The “hypervigilance, escape, struggle, tonic immobility” evolutionarily hardwired acute peritraumatic response sequence is important for clinicians to understand. Our commentary supplements the useful article on human tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé and Lexington (2008). A hallmark sign of TI is peritraumatic tachycardia, which others have documented as a major risk factor for subsequent posttraumatic stress disorder (PTSD). TI is evolutionarily highly conserved (uniform across species) and underscores the need for DSM-V planners to consider the inclusion of evolution (...) theory in the reconceptualization of anxiety and PTSD. We discuss the relevance of evolution theory to the DSM-V reconceptualization of acute dissociativeconversion symptoms and of epidemic sociogenic disorder(epidemic “hysteria”). Both are especially in need of attention in light of the increasing threat of terrorism against civilians. We provide other pertinent examples. Finally, evolution theory is not ideology driven (and makes testable predictions regarding etiology in “both directions”). For instance, it predicted the unexpected finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution theory may offer a conceptual framework in DSM-V both for treatment and for research on psychopathology. (shrink)

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

Biography of Ibn Rushd... Averroes, old heathen, If only you had been right, if Intellect Itself were absolute law, sufficient grace. Our lives could be a myth of captivity. Which we might enter: an unpeopled region.

Ethical conflicts have always been connected with new techniques of reproductive medicine such as in-vitro fertilization. The fundamental question is: When does human life begin and from which stage of development should the embryo be protected? This question cannot be solved by scientific findings only. In prenatal ontogenesis there is no moment during the development from the fertilized oocyte to a human being which could be recognized as an orientation point for all ethical problems connected with the question of the (...) right to dispose of prenatal life (interruption of pregnancy, research on embryos). The protection of an individual human life must be valid for all in the same manner and from the very beginning on. It must not depend on value judgments or on stages of development, so-called grades of humanity, because these would then become selection criteria. Procreated life must have the right to be born. These were the essential ethical arguments which led to the German Embryo Protection Law. (shrink)

Die Medikalisierung des Sterbens hat dazu geführt, dass ein „guter Tod“ zunehmend auch von medizinischen Interventionen erwartet wird. Die Möglichkeiten einer „terminalen Sedierung“ bis zum Tode werden von vielen als Ausweg angesehen, wenn bei unerträglichem Leid und aussichtsloser Prognose der Wunsch nach aktiver Sterbehilfe angesprochen wird. Durch eine Sedierung können zwar bei schwerstkranken Patienten schwerste therapierefraktäre Leidenszustände effektiv gelindert werden. Diese Therapieoption kann aber auch in der Absicht angewendet werden, den Todeseintritt medizinisch zu beschleunigen, so dass im Zusammenhang mit der (...) Euthanasiedebatte auch das Thema der terminalen Sedierung kontrovers diskutiert wird. Richtlinien zu Indikation, Technik und Dokumentation sind notwendig, um Stellenwert und Grenzen der terminalen Sedierung im Rahmen der palliativen Betreuung am Lebensende zu verdeutlichen und durch Transparenz Fehlentwicklungen zu vermeiden. (shrink)

The dissertation addresses the relationship between common sense, skepticism, and naturalistic science in Hume. It is argued that Hume's moral science uncovers numerous common illusions of visual and moral perception; it is not a defense of common-sense experience. ;Firstly, Hume views the ordinary experience of causation and external reality as illusory. The former experience is a projection of human expectation; the latter a conflation of perceptions. ;Secondly, it is argued that, according to Hume, the moral judge overlooks his biases by (...) fictively projecting himself to an impartial standpoint. Impartial sentiments are weak, however, and their weakness generates another fiction: they are mistaken for the inferences of reason. Finally, the judge falsely imagines that he can "see" the character of the persons whom he judges, when all that he actually sees are their actions. ;Thirdly, the dissertation contends that, although the practice of justice arises out of self-interest, the moral agent mistakes his personal interest for public benevolence. When his hidden selfishness fails to move him, he acts justly in the hope of re-acquiring the "lost" benevolence that he never actually had. He saves himself from disappointment by misinterpreting his actions as signs of genuine reform. In the case of promising, the agent falsely imagines that he wills its moral obligation into being with the words "I promise." ;Fourthly, it is shown how Hume denies that we can find the historical root of political obedience in enlightened self-interest and instead stresses the founding role of usurpation and conquest, erased from memory by the passage of time and the efficacy of present government. ;Finally, we see that the appearance of virtue and vice is the illusory correlate of our sentiments: we project sentiments of approval and disapproval onto others and then mistake them for objective traits. ;Contrary to what some interpreters have asserted, I conclude that, according to Hume, the philosopher is never cured of his profound skepticism. Skepticism recurs as long as the philosopher philosophizes. This is problematic, however, because at its most radical, skepticism is incompatible with moral science. (shrink)

