Debates about the ethics and effects of placebos and whether ‘placebos’ in clinical trials of complex treatments such as acupuncture are adequate rage. Yet there is currently no widely accepted definition of the ‘placebo’. A definition of the placebo is likely to inform these controversies. Grünbaum’s characterization of placebos and placebo effects has been touted by some authors as the best attempt thus far, but has not won widespread acceptance largely because Grünbaum failed to specify what he means by a (...) therapeutic theory and because he does not stipulate a special role for expectation effects. Grünbaum claims that placebos are treatments whose ‘characteristic features’ do not have therapeutic effects on the target disorder. I show that with four modifications, Grünbaum’s definition provides a defensible account of placebos for the purpose of constructing placebo controls within clinical trials. The modifications I introduce are: adding a special role for expectations, insisting that placebo controls control for all and only the effects of the incidental treatment features, relativizing the definition of placebos to patients, and introducing harmful interventions and nocebos to the definitional scheme. I also provide guidance for classifying treatment features as characteristic or incidental. (shrink)

"A tramp, a gentleman, a poet, a dreamer, a lonely fellow, always hopeful of romance and adventure." Charlie Chaplin Freud, in a letter to Max Schiller (25 Mar. 1931), writes of an occasion in which Charlie Chaplin came to Vienna. In his account, Freud cavalierly offers great insight into the person behind the actor, even though he has never met Chaplin. Just recently . . . Charlie Chaplin was in Vienna; I almost caught sight of him, but it was too (...) cold for him, and he left in a hurry. He is undoubtedly a great artist—although he always plays one and the same part, the weak, poor, helpless, clumsy boy for whom life turns out all right in the end. Now do you think he has to forget his own self in .. (shrink)

In this paper, I respond to some criticisms of Greenwood (1996) advanced by Grunbaum (1996) and Erwin (1996). I argue that Grunbaum's problematic account of "placebo effects" and placebo control treatments does not really address, far less resolve, the problems with experimental evaluations of psychotherapy documented in my original paper.

John Greenwood (this issue) claims that neglect of an important methodological distinction has contributed directly to the "epistemic impoverishment" of empirical studies of all forms of professional psychotherapy. I challenge this claim, as well as other important claims he makes about the efficacy of psychoanalysis and other forms of psychotherapy.

Hermeneutic and anti-hermeneutic sides in the debate about psychoanalysis are entangled in an epistemological and methodological antinomy, here exemplified by Grünbaum's and Spence's paradigmatic views. Both contain a partial element of truth, which they assert dialectically one against the other (§§ 1 and 2). This antinomy disappears only by reconciling an operationalist approach with man's ability to suspend the effectiveness of the‘laws’ applied to him (§ 3). The hermeneutic way in which the technical-operational criterion of truth works in psychoanalysis demands (...) that clinical and extra-clinical testing methods work synergically, through a fruitful self-correcting strategy, grounded on the very psychoanalytic object: the unconscious (§ 4). (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)