In his 1917 lecture “Science as a Vocation,” Max Weber challenged current and aspiring scholars to abandon any pretense that science bears within itself any meaning. In a disenchanted age, he argued, science could at best offer “knowledge of the techniques whereby we can control life... through calculation,” and any meaning or moral direction to scientific research—including religious meaning—must be imposed on it from without. Weber presciently anticipated that many present-day health care practitioners would struggle to find meaning for their (...) work within complex “state-capitalist” health care systems, along with predictable quasi-religious responses. But how are Christian practitioners to practice faithfully in a disenchanted age? The authors of this special issue lean deeply into the loci of Christian theology and Christian practice, some challenging the views of the body and of nature that informed Weber’s theory of disenchantment, and all offering resources and paths by which practitioners might “look the fate of the age full in the face” with courage and wisdom. (shrink)

Moral injury, the experience of having acted incommensurably with one's most deeply held moral conceptions, is increasingly recognized by the mental health disciplines to be associated with postcombat traumatic stress. In this essay I argue that moral injury is an important and useful clinical construct but that the phenomenon of moral injury beckons beyond the structural constraints of contemporary psychology toward something like moral theology. This something, embodied in specific communal practices, can rescue moral injury from the medical model and (...) the means—end logic of techne and can allow for truthful, contextualized narration of and healing from morally fragmenting combat experiences. (shrink)

Although post-traumatic stress disorder is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war’s traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what was (...) done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma. (shrink)

Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, by (...) treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer. (shrink)

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic’s advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury—particularly (...) its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury. (shrink)

Prudence, for Thomas Aquinas, is an intellectual virtue that requires coincident moral virtue for its sustainability. As such, prudence displays a way of living in which intellect, desire, and emotion are harmoniously integrated. This account resonates strongly with the aims of mindfulness practices within contemporary psychology and with the "interpersonal neurobiology" of Daniel Siegel, for whom health is understood as a context-responsive and narrative integration of cognition, emotion, and embodied experience that promotes and allows for stable self-identity and fulfilling interpersonal (...) relationships. Similarly, prudence for Aquinas is an integrative virtue, integrating intellect and will, theory and context, action and agent, reason and emotion, past and future, the individual and his or her community, and the proximate and ultimate ends of human life. Contemporary mindfulness practices are at their best a school for prudence, and thus they shed an interesting light on Aquinas's account. In turn, Aquinas's account of prudence offers theological parameters for Christian participation in contemporary mindfulness practices. (shrink)

Suggesting that underlying some violent behavior is an unhealthy identification of one's self with one's behavior, such that there is no reflective space between the acting self and unwanted or violent action, Alexandra Pârvan echoes many contemporary psychotherapeutic models in suggesting that a central goal of psychotherapy for perpetrators and recipients of violence should be to encourage clients to distance the acting self from the self's experience and behavior. Pârvan observes that this is already a feature of "attachment-informed psychotherapy," but (...) she argues that "the distinction between self and action can only be effectively established from outside strictly psychological perspectives" (p.... (shrink)

The modern editions of the Diagnostic and Statistical Manual of Mental Disorders, beginning with DSM-III in 1980, emerged in response to notable challenges to psychiatry’s practices and ways of knowing in the early 1970s. Because these challenges threatened psychiatry’s scientific self-understanding and moral authority, they exemplify what Alasdair MacIntyre has termed “epistemological crisis.” As a response to crisis, the modern DSM has been a stunning political achievement, providing the central diagnostic constructs around which psychiatric research, practice, and reimbursement has been (...) organized for four decades. Indeed, the DSM’s authority survives in the face of ongoing trenchant scientific and philosophical critique. But if psychiatry is to be healthy, it must be epistemologically humble, reckoning honestly with the limits of the DSM before a future epistemological crisis destabilizes it entirely. (shrink)

Anastasia Philippa Scrutton renders helpful service to philosophers and mental health clinicians by highlighting strongly voluntarist approaches to depression within some present-day Christian writers and communities, particularly Pentecostal and Evangelical Christian communities in the United States and the United Kingdom. Drawing on a number of evangelical Christian books and online resources, she argues that these resources are "voluntaristic because they emphasize the role of libertarian free will and choice in the attitudes and behaviors of people with depression, such that depression (...) is seen to be a sin, or the result of sin, because depression sufferers are able to do otherwise." She counters these... (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

