Если личность (personhood) 1 -это качество или состояние, позволяющее быть отдельным лицом, то церебральностью (brainhood) можно назвать качество или состояние, позволяющее быть мозгом. Через это онтоло гическое качество определяется «церебральный субъект», получивший, по крайней мере, в индустриально развитых и высокомедикализирован-ных обществах, множество социальных описаний начиная с середины ХХ века. В статье исследуется историческое развитие церебральности. Предлагается рассмотреть мозг как необходимую область локализации «современного Я», и, следовательно, церебральный субъект - как антропологический тип современности (хотя бы потому, что современность придает высшую ценность (...) человеку как автономному агенту выбора и инициативы). Также утверждается, что идеология церебральности стала причиной возникновения множества нейроисследований, а не их следствием; показано, как разрастающийся комплекс нейрокультурных дискурсов и практик воплощает и поддерживает эту идеологию. (shrink)

BackgroundThe evaluation of pain remains one of the most difficult challenges that healthcare practitioners face. Chronic pain appears to affect more than 35% of the population in the West, and indeed, pain is the most common reason patients seek medical care. Despite its ubiquity, studies in the last decades reveal that many patients feel their pain is dismissed by healthcare practitioners and that, as a result, they are denied proper medical care. Buchman, Ho, and Goldberg (J Bioethic Inq 14:31-42, 2017) (...) point to this phenomenon as a form of “epistemic injustice”: an unfair and harmful downgrading of credibility affecting some individuals and groups, which prevents them from receiving appropriate and beneficial medical care.MethodsBy exploring the existing literature on this downgrading of patients’ credibility written by healthcare professionals and scholars in medical humanities, I identify and examine the reasons patients are often not believed about their pain and why healthcare is too-often unhelpful or hurtful to people presenting with chronic pain. I also explore to what extent it is possible to forge an alternative epistemological model.ResultsI suggest that most of the causes of this downgrading of patient’s credibility result from either the difficulty in communicating pain or the widespread belief that pathology is always the result of objective tissue damage. I examine whether pain has to be effectively communicated and have an objective cause in order for it to be deemed credible. In the end, I argue that in the case of pain, both communication and objectivity are highly problematic.ConclusionsI conclude by suggesting that, although alternative epistemological models might be impossible to build, believing patients has both moral and clinical benefits, and this warrants further research. (shrink)

Fitness apps on mobile devices are gaining popularity, as more people are engaging in self-tracking activities to record their status of fitness and exercise routines. These technologies also evolved from simply recording steps and offering exercise suggestions to an integrated lifestyle guide for physical wellbeing, thus exemplify a new era of "quantified self" in the context of health as individual responsibility. There is a considerable amount of literature in science, technology and society (STS) studies looking at this phenomenon from different (...) perspectives, linking it with the sociology of self-surveillance and neoliberal regimes of health. However, the human-technology interface, through which the micro- (behavioral) and macro- (social) aspects converge, still calls for extensive examination. This paper approaches this topic from the postphenomenological perspective, in combination with empirical studies of design analysis and interviews of fitness apps, to reveal the human-technology link between the design elements and people's perception through the direct experiences and interpretations of technology. It argues that the intentionality of self-tracking fitness app designs mediates the human-technology relations by "guiding" people into a quantified knowledge regime. It shapes the perceptions of fitness and health with representations of meanings about a "good life" of individual success and management. This paper also gives a critique of current individual, performance-oriented fitness app designs and offers the possibility of seeking alternatives through the multistable nature of human-technology relations—how altering interpretation and meaning of the design with a cultural or social context could change the form of technological embodiment. (shrink)

This review article critically surveys the following literature by placing it under the historiographical banner of ‘the history of the brain and mind sciences’: Fernando Vidal and Francisco Ortega, Being Brains: Making the Cerebral Subject (New York: Fordham University Press, 2017); Katja Guenther, Localization and its Discontents: A Genealogy of Psychoanalysis & the Neuro Disciplines (Chicago: University of Chicago Press, 2015); Stephen Casper and Delia Gavrus (eds), The History of the Brain and Mind Sciences: Technique, Technology, Therapy (Rochester: University of (...) Rochester Press, 2017); Jonna Brenninkmeijer, Neurotechnologies of the Self: Mind, Brain and Subjectivity (London: Palgrave Macmillan, 2016). This framework highlights contemporary attempts to historicize the integrative project of neuroscience and set the correct limits to interdisciplinary collaboration. While attempts to critically engage with the ‘neuro’ rhetoric of contemporary neuroscientists can seem at odds with historians seeking to write the history of neuroscience from the margins, it is argued that together these two projects represent a positive historiographical direction for the history of the neurosciences after the decade of the brain. (shrink)

