Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

In this paper I consider metaphysical positions which I label as ‘perspectival’. A perspectivalist believes that some portion of reality cannot extend beyond what an appropriately characterised investigator or investigators can (in some sense) reveal about it. So a perspectivalist will be drawn to claim that a portion of reality is, in some sense, knowable. Many such positions appear to founder on the paradox of knowability. I aim to offer a solution to that paradox which can be adopted by any (...) perspectivalist, which involves no restriction on the claim of knowability and which allows certain sentences to be unknowable. The solution hinges on recognising that what is meant by ‘knowable’ will vary from one type of proposition to another and thus that characterising the modality involved in the notion in terms of possible worlds will be impossible. I thus offer a subjunctive conditional reading of that modality, a reading which, I claim, has the virtues just recounted. (shrink)

Book reviewed in this article: The Meaning of Illness. By S. Kay Toombs.

This paper explores some of the differences between the enactive approach in cognitive science and the extended mind thesis. We review the key enactive concepts of autonomy and sense-making . We then focus on the following issues: (1) the debate between internalism and externalism about cognitive processes; (2) the relation between cognition and emotion; (3) the status of the body; and (4) the difference between ‘incorporation’ and mere ‘extension’ in the body-mind-environment relation.

The concept of mechanism is analyzed in terms of entities and activities, organized such that they are productive of regular changes. Examples show how mechanisms work in neurobiology and molecular biology. Thinking in terms of mechanisms provides a new framework for addressing many traditional philosophical issues: causality, laws, explanation, reduction, and scientific change.

This essay explores some aspects of the relation between philosophy and music. First, how music can inspire philosophy; second, how philosophy can inspire music. Mathematics as a middle term between music and philosophy, the idea of wholeness in a musical composition or a philosophical text, music as a mode of thought displaying traits such as logic, coherence, and sense—these are some ways in which music and philosophy may be seen to be connected. Also, composers sometimes have explicit recourse to philosophical (...) ideas in advancing their music, there being prominent examples of this in the twentieth century. Lastly, given there is such a thing as the philosophy of music, might there also be the music of philosophy? (shrink)

Biological science does not try to distinguish between health and disease. Biology is concerned with the interaction between living organisms and their environment. What we call health or disease is quite irrelevant.These reactions between the individual and his environment are complex. The individual and his surroundings form an integrated system which we can arbitrarily divide into two parts. There is an “external” component, by which we mean such factors as light, heat, percentage of oxygen in the air, quantity of minerals (...) or vitamins in food, micro-organisms in food or air, and so on. These can induce changes in what we arbitrarily call the “internal” component. Here we include such crude factors as anatomical structures, or finer details like composition of intercellular fluid, or secretions of glands, or changes of electrical potential in nerve or muscle. (shrink)

In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at (...) once practically relevant and philosophically significant. (shrink)

The aim of this paper is, on the one hand, to critically investigate Kuhn’s stance on the assessment of the pursuit worthiness of scientific theories, and, on the other hand, to show the actuality of some of Kuhn’s points on this issue, in view of their critical analysis. To this end we show that Kuhn presents certain tools, which may help scientists to overcome communication breakdowns when engaging in the process of rational deliberation regarding the question whether a theory is (...) worthy of further pursuit. These tools are persuasion, translation and interpretation. However, we argue that the perspective of epistemic semantic monism present in Kuhn’s work obstructs the full applicability of these tools. We show that dropping this perspective makes the notions of persuasion and interpretation more fruitful, and moreover, allows for a pluralism of scientific theories and practices that complements the pluralism based on disagreement among scientists, emphasized by Kuhn. (shrink)

The essay shows the common ground between music and philosophy from the origin of Western philosophy to the crisis of metaphysical thinking, in particular with Nietzsche and Benjamin. At the beginning, the relationship between philosophy and music is marked by the hegemony of the word on the sound. This is the nature of the Platonic idea of music. With Nietzsche and Benjamin this hegemony is denied and a new vision of the relationship becomes possible. The sound is the origin both (...) of language and of music. In thinking about this origin, philosophy shows that “thinking about music” is “thinking in music”, and that this thinking is the origin of philosophy itself. (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and value (...) judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

Proceedings of the first trans-disciplinary symposium on philosophy and medicin held at Galveston, Texas, May 9-11,1974.