The aims of this study were to examine the effectiveness of a range of smartphone apps for managing symptoms of anxiety and depression and to assess the utility of a single-case research design for enhancing the evidence base for this mode of treatment delivery. The study was serendipitously impacted by the COVID-19 pandemic, which allowed for effectiveness to be additionally observed in the context of significant community distress. A pilot study was initially conducted using theSuperBetter app to evaluate the proposed (...) methodology, which proved successful with the four finishing participants. In the main study, 39 participants commenced, with 29 finishing the intervention phase and completing post-intervention measures. At 6-month follow-up, a further three participants could not be contacted. This study used a digitally enhanced, multiple baseline across-individuals single-case research design. Participants were randomly assigned to the following apps:SuperBetter,Smiling Mind,MoodMission,MindShift, andDestressify. Symptomatology and life functioning were measured at five different time points: pre-baseline/screening, baseline, intervention, 3-week post-intervention, and 6-month follow-up. Detailed individual perceptions and subjective ratings of the apps were also obtained from participants following the study’s completion. Data were analyzed using visual inspection, time-series analysis, and methods of statistical and clinical significance. Positive results were observed for all apps. Overall, more favorable outcomes were achieved by younger participants, those concurrently undertaking psychotherapy and/or psychotropic medication, those with anxiety and mixed anxiety and depression rather than stand-alone depression, and those with a shorter history of mental illness. Outcomes were generally maintained at 6-month follow-up. It was concluded that a diverse range of evidence-based therapies offered via apps can be effective in managing mental health and improving life functioning even during times of significant global unrest and, like all psychotherapies, are influenced by client features. Additionally, this single-case research design is a low-cost/high value means of assessing the effectiveness of mental health apps.Clinical Trial Registration: The study is registered with the Australian and New Zealand Clinical Trials Registry, which is a primary registry in the World Health Organization Registry Network, registration number ACTRN12619001302145p. (shrink)

This book includes a selection of contributions to the Iowa State University Symposium on agricultural bioethics in november 1987. The papers are grouped in the sections "Safety and regulatory issues", "Impact on scientific and industrial communities", "Public perceptions", "Economic prospects", "Social considerations" and "Ethical dilemmas".

**** Reprint of the Indiana U. Press edition of 1966--which is cited in BCL3. Annotation copyright by Book News, Inc., Portland, OR.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has for decades been a locus of dispute between ardent defenders of its scientific validity and vociferous critics who charge that it covertly cloaks disputed moral and political judgments in scientific language. This essay explores Alasdair MacIntyre's tripartite typology of moral reasoning—"encyclopedia," "genealogy," and "tradition"—as an analytic lens for appreciation and critique of these debates. The DSM opens itself to corrosive neo-Nietzschean "genealogical" critique, such an analysis holds, only (...) insofar as it is interpreted as a presumptively objective and context-independent encyclopedia free of the contingencies of its originating communities. A MacIntyrean tradition-constituted understanding of the DSM, on the other hand, helpfully allows psychiatric nosology to be understood both as "scientific" and, simultaneously, as inextricable from the political and moral interests—and therefore the moral successes and moral failures—of the psychiatric guild from which it arises. (shrink)