Brain imaging provides ever more sensitive measures of structure and function relevant to human psychology and has revealed correlates for virtually every psychiatric disorder. Yet it plays no accepted role in psychiatric diagnosis beyond ruling out medical factors such as tumors or traumatic brain injuries. Why is brain imaging not used in the diagnosis of primary psychiatric disorders, such as depression, bipolar disease, schizophrenia, and attention-deficit hyperactivity disorder (ADHD)? This article addresses this question. It reviews the state of the art (...) in psychiatric imaging, including diagnostic and other applications, and explains the nonutility of diagnostic imaging in terms of aspects of both the current state of imaging and the current nature of psychiatric nosology. The likely future path by which imaging-based diagnoses will be incorporated into psychiatry is also discussed. By reviewing one well-known attempt to use SPECT scanning in psychiatric diagnosis, the article examines a real-world practice that illustrates several related points: the appeal of the idea of image-assisted diagnosis for physicians, patients and families, despite a lack of proven effectiveness, and the mismatch between the categories and dimensions of current nosology and those suggested by imaging. (shrink)

Next SectionThe current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value of (...) early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given “disease” in non-research-oriented medical settings? The very problem of framing this question in terms of diagnostic misconceptions connects conceptual with ethical issues of research into preclinical stages of neurodegenerative diseases. (shrink)

This article explores Foucault’s two different notions of power: one where the subject is constituted by power–knowledge relations and another that emphasizes how power is a central feature of human action. By drawing out these two conceptualizations of power, Foucault’s work contributes three critical points to the formation of medicalized subjectivities: the issue of medicalization needs to be discussed both in terms of both specific practices and holistically ; we need to think how we as human beings are “disciplined” and (...) “subjectivated” through medicalization, as discourses, practices, and institutions are all crystallizations of power relations; and we need to reflect on how we can “resist” this process of subjectification, since “power comes from below” and patients shape themselves through “technologies of the self.” Ultimately, Foucault’s work does not merely assist us in refining our analysis; rather, it is essential for conceptualizing medicalization in contemporary society. (shrink)

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder (CD) and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be (...) converted into deviant behaviour – these neurologists use the term functional neurological disorder (FND) and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

This paper offers a critical analysis of the strategic use of biomedical models of mental illness as a means of challenging stigma. Likening mental illnesses to physical illnesses reinforces notions that persons with mental illnesses are of a fundamentally “different kind,” entrenches misperceptions that they are inherently more violent, and promotes overreliance on diagnostic labeling and pharmaceutical treatments. I conclude that too much has been invested in the claim that the body is somehow morally neutral, and that advocates of this (...) approach oversimplify, misrepresent, and underestimate the personal and social costs of physical illness. (shrink)

Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the extent (...) that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect. (shrink)

Background Autism self-advocates’ views regarding genetic tests for autism are important, but critical questions about their perspectives arise.Methods We interviewed 11 autism self-advocates, recruited through autism self-advocacy websites, for 1 h each.Results Interviewees viewed genetic testing and its potential pros and cons through the lens of their own indiviudal perceived challenges, needs and struggles, especially concerning stigma and discrimination, lack of accommodations and misunderstandings from society about autism, their particular needs for services, and being blamed by others and by themselves (...) for autistic traits. Their views of genetic testing tended not to be binary, but rather depended on how the genetic test results would be used. Interviewees perceived pros of genetic testing both in general and with regard to themselves (e.g., by providing “scientific proof” of autism as a diagnosis and possibly increasing availability of services). But they also perceived disadvantages and limitations of testing (e.g., possible eugenic applications). Participants distinguished between what they felt would be best for themselves and for the autistic community as a whole. When asked if they would undergo testing for themselves, if offered, interviewees added several considerations (e.g., undergoing testing because they support science in general). Interviewees were divided whether a genetic diagnosis would or should reduce self-blame, and several were wary of testing unless treatment, prevention or societal attitudes changed. Weighing these competing pros and cons could be difficult.Conclusions This study, the first to use in-depth qualitative interviews to assess views of autism self-advocates regarding genetic testing, highlights key complexities. Respondents felt that such testing is neither wholly good or bad in itself, but rather may be acceptable depending on how it is used, and should be employed in beneficial, not harmful ways. These findings have important implications for practice, education of multiple stakeholders, research, and policy. (shrink)

If personhood is the quality or condition of being an individual person, brainhood could name the quality or condition of being a brain. This ontological quality would define the `cerebral subject' that has, at least in industrialized and highly medicalized societies, gained numerous social inscriptions since the mid-20th century. This article explores the historical development of brainhood. It suggests that the brain is necessarily the location of the `modern self', and that, consequently, the cerebral subject is the anthropological figure inherent (...) to modernity (at least insofar as modernity gives supreme value to the individual as autonomous agent of choice and initiative). It further argues that the ideology of brainhood impelled neuroscientific investigation much more than it resulted from it, and sketches how an expanding constellation of neurocultural discourses and practices embodies and sustains that ideology. (shrink)

