Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

The biopsychosocial model (BPSM) is increasingly influential in medical research and practice. Several philosophers and scholars of health have criticized the BPSM for lacking meaningful scientific content. This article extends those critiques by showing how the BPSM’s epistemic weaknesses have led to certain problems in medical discourse. Despite its lack of content, many researchers have mistaken the BPSM for a scientific model with explanatory power. This misapprehension has placed researchers in an implicit bind. There is an expectation that applications of (...) the BPSM will deliver insights about disease; yet the model offers no tools for producing valid (or probabilistically true) knowledge claims. I argue that many researchers have, unwittingly, responded to this predicament by developing certain patterns of specious argumentation I call “wayward BPSM discourse.” The arguments of wayward discourse share a common form: They appear to deliver insights about disease gleaned through applications of the BPSM; on closer inspection, however, we find that the putative conclusions presented are actually assertions resting on question-begging arguments, appeals to authority, and conceptual errors. Through several case studies of BPSM articles and literatures, this article describes wayward discourse and its effects. Wayward discourse has introduced into medicine forms of conceptual instability that threaten to undermine various lines of research. It has also created a potentially potent vector of medicalization. Fixing these problems will likely require reimposing conceptual rigor on BPSM discourse. (shrink)

Psychoanalysis is sometimes thought to rely on a “pragmatic theory of truth,” whose chief assumption should be that the effectiveness of a treatment counts as evidence for the truth of the interpretations provided during each treatment, and/or the psychoanalytic ontology of mind itself. While there is some support for this claim in psychoanalytic views both on the nature of psychic reality and on clinical practice, it needs qualification. It should not be taken to imply that the theory is true because (...) or insofar as it (clinically) works. What I mean to show is, rather, that psychoanalysis is a distinctive illustration of the pragmatist concept that effective explanations are, in Dewey’s words, “experimental,” and adjust themselves to real processes while changing reality, and indeed by changing reality. Truth enjoys, in psychoanalysis, a peculiar status, being what one might call an emergent property of a relational process. But not just any relational process, even if it “works,” will produce truth. The key of psychoanalytic treatment is transference, and the main pragmatic character of transference is what one may call its theatrical quality. I try to clarify this through a comparison of Freud’s and Pierre Janet’s clinical approaches. (shrink)

In this contribution, I comment on Raffaella Campaner’s defense of explanatory pluralism in psychiatry (in this volume). In her paper, Campaner focuses primarily on explanatory pluralism in contrast to explanatory reductionism. Furthermore, she distinguishes between pluralists who consider pluralism to be a temporary state on the one hand and pluralists who consider it to be a persisting state on the other hand. I suggest that it would be helpful to distinguish more than those two versions of pluralism – different understandings (...) of explanatory pluralism both within philosophy of science and psychiatry – namely moderate/temporary pluralism, anything goes pluralism, isolationist pluralism, integrative pluralism and interactive pluralism. Next, I discuss the pros and cons of these different understandings of explanatory pluralism. Finally, I raise the question of how to implement or operationalize explanatory pluralism in scientific practice; how to structure the “genuine dialogue” or shape “the pluralistic attitude” Campaner is referring to. As tentative answers, I explore a question-based framework for explanatory pluralism as well as social-epistemological procedures for interaction among competing approaches and explanations. (shrink)

We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources – the plea for individual autonomy and the idea of Managed Care – and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mental illness. It ignores that the psychiatrist’s profession is essentially characterized by fragility: fluctuating between scientific reduction and the irreducible complexity (...) of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well. (shrink)

‘Cosmetic psychopharmacology’ is a term coined by Peter Kramer in his 1993 best‐seller, Listening to Prozac. It has come to refer to the use of psychoactive substances to effect changes in function for conditions that are either normal or subclinical variants. In this paper, I ask: What distinguishes an existential ailment from clinical depression, or either of those from normal depressed mood, melancholic temperament, dysthymia or other depressive disorders? Can we reliably distinguish one from the other? Are the boundaries of (...) illness and disorder really so distinct? If not, how can we know that treatment of ‘depression’ with Prozac in any given instance constitutes a cosmetic as opposed to, say, a medical or clinical use of psychopharmacology – a distinction that seems to turn on our ability to clearly differentiate the clinical from the cosmetic. If we cannot reliably distinguish between such conditions, can we even have a cosmetic psychopharmacology that is not a form of malpractice, broadly speaking? What if we unplugged Prozac from all the amplitude and hype that resulted in Listening to Prozac becoming an instant best‐seller and simply asked whether or not we can clearly distinguish an appropriate cosmetic use of Prozac for ‘depression’ from an inappropriate cosmetic use of Prozac, and both of those from Prozac's appropriate clinical, that is, non‐cosmetic uses? If we cannot make these distinctions, perhaps it is too early to say there can be such a thing as a cosmetic psychopharmacology. (shrink)

Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics—and the specific role it can or should play—remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three (...) methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: function identification, function enrichment, and function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing. We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts. (shrink)

Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and (...) promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources. (shrink)

Research suggests that people tend to overweight arguments accompanied by neuroscientific terminology, which is dubbed as the seductive allure of neuroscience explanations (SANE) in the literature. Such an effect might be of particular significance when it comes to physicians and mental health professionals (MHP), given that it has the potential to cause significant bias in their understanding as well as their treatment approaches toward psychiatric symptoms. In this study, we aimed to test the SANE effect among Turkish medical students, and (...) assess its uniqueness by comparing it with a discipline that still maintains an important role in contemporary psychiatric training in Turkey: psychoanalysis. 109 medical students with a basic level of knowledge of psychiatry and clinical neuroscience were asked to rate the credibility of explanations of differing quality (good vs. circular) for psychological phenomena, followed by three types of information: none, neuroscientific (SNI) or psychoanalytical (SPI). Our findings showed that SNI significantly increased the judged quality of explanations for both conditions with the effect being more prominent for circular explanations. On the other hand, SPI had no effect on good explanations but enhanced the judged quality of circular explanations in a level comparable to that of SNI. For the first time, the SANE effect was replicated among medical students and provided preliminary data in favor of a similar effect for psychoanalytically oriented information. (shrink)

The article provides historical and philosophical reconstruction of the emergence and development of the philosophy of psychiatry. The main cases of interaction between philosophy and psychiatry in the context of the development of the history of philosophical thought from antiquity to the present are demonstrated. The key points of interaction between philosophy and psychiatry from Antiquity to the middle of the twentieth century are revealed. The phenomenon of existential-phenomenological psychiatry is described as one of the first attempts of thorough interaction (...) between psychiatry and philosophy. Its main task is defined – to describe the experience of mental illness. Which is an important and necessary task to raise awareness of the impact of mental disorders on people's lives, attempts to reduce stigma. Describing this type of experience creates a unique window into understanding a person with a mental disorder, and illustrates the common and distinctive features of the experience of people with different psychiatric nosologies. These studies provide a deeper understanding of how mental pathology impoverishes a person's relationship with themselves and their community, with the subsequent use of the findings and humanization of psychiatric practice. The prerequisites for the emergence of modern philosophy of psychiatry, in particular the cognitive revolution, the development of philosophy of science, the development of analytical and continental philosophy, in particular phenomenology, existential philosophy, hermeneutics, are determined. The main directions of research in the philosophy of psychiatry are determined. Which are aimed at clarifying the meaning of terms related to mental illness and describing the phenomenon of mental illness itself, analyzing and clarifying those definitions that are directly used in clinical practice and the basis of psychiatric knowledge, as such, to highlight the prerequisites behind certain theoretical positions of psychiatry, to describe the nature of mental illness. (shrink)