory -- Towards transdisciplinarity -- Complexity in philosophy: complexification and the limits to knowledge -- Complexity in ethics -- Earth in the anthropocene -- Complexity and climate change -- American dreams, ecological nightmares and new visions -- Complexity and sustainability: wicked problems, gordian knots and synergistic solutions -- Conclusion.

This paper provide the first extended discussion in the philosophical literature of the epistemic significance of the phenomenon of “being known” and the relationship it has to reparations that are distinctively epistemic. Drawing on a framework provided by the United Nations of the “right to know,” it is argued that victims of gross violations and injustices not only have the right to know what happened, but also the right to be known—to be a giver of knowledge to others about their (...) own experiences. It is shown that such victims can suffer epistemic wrongs by being rendered invisible, vilified or demonized, or systematically distorted, and that these ways of not being known demand epistemic reparations. While there are traditional reparations that are epistemic in nature, such as memorialization and education, it is argued that there is a prior and arguably more important epistemic reparation—knowing victims of gross violations and injustices in the sense of bearing witness. The paper concludes with a sketch of an epistemological picture to underwrite this notion of epistemic reparations, one that significantly expands the traditional picture by including epistemic duties that are imperfect in nature and concern actions in addition to beliefs. (shrink)

Jennifer Hornsby offers here detailed discussions of ontology, human agency, and everyday psychological explanation. In her distinctive view of questions about the mind's place in nature she argues for a particular position in philosophy of mind: naive naturalism.

In this collection of original essays, international scholars put Asian traditions, such as Hinduism, Buddhism, Daoism, and Confucianism, into conversation with one or more contemporary feminist philosophies, founding a new mode of inquiry that attends to diverse voices and the complex global relationships that define our world. -/- These cross-cultural meditations focus on the liberation of persons from suffering, oppression, illusion, harmful conventions and desires, and other impediments to full personhood by deploying a methodology that traverses multiple philosophical styles, historical (...) texts, and frames of reference. Hailing from the discipline of philosophy in addition to Asian, gender, and religious studies, the contributors offer a fresh take on the classic concerns of free will, consciousness, knowledge, objectivity, sexual difference, embodiment, selfhood, the state, morality, and hermeneutics. One of the first anthologies to embody the practice of feminist comparative philosophy, this collection creatively and effectively engages with global, cultural, and gender differences within the realms of scholarly inquiry and theory construction. -/- http://cup.columbia.edu/book/978-0-231-16624-9/asian-and-feminist-philosophies-in-dialogue. (shrink)

Current models of autobiographical memory suggest that self-identity guides autobiographical memory retrieval. Further, the capacity to recall the past and imagine one’s self in the future can influence social problem solving. We examined whether manipulating self-identity, through an induction task in which students were led to believe they possessed high or low self-efficacy, impacted episodic specificity and content of retrieved and imagined events, as well as social problem solving. Compared to individuals in the low self efficacy group, individuals in the (...) high self efficacy group generated past and future events with greater specificity, positive words, and self-efficacious statements, and also performed better on social problem solving indices. A lack of episodic detail for future events predicted poorer performance on social problem solving tasks. Strategies that increase perceived self-efficacy may help individuals to selectively construct a past and future that aids in negotiating social problems. (shrink)

A disjunctivist conception of acting for reasons is introduced by way of showing that a view of acting for reasons must give a place to knowledge. Two principal claims are made. 1. This conception has a rôle analogous to that of the disjunctive conception that John McDowell recommends in thinking about perception; and when the two disjunctivist conceptions are treated as counterparts, they can be shown to have work to do in combination. 2. This conception of acting for reasons safeguards (...) the connection between considerations that move us to act in particular ways and considerations that favour our acting in particular ways. (shrink)

How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old. These new foundations rest on familiar observations of human nature and human needs. (...) Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues-based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today. This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world. (shrink)

Translated by Anthony Bower With an Introduction by Oliver Todd 'A conscience with style' V.S. Pritchett The Rebel (1951) is Camus's 'attempt to understand the time I live in' and a brilliant essay on the nature of human revolt. Here he makes a daring critique of communism - how it had gone wrong behind the Iron Curtain and the resulting totalitarian regimes. And he questions two events held sacred by the left wing - the French Revolution of 1789 and the (...) Russian Revolution of 1917 - that had resulted, he believed, in the use of terrorism as a political instrument. In this towering intellectual document, Camus argues that hope for the future lies in revolt with revolution - a chance to achieve change without losing our freedom. 'The last French intellectual to take the side of humanity and talk its language... a figure of immense moral stature' Sunday Times Winner of the Nobel Prize for Literature. (shrink)

Do epistemic intuitions tell us anything about knowledge? Stich has argued that we respond to cases according to our contingent cultural programming, and not in a manner that tends to reveal anything significant about knowledge itself. I’ve argued that a cross-culturally universal capacity for mindreading produces the intuitive sense that the subject of a case has or lacks knowledge. This paper responds to Stich’s charge that mindreading is cross-culturally varied in a way that will strip epistemic intuitions of their evidential (...) value. I argue that existing work on cross-cultural variation in mindreading favors my position over Stich’s. (shrink)

Do we need a right to mental privacy? In an era of increasing sophistication in recording, interpreting, and directly intervening on our neural activity – not to mention efforts at combining neural...

