This article explores illness as an assemblage of bodies, discourses, and practices by tracing a genealogy of the condition hystero-epilepsy in order to show the precarity of dominant bio-psychiatric ideology in the present. I read Siri Hustvedt’s case study of her own nervous condition with and against other histories of nerves, including Charcot’s treatment of hystero-epilepsy in the 1870s, Foucault’s treatment of hysteria, simulation, and the ‘neurological body’ presented in his lectures in 1974, and Elizabeth Wilson’s recent treatment of the (...) Freudian concept of ‘somatic compliance.’ I assemble this eclectic hystero-epileptic archive not in order to present a definitive history of hystero-epilepsy, but rather to think about how illness is made, unmade, and remade in the clinic and narrative. (shrink)

Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served (...) to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients risks being ignored. Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterise more or less developed thinking and judgement on the part of the particular practitioner. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

Since the inception of psychology as a distinct field of study in the modern West, it has been widely regarded as the only valid form of this discipline, supplanting all other accounts of the mind and human behavior. The modern West is unique in having produced the only psychology that consciously severed itself from metaphysics and spiritual principles. The momentous intellectual revolutions inaugurated by the Renaissance and the European Enlightenment further entrenched the prejudices of its purely secular and reductionist approach. (...) Yet, across the diverse cultures of the world, we find spiritual traditions that embrace a fully-integrated psychology, unsullied by the limitations of the modern scientific method. It is only by grounding psychology on a foundation of sacred and universal truths—found in all traditional civilizations—that we can begin to restore a true “science of the soul” that addresses the entire gamut of human needs and possibilities. (shrink)

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed (...) to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology. (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of (...) objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

Rad prikazuje kako se enaktivizam može koristiti kao integrativni pojmovni okvir u psihijatriji. Enaktivistički pristup može pomoći u rešavanju problema integracije u psihijatriji, to jest u tome kako da smisleno povežemo različite perspektive iz kojih objašnjavamo uzroke i prirodu psihijatrijskih poremećaja. Enaktivizam nam pruža mogućnost da povežemo fenomenološke, neurofiziološke, sociokulturalne, i egzistencijalne aspekte psihijatrijskih poremećaja i holistički pristupimo razumevanju i lečenju. Objasniću šta je enaktivizam, šta je problem integracije u psihijatriji, te kako, prema Saneke de Han, možemo putem enaktivizma pružiti (...) rešenje ovog problema. Naposletku, predložiću kako se enaktivistički pristup može obogatiti dodavanjem ekološke perspektive. (shrink)

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain (...) the phenomenon. Results showed that delusions can sometimes provide pragmatic benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings. (shrink)

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of medicine is (...) secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

This thesis investigates how preservice teachers understand ‘challenging behaviour’ and how this knowledge informs their teaching practice. Challenging behaviour is problematised as a knowledge referent and the epistemic tensions that preservice teachers experience in coming to ‘know’ about challenging behaviour are explored. This is an in-depth, qualitative study that focuses on the experiences, knowledge and knowledge-change of five final-year preservice primary teachers before, during and after their final Professional Experience. Data was gathered via interviews, focus groups, concept maps, document analysis (...) and classroom observations. Foucault’s theories of knowledge comprised the theoretical framework of the study and discourse analysis was used for data analysis. Major conclusions reached were threefold. Firstly, this study embraced the ambiguity and complexity of ‘challenging behaviour’ by avoiding the definitional debate and instead identifying and positing three discourses of challenging behaviour. This approach was found helpful in understanding preservice teachers’ knowledge of the topic. Secondly, it was found that the preservice teachers’ knowledge of challenging behaviour was, at best, ‘confused’ insofar as it was rarely discursively consistent. Thirdly, the types of epistemic processes through which the preservice teachers reconstructed their discursively inconsistent knowledge were theorised as either ‘matching’ or ‘squishing’. These epistemic processes were cast as problematic. Both ‘matching’ and ‘squishing’ demonstrated potential to maintain epistemic equilibrium and so limit possibilities for knowledge expansion and reflective practice. Moreover, in the case of ‘squishing’, this epistemic process was found to generate confusions, which were at times unsupportive of pedagogical decision-making. Two major implications of the research concern teacher education. Firstly, because the preservice teachers’ confusions, pedagogical distress and quandaries around challenging behaviour seemed to stem from discursively inconsistent knowledge, there is a call for teacher education programs to more clearly delineate multiple knowledges of challenging behaviour. Secondly, the preservice teachers’ epistemology was characterised by an overwhelming propensity to perceive a theory/practice divide in their professional knowledge. However, for these preservice teachers, there was not such a polarity to be bridged regarding challenging behaviour. Recasting the theory/practice problem in terms of knowledge showed the preservice teachers were doing a good deal of complex epistemological work ‘in the middle’ of theory and practice. Theory was not considered irrelevant, it was mobilised to make specific pedagogical decisions during practicum. However, understandings of these ‘practical theories’ were fraught with the incoherence and confusions associated with the epistemic practice of ‘squishing’. Thus, although the preservice teachers’ knowledge indicated they were ‘working in the middle’ of theory and practice, they were not doing so with great accuracy or effectiveness. It then is necessary to offer preservice teachers more comprehensive tools to work with and understand ‘knowledge’, rather than ‘theory/practice’. (shrink)

