Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

Part philosophical meditation, part cultural critique, The Body in Pain is a profoundly original study that has already stirred excitement in a wide range of intellectual circles. The book is an analysis of physical suffering and its relation to the numerous vocabularies and cultural forces--literary, political, philosophical, medical, religious--that confront it.Elaine Scarry bases her study on a wide range of sources: literature and art, medical case histories, documents on torture compiled by Amnesty International, legal transcripts of personal injury trials, and (...) military and strategic writings by such figures as Clausewitz, Churchill, Liddell Hart, and Kissinger, She weaves these into her discussion with an eloquence, humanity, and insight that recall the writings of Hannah Arendt and Jean-Paul Sartre.Scarry begins with the fact of pain's inexpressibility. Not only is physical pain enormously difficult to describe in words--confronted with it, Virginia Woolf once noted, "language runs dry"--it also actively destroys language, reducing sufferers in the most extreme instances to an inarticulate state of cries and moans. Scarry analyzes the political ramifications of deliberately inflicted pain, specifically in the cases of torture and warfare, and shows how to be fictive. From these actions of "unmaking" Scarry turns finally to the actions of "making"--the examples of artistic and cultural creation that work against pain and the debased uses that are made of it. Challenging and inventive, The Body in Pain is landmark work that promises to spark widespread debate. (shrink)

Objectivity has a history, and it is full of surprises. In Objectivity, Lorraine Daston and Peter Galison chart the emergence of objectivity in the mid-nineteenth-century sciences--and show how the concept differs from its alternatives, truth-to-nature and trained judgment. This is a story of lofty epistemic ideals fused with workaday practices in the making of scientific images. From the eighteenth through the early twenty-first centuries, the images that reveal the deepest commitments of the empirical sciences--from anatomy to crystallography--are those featured in (...) scientific atlases, the compendia that teach practitioners what is worth looking at and how to look at it. Galison and Daston use atlas images to uncover a hidden history of scientific objectivity and its rivals. Whether an atlas maker idealizes an image to capture the essentials in the name of truth-to-nature or refuses to erase even the most incidental detail in the name of objectivity or highlights patterns in the name of trained judgment is a decision enforced by an ethos as well as by an epistemology. As Daston and Galison argue, atlases shape the subjects as well as the objects of science. To pursue objectivity--or truth-to-nature or trained judgment--is simultaneously to cultivate a distinctive scientific self wherein knowing and knower converge. Moreover, the very point at which they visibly converge is in the very act of seeing not as a separate individual but as a member of a particular scientific community. Embedded in the atlas image, therefore, are the traces of consequential choices about knowledge, persona, and collective sight. Objectivity is a book addressed to anyone interested in the elusive and crucial notion of objectivity-- and in what it means to peer into the world scientifically. Lorraine Daston is Director at the Max Planck Institute for the History of Science in Berlin, Germany. She is the coauthor of Wonders and the Order of Nature, 1150-1750 and the editor of Things That Talk: Object Lessons from Art and Science. Peter Galison is Pellegrino University Professor of the History of Science and of Physics at Harvard University. He is the author of Einstein's Clocks, Poincaré's Maps: Empires of Time, How Experiments End, and Image and Logic: A Material Culture of Microphysics, and other books, and coeditor of The Architecture of Science. (shrink)

Editorial preface to the fourth edition and modified translation -- The text of the Philosophische Untersuchungen -- Philosophische untersuchungen = Philosophical investigations -- Philosophie der psychologie, ein fragment = Philosophy of psychology, a fragment.

In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and pain (...) in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US. (shrink)