Brain imaging is a persuasive visual rhetoric by which neuroscience is articulated as relevant to the construction and maintenance of desirable selves. In this essay, I describe how “brain-based self-help” literature disseminates neuroscientific vocabularies to public audiences. In this genre, brain images are an authoritative visual resource for translating neuroscience into a comprehensive program for living. I use Foucault’s discussion of biopower to describe the ways in which brain-based self-help literature enables self-constitution in a biosocial age where health is a (...) central means of communicating personal worth, social value and political order. The implications of this continuous self-fashioning are not limited to the personal realm but have important political consequences. (shrink)

This article uses Betty Friedan’s idiosyncratic invocations of heart disease in her work from the 1960s through the 1990s, as well as her autobiographical comments about it and her theory of the feminine mystique, to grapple with a feminist articulation of heart disease. Although this leading cause of death for women in industrialized countries has been peripheral to feminist health discourse and most women’s preoccupations, heart disease played an interesting narrative role in Friedan’s work and life. Drawing on Friedan’s unconventional (...) philosophy of health provides an opportunity to problematize health awareness and reconsider the role of disease and health in feminist critique more generally. As we try to understand gendered stories of disease that are emerging at the dawn of the 21st century, rereading Friedan can help illuminate the limits, possibilities and dangers of framing heart disease as a ‘women’s health issue’. (shrink)

Advances in neuroscience are changing how mental health issues such as addiction are understood and addressed as a brain disease. Although a brain disease model legitimizes addiction as a medical condition, it promotes neuro-essentialist thinking and categorical ideas of responsibility and free choice, and undermines the complexity involved in its emergence. We propose a “biopsychosocial systems” model where psychosocial factors complement and interact with neurogenetics. A systems approach addresses the complexity of addiction and approaches free choice and moral responsibility within (...) the biological, lived experience and sociohistorical context of the individual. We examine heroin-assisted treatment as an applied case example within our framework. We conclude with a discussion of the model and its implications for drug policy, research, addiction health care systems and delivery, and treatment of substance use problems. (shrink)

This article presents an ethnographical and historical analysis of the mode of being that is constituted when people use neurofeedback (brainwave training) for self-improvement. I analyse how human brainwaves have been associated with the psyche since their first demonstration by the psychiatrist Hans Berger, how they were connected to personality types by the cybernetician Grey Walter, and made trainable by the psychologists Joe Kamiya and Barry Sterman. I compare these cases with the reports of contemporary neurofeedback practitioners and users, and (...) demonstrate that working on the self by working on the brain constitutes a complicated relationship between the brain and the self. Moreover, I demonstrate that combinations of brains and selves, material and spiritual ideas, and biological and social explanations are not confusions due to the ignorance of neurofeedback users, but amalgamations that emerged in the work and ideas of early scientists. (shrink)

Medicine in a Neurocentric World: About the Explanatory Power of Neuroscientific Models in Medical Research and Practice Content Type Journal Article Category Editorial Notes Pages 307-313 DOI 10.1007/s12376-009-0036-2 Authors Lara Huber, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 Mainz Germany Lara K. Kutschenko, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 Mainz Germany Journal (...) Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4. (shrink)

The neurodiversity movement has so far been dominated by autistic people who believe their condition is not a disease to be treated and, if possible, cured, but rather a human specificity (like sex or race) that must be equally respected. Very few studies have been conducted to examine the significance of the neurosciences and the cerebralization of autistic culture for promoting these ideas. The article explores the role of the brain and the neurosciences in projects of identity formation as illustrated (...) in the case of the emergence of the neurodiversity movement. The movement is driven by so called high functioning autistic individuals, who argue that autism is not a disease, but a form of human difference. The article examines the development of autistic individuals and autistic socialities as well as social and community networks. It also addresses the emergence of autistic cultures and various issues concerning autistic identities. It shows that the formation of identities is associated with the cerebralization of the condition. Facts about the brain are mobilized to depict autism positively. The move toward neurosciences has to be understood in a wider social context in which a brain-based vocabulary disseminates outside the lab and penetrates different domains of contemporary societies. This vocabulary is taken up by individuals and groups to speak about themselves and their relation with others as well as in their identity claims and fights for rights. (shrink)

Given that visualisations via medical imaging have tremendously increased over the last decades, the overall presence of colour-coded brain slices generated on the basis of functional imaging, i.e. neuroimaging techniques, have led to the assumption of so-called kinds of brains or cognitive profiles that might be especially related to non-healthy humans affected by neurological, neuropsychological or psychiatric syndromes or disorders. In clinical contexts especially, one must consider that visualisations through medical imaging are suggestive in a twofold way. Imaging data not (...) only visually render pathological entities, but also tend to represent objective and concrete evidence for these psychophysical states in question. This article aims to identify key issues in visually rendering psychiatric disorders via functional approaches of imaging within the neurosciences from an epistemological point of view. (shrink)