On July 4, 1990, while on a morning walk in southern France, Susan Brison was attacked from behind, severely beaten, sexually assaulted, strangled to unconsciousness, and left for dead. She survived, but her world was destroyed. Her training as a philosopher could not help her make sense of things, and many of her fundamental assumptions about the nature of the self and the world it inhabits were shattered.At once a personal narrative of recovery and a philosophical exploration of trauma, this (...) book examines the undoing and remaking of a self in the aftermath of violence. It explores, from an interdisciplinary perspective, memory and truth, identity and self, autonomy and community. It offers imaginative access to the experience of a rape survivor as well as a reflective critique of a society in which women routinely fear and suffer sexual violence.As Brison observes, trauma disrupts memory, severs past from present, and incapacitates the ability to envision a future. Yet the act of bearing witness, she argues, facilitates recovery by integrating the experience into the survivor's life's story. She also argues for the importance, as well as the hazards, of using first-person narratives in understanding not only trauma, but also larger philosophical questions about what we can know and how we should live.Bravely and beautifully written, Aftermath is that rare book that is an illustration of its own arguments. (shrink)

Paul Ricoeur has been hailed as one of the most important thinkers of the century. Oneself as Another, the clearest account of his "philosophical ethics," substantiates this position and lays the groundwork for a metaphysics of morals.

Violence and the Remaking of a Self Susan J. Brison. Political activism (including lobbying for new legislation, speaking out, educating others, helping survivors) can also help to undo the double bind of self-blame versus helplessness.

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. (...) In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties. (shrink)

Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has (...) been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem. (shrink)

Images of myself being Napoleon can scarcely merely be images of the physical figure of Napoleon.... They will rather be images of, for instance, the desolation at Austerlitz as viewed by me vaguely aware of my short stature and my cockaded hat, my hand in my tunic.