Ce livre est donc voué à la bizarrerie. Mais c'est qu'à accorder tout son soin à l'écriture, il la soumet à une réévaluation radicale. Et les voies sont nécessairement extravagantes lorsqu'il importe d'excéder, pour en penser la possibilité, ce qui se donne pour la logique elle-même - celle qui doit déterminer les rapports de la parole et de l'écriture en se rassurant dans l'évidence du sens commun, dans les catégories de 'représentation' ou 'd'image', dans l'opposition du dedans et du dehors, (...) du plus et du moins, de l'essence et de l'apparence, de l'originaire et du dérivé. Analysant les investissements dont notre culture a chargé le signe écrit, Jacques Derrida en démontre aussi les effets les plus actuels et parfois les plus inaperçus. Cela n'est possible que par un déplacement systématique des concepts - on ne saurait en effet répondre à la question 'qu'est-ce que l'écriture?' par un appel de style 'phénoménologique' à quelque expérience sauvage, immédiate, spontanée. L'interprétation occidentale de l'écriture commande tous les champs de l'expérience, de la pratique et du savoir, et jusqu'à la forme ultime de la question ('qu'est-ce que?') qu'on croit pouvoir libérer de cette prise. L'histoire de cette interprétation n'est pas celle d'un préjugé déterminé, d'une erreur localisée, d'une limite accidentelle. Elle forme une structure finie mais nécessaire dans le mouvement qui se trouve ici reconnu sous le nom de différance. (shrink)

One of our most daring intellectuals offers a Lacanian interpretation of religion, finding that early Christianity was the first revolutionary collective. Slavoj Žižek has been called "an academic rock star" and "the wild man of theory"; his writing mixes astonishing erudition and references to pop culture in order to dissect current intellectual pieties. In The Puppet and the Dwarf he offers a close reading of today's religious constellation from the viewpoint of Lacanian psychoanalysis. He critically confronts both predominant versions of (...) today's spirituality—New Age gnosticism and deconstructionist-Levinasian Judaism—and then tries to redeem the "materialist" kernel of Christianity. His reading of Christianity is explicitly political, discerning in the Pauline community of believers the first version of a revolutionary collective. Since today even advocates of Enlightenment like Jurgen Habermas acknowledge that a religious vision is needed to ground our ethical and political stance in a "postsecular" age, this book—with a stance that is clearly materialist and at the same time indebted to the core of the Christian legacy—is certain to stir controversy. (shrink)

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness (...) as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient. (shrink)

Everyone knows what is feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them. It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has (...) changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'. Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment? (shrink)

Cet ouvrage est la thèse de doctorat en médecine présentée en 1943 par Georges Canguilhem, augmentée, lors de sa réédition vingt ans plus tard, de réflexions philosophiques sur la signification du terme « normal » en médecine. La thèse débute par une étude historique sur l’identité des phénomènes normaux et pathologiques, dogme de la pensée médicale au XIXe siècle. La seconde partie est une étude systématique, sous la forme d’une analyse critique, des concepts de normal et de pathologique. Georges Canguilhem (...) (1904-1995), philosophe puis médecin, contribua à rénover l’épistémologie française. (shrink)

This book brings together, in systematic and generalized form, the main outlines of a conceptual scheme for the analysis of the structure and processes of social systems. It carries out Pareto's intention by using the "structural-functional" level of analysis.

This article considers the roles played by brain images (e.g., from PET scans) in mass media as experienced by people suffering from mental illness, and as used by scientists and activist groups in demonstrating a biological basis for mental illness. Examining the rhetorical presentation of images in magazines and books, the article describes the persuasive power that brain images have in altering the understanding people have of their own body—their objective self. Analyzing first-person accounts of encounters with brain images, it (...) argues that people come to understand themselves as having neurotransmitter imbalances that are the cause of their illnesses via received facts and images of the brain, but that this understanding is incomplete and in tension with the sense that they are their brain. The article concludes by querying the emergence of a pharmaceutical self, in which one experiences one's brain as if on drugs, as a new form of objective self-fashioning. (shrink)

The point of departure for this essay is the question of why pain is seriously undertreated in the United States. Some kinds of pain (for example, chronic nonmalignant pain) are treated worse than others (acute pain secondary to cancer), but there is excellent evidence that no matter what kind of pain, astonishingly large percentages of pain sufferers are undertreated (Furrow 2001; Hill 1995; Kirou-Mauro et al. 2009; Martino 1998; Morris 1991; NCHS 2006; Resnik, Rehm, and Minard 2001). Although some kinds (...) of pain are difficult to treat, we generally possess the technical armamentarium to significantly ameliorate the vast majority of pain experiences. Yet we do not. And, for as long as anyone in the United States .. (shrink)