Real Materialism is a collection of highly original essays on a set of related topics in philosophy of mind and metaphysics: consciousness and the mind-body problem; our knowledge of the world; the nature of the self or subject; free will and moral responsibility; the nature of thought and intentionality; causation and David Hume.

Surely since the Enlightenment, if not before, the study of mind has centered principally on how man achieves a “true” knowledge of the world. Emphasis in this pursuit has varied, of course: empiricists have concentrated on the mind’s interplay with an external world of nature, hoping to find the key in the association of sensations and ideas, while rationalists have looked inward to the powers of mind itself for the principles of right reason. The objective, in either case, has been (...) to discover how we achieve “reality,” that is to say, how we get a reliable fix on the world, a world that is, as it were, assumed to be immutable and, as it were, “there to be observed.”This quest has, of course, had a profound effect on the development of psychology, and the empiricist and rationalist traditions have dominated our conceptions of how the mind grows and how it gets its grasp on the “real world.” Indeed, at midcentury Gestalt theory represented the rationalist wing of this enterprise and American learning theory the empiricist. Both gave accounts of mental development as proceeding in some more or less linear and uniform fashion from an initial incompetence in grasping reality to a final competence, in one case attributing it to the work out of internal processes or mental organization, and in the other to some unspecified principle of reflection by which—whether through reinforcement, association, or conditioning—we came to respond to the world “as it is.” There have always been dissidents who challenged these views, but conjectures about human mental development have been influenced far more by majoritarian rationalism and empiricism than by these dissident voices. Jerome Bruner is research professor of psychology at New York University, where he is also serving as Meyer Visiting Professor of Law. His most recent book, Acts of Meaning, appeared in 1990. In 1987 he received the Balzan Prize for “a lifetime contribution to the study of human psychology.”. (shrink)

Over the decades of experimentation on the placebo effect, it has become clear that it is driven largely by expectation, and that strong expectations of efficacy are more likely to give rise to the experience of benefit. No wonder the placebo effect has come to resemble a self-fulfilling prophecy. However, this resemblance is considerably exaggerated. The placebo effect does not work as strongly as it is advertised to do in some efforts to elicit it. Half-truths about the placebo effect are (...) now in circulation, reinforced by a number of other equivocations that it seems to attract. As the deceptive use of placebos has fallen into discredit, the use of half-truths and exaggerations—neither of which is technically a deception—becomes an ever more inviting possibility. However, there are risks and costs associated with the half-truth that the doctor possesses the power to make his or her words come true by the alchemy of the placebo effect. (shrink)

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Is it ever right to prescribe placebos to patients in clinical practice? The General Medical Council is ambivalent about the issue; the American Medical Association asserts that placebos can be administered only if the patient is (somehow) ‘informed’. The potential problem with placebos is that they may involve deception: indeed, if this is the case, an ethical tension arises over the patient's autonomy and the physician's requirement to be open and honest, and the notion that medical care should be the (...) primary concern. This paper examines the case of depression as an entry point for understanding the complexities of the prescription of placebos. Recent important meta-analyses of antidepressants claim that they are not significantly more effective in a clinical setting than placebos. Given that antidepressants have numerous adverse side effects and are hugely expensive, this provocative research has serious potential ethical and practical implications for patients and medical providers. Should placebos be prescribed in place of antidepressants? The case of depression highlights another important issue which medical ethical codes have hitherto overlooked: well-being is not synonymous with being realistic about oneself, one's circumstances and the future. While severely depressed individuals are unduly pessimistic about themselves and the world around them, treatment of depressed individuals can be deemed successful when patients have successfully attained those positive illusions that are indicative of psychological health. This is exactly what successful psychological treatments of depression seem to achieve. It is therefore possible that there may be a limited unavoidable role for deception in medicine. (shrink)

Dawes points out the fallacy in many commonly held beliefs in therapy and takes issue with many current treatment methods.

Lectures delivered as the Mary Flexner Lectures, Bryn Mawr College, fall 1965, under the title: The long perspectives.

Contemporary psychiatry maintains the myth that it is value neutral by appeal to modern medical science for both its diagnostic categories and its therapeutic interventions, leaving the impression that it relies on reason—that is to say, reason divorced from tradition—to master human nature. Such a practice has a certain way of characterizing and defining humanity's lapses from acceptable human behavior—a lapse from human being. The modern practice of psychiatry applies a particular notion (largely influenced by Enlightenment ideals) of scientific instrumentation (...) to the human person in order to diagnose the ailment and manufacture a corresponding treatment in keeping with a hidden conception of human biological flourishing. This covert vision is an impoverished (and possibly dangerous) one. As much as the practice of psychiatry is constrained by the goals of the dominant moral tradition of our day, it becomes a tool (or technique) for achieving the transient and partial ends of modern individualism. Given this truncated view of human nature and human end, modern psychiatry fails to attend comprehensively to the unity of a life, missing altogether the essential relevance of character formation, and thereby forfeiting excellence in human flourishing. (shrink)

In this article I critically discuss a claim made by several writers in philosophy and the social sciences that for an individual to count as a person, a single personality, or the subject of a life, the experiences of the subject in question must take a narrative form. I argue that narrativity is a misleading and, in some ways of understanding it, implausible condition of what it is that adds unity to personhood and personality. I pursue this critique by considering (...) canonical accounts of narrativity in philosophy and literary studies. I consider those connections between events that must hold for the sequence to be considered a narrative: causal, teleological, and thematic connections. I argue that for each of these, the condition that experiential sequences (for a given subject) must have this structure is empty: any life sequence that is reflected upon in an interpretive spirit can meet it. What the condition of narrativity amounts to, then, is the more basic requirement that the person must be able to look upon the factors and events of her life with a certain interpretive reflection, whether or not those factors and events have any particular narrative unity in a traditional sense. (shrink)

Recent evidence from the neurosciences and cognitive sciences provides some support for a narrative theory of self-understanding. However, it also suggests that narrative self-understanding is unlikely to be accurate, and challenges its claims to truth. This article examines a range of this empirical evidence, explaining how it supports a narrative theory of self-understanding while raising questions of these narrative's accuracy and veridicality. I argue that this evidence does not provide sufficient reason to dismiss the possibility of truth in narrative self-understanding. (...) Challenges to the possibility of attaining true, accurate self-knowledge through a self-narrative have previously been made on the basis of the epistemological features of narrative. I show how the empirical evidence is consistent with the epistemological concerns, and provide three ways to defend the notion of narrative truth. I also aim to show that neuroethical discussions of self-understanding would benefit from further engagement with the philosophical literature on narrative truth. (shrink)

If placebos have been squeezed out of medicine to the point where their official place is in clinical trials designed to identify their own confounding effect, the placebo effect nevertheless thrives in psychotherapy. Not only does psychotherapy dispose of placebo effects that are less available to medicine as it becomes increasingly technological and preoccupied with body parts, but factors of the sort inhibiting the use of placebos in medicine have no equivalent in psychology. Medicine today is disturbed by the placebo (...) effect in a way psychotherapy is not. Psychotherapy does not have to grapple with such a disconcerting paradox as successful sham surgery, and unlike those physicians who once pretended to treat the patient’s body while actually attempting to treat the mind, the psychotherapist can treat the mind in all frankness. Perhaps it is because psychotherapy is less burdened by doubts about the placebo effect that it was able to come to its aid when it was orphaned by medicine. It is vain to expect something with so long a history as the placebo effect to disappear from the practices of healing. (shrink)