Despite a wealth of findings that psychotherapy is an effective psychological intervention the principal mechanisms of psychotherapy change are still in debate. It has been suggested that all forms of psychotherapy provide a context which enables clients to transform the meaning of their experiences and symptoms in such a way as to help clients to feel better, and function more adaptively. However, psychotherapy is not the only healthcare intervention that has been associated with ‘meaning’: the reason why placebo have effects (...) has also been proposed to be a ‘meaning response’. Thus, it has been argued that the meaning of treatments has a central impact on beneficial (and by extension, negative) health-related responses. In light of the strong empirical support of a contextual understanding of psychotherapy and its effects, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy – in general – and within three different, commonly-used psychotherapy modalities. (shrink)

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue (...) that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects. (shrink)

POHLMAN S, CIBULKA NJ, PALMER JL, LORENZ RA and SMITHBATTLE L. Nursing Inquiry 2013; 20: 71–81 The placebo puzzle: examining the discordant space between biomedical science and illness/healingThe placebo response presents an enigma to biomedical science: how can ‘inert’ or ‘sham’ procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and treatment, (...) and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients’ life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients’ priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing. (shrink)

In the aftermath of a normalized Foucaultian world with an all encompassing web of biopower, one remaining hope is to cultivate nimbleness. Nimbleness is an embodied aesthetic sensitivity to the material presence. Cultivating nimbleness is a particular style of cultivation; it is to willfully gather together one’s self in the wake of a formative force far richer than the derivative web of living power relationships of human embeddness within a horizon of social, economical, political and historical subjectivating power relations; which (...) are chronicled and labeled by Michel Foucault as the normalizing practices of biopower. In other words to have freedom, one must start by rejecting the categories and labels normally internalized in order to relearn to learn from the material presence. Such a style of cultivation is a means of resisting normalizing power relations which co-opt cultivating practices to engross their own dominance which has had the by-product of an impotence to negate the gross material injustices present. This normalizing style of cultivation is a prevalent, corrupted, semblance which denies the importance of beauty for that of efficiency, rejects non-human purposiveness, and limits its measure of ethics to short term economical pragmatism. The thesis acknowledges that something is awry with the world and that giving care to beauty might help. The aim is to examine the event of Beauty as depicted by the philosopher Immanuel Kant and to apply this characterization to elective architectural spaces such that it may motivate individuals to cultivate their own nimbleness in relation to a formative force of nature. However given the revealed need for sensitivity to the particular material presence, the thesis can not be a rule book or catalog for beautiful design. Rather it is a rehabilitation for architects who are already heterospatially curious, with the desired outcome of architects cultivating their own nimbleness to reflectively judge as a ground up, multi-node, rhizomatic means of resistance to normalizing power practices as manifest in bad architecture. (shrink)

Two sources of possible disagreement in bioethics may be associated with pessimism about what bioethics can achieve. First, pluralism implies that bioethics engages with interlocutors who hold divergent moral beliefs. Pessimists might believe that these disagreements significantly limit the extent to which bioethics can provide normatively robust guidance in relevant areas. Second, the interdisciplinary nature of bioethics suggests that interlocutors may hold divergent views on the nature of bioethics itself—particularly its practicality. Pessimists may suppose that interdisciplinary disagreements could frustrate the (...) goals of bioethics. In this article, I explore how wonder may alleviate the concerns of the first group of pessimists regarding problems associated with pluralism, provided that we are willing to accept some interdisciplinary frustrations. Then, I invite readers of this issue of The Journal of Medicine & Philosophy to test these intuitions by considering the role of wonder in these articles. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

BackgroundThis article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them are critically discussed with such purpose.MethodsA philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are (...) found as better definitions of suffering and pain.ResultsPain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one’s own attachment to the world. An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person’s life, and the self is the ever-changing sum of these experiences.ConclusionsThe provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain. (shrink)

This paper examines Fechner’s introduction to experimental psychophysics from a phenomenological perspective. Horst’s analysis is used to demonstrate the phenomenology that is inherent to classical perceptual psychophysics. Horst argues that the psychophysical event of perception can only be understood as an intentional intertwining of subject and object. From this we move to physiological component of psychophysics—that is, the processes that mediate perceptual awareness. Drawing primarily on the work of Rosen, it is argued the phenomenology provides the most appropriate approach for (...) what could be understood as a contemporary psychophysics—one that borrows from recent trends in physics, neuro-physiology, and perception as classical psychophysics had done. This results in a psychiatric neurophenomenology. Examples of the placebo effect and treatment of traumatic brain injury are used to demonstrate the usefulness of a phenomenological psychophysics, one that ultimately meets the demands of Fechner’s original proposal. (shrink)

Se comparan críticamente las teorías del condicionamiento y la expectativa. Luego se retoma la propuesta de Oron Frenkel (2008) a fin de juzgar si la noción de intencionalidad motriz permite establecer un marco teórico superador de las deficiencias de dichas teorías. Finalmente se analiza la noción de forma y los órdenes físico, vital y humano, propuestos en La Estructura del Comportamiento (1976), como abordajes alternativos. Como conclusión se destaca el valor de la experiencia del paciente en los ensayos y se (...) plantea la posibilidad de redefinir la noción tradicional de conciencia entendida como formación de representaciones y juicios. (shrink)