In this talk I present the main results from Anta (2021), namely, that the theoretical division between Boltzmannian and Gibbsian statistical mechanics should be understood as a separation in the epistemic capabilities of this physical discipline. In particular, while from the Boltzmannian framework one can generate powerful explanations of thermal processes by appealing to their microdynamics, from the Gibbsian framework one can predict observable values in a computationally effective way. Finally, I argue that this statistical mechanical schism contradicts the Hempelian (...) (1958) thesis that the predictive power of a scientific theory is directly proportional to its explanatory potential, and vice versa. (shrink)

In this paper we focus on the psychiatric approach of Open Dialogue and seek to explain why the intersubjective process of dialogue, one of OD’s core clinical principles, is effective in schizophrenia treatment. We address this question from an interdisciplinary viewpoint, by linking the OD approach with a theoretical account of the self as endorsed by enactive cognitive science. The paper is structured as follows: first, we introduce the OD approach and focus in particular on the principles that are characteristic (...) of the dialogical therapeutic attitude. Second, we clarify our stance on the concept of schizophrenia by relying on insights from phenomenological psychiatry. Third, we introduce an enactive perspective on mental disorders, which elaborates on phenomenological psychiatry and conceives of the self as a self-organizing system, brought forth through interactional processes. Based on this enactive approach, we draw clinical implications for schizophrenia. In the fourth and final part, we propose conceptual bridges between the OD and the enactive approach by bringing to attention the intersubjective nature of the human self and the inherent vulnerability entailed in both the self’s maintenance and in the practice of dialogue. We then propose that the dialogical stance adopted by OD is effective in supporting the recovery of a balanced sense of self precisely because it provides an intersubjective space in which clients can safely experience and maintain the basic structures underlying the socially constituted self. Since our analysis touches upon fundamental structures of the therapeutic relationship, we hope that it will also be useful to inform general psychiatric practice and help advancing a more integrative understanding of psychotherapy for schizophrenia. (shrink)

This thesis is about the crisis in representation that accompanies the attempt to account for lived experience, with particular reference to bodily pain in social science. The diagnosis of this problem of experience identifies epistemology as an inappropriate means of knowing that initiates a translational paradox unable to satisfy the simultaneous demands of making lived experience familiar in representational form yet retaining the foreignness of the original experience at the same time. This problem of simultaneity is not a problem, however, (...) if it is built into a way of knowing, something that escapes epistemological conditions of possibility with its either/or of singularities. To know in such ‘double vision’, or fractionally, characterises post-epistemological thinking. This thesis draws on a relatively underdeveloped method for practicing a fractional means of knowing from post- actor-network theory, that of the pinboard, and explores how it might be usefully applied to the problem of experience. The thesis constitutes an experiment in producing a social science account of the lived experience of chronic pain using this method as an alternative to conventional epistemological techniques that initiate the problem of experience. Through initial theoretical discussion, followed by reflection on its practical application involving the construction of fractional accounts of lived experience for five participants experiencing chronic pain, the pinboard is developed as a technique that seeks to maintain ‘double vision’ whilst inherently resisting attempts to resolve the juxtaposition it makes visible, enacting and engaging in an ontological politics with conventional methods of social analysis. This includes discussion of how the method might be transported from methodological knowledge spaces to effectively intervene on such conventional methods. (shrink)