Although agriculture in Australia is very productive, the current food supply systems in Australia fail to deliver healthy diets to all Australians and fail to protect the natural resources on which they depend. The operation of the food systems creates ‘collateral damage’ to the natural environment including biodiversity loss. In coming decades, Australia’s food supply systems will be increasingly challenged by resource price inflation and climate change. Australia exports more than half of its current agricultural production. Government and business are (...) aiming to substantially increase production to bolster exports. This will increase pressure on agricultural resources and exacerbate ‘collateral’ damage to the environment. The Australian public have a deep and ongoing interest in a very wide range of issues associated with the food systems including the environment, health and sustainability. Food is something we require in order to live and a good diet is something we have to have to be healthy. For health over a life-time we need food security. However, we also require a range of other material goods and social arrangements in order to develop and flourish as human beings. And we need these other things to be secure over a life-time. Food is therefore one security among a range of other securities we need in order to flourish. The paper outlines a number of approaches, as examples, that help to identify what these other goods and arrangements might be. The approaches mentioned in this paper include human rights, national securities, human needs, authentic happiness, capabilities, sustainability and environmental ethics. The different approaches provide a way of evaluating the current situation and indicating a direction for change within the food systems that will address the problems. However, changing large systems such as those involved in food supply is difficult because inertias and vested interests make the current food supply systems resilient to change. The paper suggests that one of the first and ongoing tasks is to develop an understanding of the situation from a comprehensive social–ecological systems perspective. The paper also suggests that a practical leverage point for system change is restructuring the flow of information on the health, natural resources and biodiversity loss issues related to the food supply systems. (shrink)

To what extent should we trust our natural instincts about knowledge? The question has special urgency for epistemologists who want to draw evidential support for their theories from certain intuitive epistemic assessments while discounting others as misleading. This paper focuses on the viability of endorsing the legitimacy of Gettier intuitions while resisting the intuitive pull of skepticism – a combination of moves that most mainstream epistemologists find appealing. Awkwardly enough, the “good” Gettier intuitions and the “bad” skeptical intuitions seem to (...) be equally strong. This chapter argues that it is not a coincidence that these two types of intuition register with equal force: they are generated by a common mechanism. However, the input to this mechanism is interestingly different in the two types of case, and different in a way that can support the mainstream view that Gettier cases tell us something about knowledge where skeptical intuitions involve systematic error. (shrink)

In this article I explore various facets of Nozick’s famous thought experiment involving the experience machine. Nozick’s original target is hedonism—the view that the only intrinsic prudential value is pleasure. But the argument, if successful, undermines any experientialist theory, i.e. any theory that limits intrinsic prudential value to mental states. I first highlight problems arising from the way Nozick sets up the thought experiment. He asks us to imagine choosing whether or not to enter the machine and uses our choice (...) (or rather the choice he assumes most people will have) as evidence against experientialist theories. But for this strategy to succeed it must be possible to distinguish between self-interested and non-self-interested reasons for declining to enter the machine, and there is no obvious way to do this without begging the question against the hedonist. In successive sections I then (a) consider a common misconception of Nozick’s conclusion (that he thinks machine life is the worst life), (b) consider different intuitions about what is important to well-being but missing from machine life, and finally (c) explain what “the experience requirement” is, and describe its relationship to debates about experientialist theories. (shrink)

Curiosity is evident in humans of all sorts from early infancy, and it has also been said to appear in a wide range of other animals, including monkeys, birds, rats, and octopuses. The classical definition of curiosity as an intrinsic desire for knowledge may seem inapplicable to animal curiosity: one might wonder how and indeed whether a rat could have such a fancy desire. Even if rats must learn many things to survive, one might expect their learning must be driven (...) by simpler incentives, such as hunger. One might also wonder what proximal signals could guide animals towards knowledge itself, or how something as abstract as knowledge could ever be a motivational target for an unreflective animal. Taking a cue from recent work in reinforcement learning, I argue that surprise functions as a reward signal for the curious animal, and then show how this amounts to a desire for knowledge gain, where knowledge is conceived of as a cognitive adaptation to reality. This adaptation results in a mental state whose existence depends essentially on the truth of its contents, a factive mental state. Curious creatures benefit from an interaction between the prediction-error correction processes of basic learning and the active surprise-seeking force of their curiosity. This internally adversarial interaction accelerates knowledge gain in ways that are very helpful for agents with the restrictions of biological creatures, in environments with the complexity of our natural world. (shrink)

Testimony is a vital and ubiquitous source of knowledge. Were we to refrain from accepting the testimony of others, our lives would be impoverished in startling and debilitating ways. Despite the vital role that testimony occupies in our epistemic lives, traditional epistemological theories have focused primarily on other sources, such as sense perception, memory, and reason, with relatively little attention devoted specifically to testimony. In recent years, however, the epistemic significance of testimony has been more fully appreciated. I shall here (...) focus on two questions that have received the most attention in recent work in the epistemology of testimony. First, is testimonial knowledge acquired only by being transmitted from speaker to hearer? Second, must a hearer have positive reasons to justifiedly accept a speaker's testimony? (shrink)

'This book not only revises the interpretation of Dewey's ethics but also has relevance to recent discussions about the possibility of naturalistic, ...