Though many well-known German philosophers have devoted considerable attention to music and its aesthetics, surprisingly few of their writings on the subject have been translated into English. Stefan Lorenz Sorgner, a philosopher, and Oliver Fürbeth, a musicologist, here fill this important gap for musical scholars and students alike with this compelling guide to the musical discourse of ten of the most important German philosophers, from Kant to Adorno. _Music in German Philosophy_ includes contributions from a renowned group of ten (...) scholars, including some of today’s most prominent German thinkers, all of whom are specialists in the writers they treat. Each chapter consists of a short biographical sketch of the philosopher concerned, a summary of his writings on aesthetics, and finally a detailed exploration of his thoughts on music. The book is prefaced by the editors’ original introduction, presenting music philosophy in Germany before and after Kant, as well as a new introduction and foreword to this English-language addition, which places contemplations on music by these German philosophers within a broader intellectual climate. (shrink)

We thank Leo Lam and Taylor Nichols for their response1 to our paper ‘COVID-19 vaccine boosters for young adults: a risk–benefit assessment and ethical analysis of mandate policies at universities’.2 In our paper, we demonstrate that the risk–benefit calculus to mandate boosters for young adults aged 18–29 is a net risk intervention. The authors assert that we have made three inappropriate comparisons of benefits versus risks of the mRNA vaccine booster dose in this age group. We provide our response to (...) each below. We erred on the side of overestimating benefits of the booster dose against severe COVID-19 in this age group and still found net harms to outweigh net benefits. The conclusion of our paper holds, and university booster mandates for young people were—and remain—unethical. For the first comparison, we weighed predicted hospitalisations prevented by one booster dose of BNT162b2 with vaccine-associated SAEs from the manufacturer’s randomised trial (3/5055).3 We found that the rate of expected SAEs would outweigh the benefits of the booster against hospitalisation by at least 18-fold. Lam and Nichols suggest that this was an inappropriate comparison, as not all SAEs result in hospitalisation. However, the definition of SAE as used in the trial included death, hospitalisation, disability, permanent damage, life-threatening event or condition, which required medical or surgical intervention to prevent a serious outcome.4 While all comparisons include some degree of incommensurability, comparing these SAEs with hospitalisations prevented by the booster is more reasonable than Lam and Nichols’ suggestion of comparing SAEs to infections prevented. The COVID-19 infection hospitalisation risk in this age group was <0.5% (or <1/200)5 even prior to widespread immunity, thus comparing SAEs to infection risk is entirely inappropriate. Furthermore, a booster dose will only offer transient (if any) protection against infection6 and cumulative infection rates …. (shrink)

In this reflection piece, Ralph Johnson provides an account of the development of informal logic and how it intersected with the Critical Thinking Movement. Section I is an account of the origins of what Johnson calls the “Informal Logic Initiative.” Section II discusses how the Informal Logic Initiative connected with the Critical Thinking Movement at the Sonoma State University Conferences starting in 1981. Section III discusses the relationship between logic and critical thinking. Section IV describes “The Network Problem,” which emerged (...) for Johnson in the mid-1980s – largely as a result of his experiences at critical thinking conferences, especially the Sonoma State conference. Section V expresses some concerns about the current status of critical thinking as an educational idea and about the Critical Thinking Movement. (shrink)

Drawing on the great wealth of knowledge and experience of education practitioners and theorists, the volumes in the Sociology of Education set of the International library of Sociology explore the very important relationship between education and society. These books became standard texts for actual and intending teachers. Drawing upon comparative material from Israel, France and Germany, titles in this set also discuss the key questions of girls' and special needs education, and the psychology of education.

Drawing on the great wealth of knowledge and experience of education practitioners and theorists, the volumes in the Sociology of Education set of the International library of Sociology explore the very important relationship between education and society. These books became standard texts for actual and intending teachers. Drawing upon comparative material from Israel, France and Germany, titles in this set also discuss the key questions of girls' and special needs education, and the psychology of education.

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or (...) more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity. (shrink)