The ancient philosophical school of Epicureanism tried to argue that death is "nothing to us." Were they right? James Warren provides a comprehensive study and articulation of the interlocking arguments against the fear of death found not only in the writings of Epicurus himself, but also in Lucretius' poem De rerum natura and in Philodemus' work De morte. These arguments are central to the Epicurean project of providing ataraxia (freedom from anxiety) and therefore central to an understanding of Epicureanism (...) as a whole. They also offer significant resources for modern discussions of the value of death--one which stands at the intersection of metaphysics and ethics. If death is the end of the subject, and the subject can not be benefited nor harmed after death, is it reasonable nevertheless to fear the ceasing-to-be? If the Epicureans are not right to claim that the dead can neither be benefited nor harmed, what alternative models might be offered for understanding the harm done by death and do these alternatives suffer from any further difficulties? The discussion involves consideration of both ethical and metaphysical topics since it requires analysis not only of the nature of a good life but also the nature of personal identity and time. A number of modern philosophers have offered criticisms or defences of the Epicureans' views. Warren explores and evaluates these in the light of a systematic and detailed study of the precise form and intention of the Epicureans' original arguments. Warren argues that the Epicureans also were interested in showing that mortality is not to be regretted and that premature death is not to be feared. Their arguments for these conclusions are to be found in their positive conception of the nature of a good and complete life, which divorce the completeness of a life as far as possible from considerations of its duration. Later chapters investigate the nature of a life lived without the fear of death and pose serious problems for the Epicureans being able to allow any concern for the post mortem future and being able to offer a positive reason for prolonging a life which is already complete in their terms. (shrink)

This book completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine.

This book is an interdisciplinary study of the fundamental normative issues underpinning immigration policy. Economists, political scientists and philosophers address issues such as the proper role of the state in supporting a particular culture, the possible destabilization of the political and social life of a country through immigration, the size and distribution of economic losses and gains, and the legitimacy of discriminating against potential immigrants in favour of members of the resident population. The need for serious philosophical consideration of this (...) subject is beyond question. This volume should advance discussion in an area of great practical as well as philosophical importance. (shrink)

A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over (...) from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT. (shrink)

The Epicurean philosophical system has enjoyed much recent scrutiny, but the question of its philosophical ancestry remains largely neglected. It has often been thought that Epicurus owed only his physical theory of atomism to the fifth-century BC philosopher Democritus, but this study finds that there is much in his ethical thought which can be traced to Democritus. It also finds important influences on Epicurus in Democritus' fourth-century followers such as Anaxarchus and Pyrrho, and in Epicurus' disagreements with his own Democritean (...) teacher Nausiphanes. The result is not only a fascinating reconstruction of a lost tradition, but also an important contribution to the philosophical interpretation of Epicureanism, bearing especially on its ideal of tranquillity and on the relation of ethics to physics. (shrink)

We face reality presented with the data of conscious experience and nothing else. The project of early modern philosophy was to build a complete theory of the world from this starting point, with no cheating. Crucial to this starting point is the data of conscious sensory experience – sense data. Attempts to avoid this project often argue that the very idea of sense data is confused. But the sense-data way of talking, the sense-data language, can be freed from every blemish (...) using ideas from contemporary metaontology. We can adopt a sense-data framework that vindicates the traditional claims of sense-data theories and leads to plausible theories of perception and color. We can, we should, and in a sense, we must. Yet when we do, we face the traditional problem of external world skepticism, head-on. The real challenge of skepticism is forced upon us; it cannot honestly be avoided using externalist tricks, burden of proof shifting, or other razzle dazzle. But the challenge can be met: we are rational to posit the external world as the best explanation of the many synchronic and diachronic patterns over our sense-data. This paper argues for all of these points and ends with a plea for analytic empiricism – a traditional sense-data version of empiricism that uses all of the tools of analytic philosophy while avoiding the more questionable doctrines of the Vienna Circle (phenomenalism, verificationism). Analytic empiricism is our last best hope for completing the great philosophical project of early modern philosophy. (shrink)

Emotion in Aesthetics is the first book on aesthetics to provide an extensive theory of emotion; application of the cognitive-emotive theory to aesthetics; analysis of the relationship between aesthetics, metaphor and emotion; a full theory of meaning and its application to aesthetics; discussion of the relationship between aesthetics, music and language in terms of phonetics, phonology and intonation; an analysis of humanistic aesthetics; a well-developed naturalistic theory of ethics as applied to aesthetics and emotion. Stress is placed on the views (...) of contemporary philosophers as well as some of the main historical accounts of emotion in aesthetics. The important recent work on emotion has not hitherto been applied to aesthetics. As a result there is still much confusion in aesthetics about aesthetic emotion and related concepts, such as the expression theory of emotion. The present book has been written to show how the theory can be used to clarify the issue, resulting in a major breakthrough in aesthetics. In addition, the theory presented is valuable in relating aesthetics to ethics and humanism. (shrink)