Gegenstand dieses Beitrags ist eine Auseinandersetzung mit der Wissenschaftlichkeit der Medizin. Den Leitfaden der Analyse bildet dabei ein jüngerer Ansatz in der analytischen Wissenschaftstheorie, wonach Systematizität als zentrales Kriterium von Wissenschaft anzusehen ist (Hoyningen-Huene 2013). Ich werde im Detail zeigen, dass die Medizin dieses mehrdimensionale Kriterium insgesamt erfüllt, dass aus der Wissenschaftlichkeit der Medizin aber gleichwohl normative Konsequenzen folgen, die beispielsweise zur Abgrenzung von der Homöopathie und einer kritischen Bewertung des biopsychosozialen Modells führen. Zudem resultieren der Anwendungscharakter der Medizin und (...) die zentrale Bedeutung des Arzt-Patienten-Verhältnisses nicht in einer Schwächung des Anspruchs der Medizin als Wissenschaft. (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

Attitudes to humankind will have different effects on health service delivery. Health might used to be intended to provide physical health in the past; today, however, many researchers and clinicians consider the concept health to be beyond physical health. In support of this claim, it is enough to indicate that the bio-psycho-social model has for years been held by scientific communities to be a fully admitted model. However, the missing ring in this model, as suggested by many, is the spiritual (...) health. In recent years, the relationship between spirituality and clinical interventions with a comprehensive focus on health has been under increasing scrutiny. Although different models have been presented for investigation of the relationship between spiritual health and other dimensions, the fundamental challenge in this regard is the actual place of spiritual health compared with other dimensions. In this article, attempts are made to address the position and weight of spiritual health from the Islam’s point of view. (shrink)

La actual crisis sanitaria nos invita a repensar el actual modelo de salud, así como sus implicaciones antropológicas, sociales y económicas. A partir de una breve historia del concepto de salud, en este artı́culo tratamos de evidenciar los cambios que ese mismo concepto ha implicado a nivel de relación médico-paciente y a nivel de relaciones sociales. Un nuevo paradigma de salud, más ajustado a los nuevos fenómenos globales que están aconteciendo, implica también una critica a los enfoques individualistas, reduccionistas, tecnocráticos (...) y economicistas que se encontraban en la raı́z del “antiguo” modelo de salud. Por último, proponemos el modelo One Health como una posible respuesta a los problemas teóricos del “antiguo paradigma” de salud, fuertemente enfatizados por la crisis sanitaria actual. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

The current health legislation recognizes minors’ capacity to make decisions or, at least, to take part in those that affect them, according to their age and maturity. But this capacity is not promoted. Capacitating minors to make their own decisions is still a challenge, because it requires something that today is not happening: autonomy has to be understood not as a state, but as a process that needs support. Our proposal is that this support should be based on recognizing minors (...) as vulnerable persons, that is to say, as persons with emotional needs, who are the subjects of rights and duties, and who have social needs of self-fulfillment. All in all, autonomy has to be understood as a process based on recognizing minors’ dignity as a previous condition to help them acquire those typical capabilities of autonomous persons. This concept of support requires, in the first place, a change of the social view of minors. (shrink)

Advances in emotion and affective science have yet to translate routinely into psychiatric research and practice. This is unfortunate since emotion and affect are fundamental components of many psychiatric conditions. Rectifying this lack of interdisciplinary integration could thus be a potential avenue for improving psychiatric diagnosis and treatment. In this contribution, we propose and discuss an ontological framework for explicitly capturing the complex interrelations between affective entities and psychiatric disorders, in order to facilitate mapping and integration between affective science and (...) psychiatric diagnostics. We build on and enhance the categorisation of emotion, affect and mood within the previously developed Emotion Ontology, and that of psychiatric disorders in the Mental Disease Ontology. This effort further draws on developments in formal ontology regarding the distinction between normal and abnormal in order to formalize the interconnections. This operational semantic framework is relevant for applications including clarifying psychiatric diagnostic categories, clinical information systems, and the integration and translation of research results across disciplines. (shrink)

Based on the Aristotelian dynamis-energeia-differentiation, a concept issuing dynamic coherence providers as the sub-level of individual realizations. This logical sub-level is given for any kind of realizations. Based on this two-level approach, to some degree similar to the two-level approach developed by Polanyi, model of biopsychosocial interaction is established. It is suggested as the theoretical basis for a person-centered approach in healthcare, integrating science and humanitites.

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.