The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

As national and state health care policy -making becomes contentious and complex, there is a need for a forum to debate and explore public concerns and values in health care, give voice to local citizens, to facilitate consensus among various stakeholders, and provide feedback and direction to health care institutions and policy makers. This paper explores the role that regional health care ethics committees can play and provides two contrasting examples of Networks involved in facilitation of public input into and (...) the development of health care policies and adoption of state-wide practices. (shrink)

The work of Gregory Bateson offers a metaphysical basis for a “process psychology,” that is, a view of psychological practice and research guided by an ontology of becoming—identifying change, difference, and relationship as the basic elements of a foundational metaphysics. This article explores the relevance of Bateson's recursive epistemology, his re-conception of the Great Chain of Being, a first-principles approach to defining the nature of mind, and understandings of interaction and difference, pattern and symmetry, interpretation and context. Bateson's philosophical contributions (...) will be drawn into relationship with Wittgenstein's philosophy of language as use, Melnyk's theory of causal levels of explanation, Korzybski's account of map and territory, the rejection of the heuristic rigidity of substantialist ontologies, and a cybernetics communication science-informed approach to contextual bi-directionality of causality. We thereby arrive at an understanding of Bateson's process psychology that, given its ecological-systemic nature, is explanatorily applicable across the mind sciences. This process psychology equips us to answer the question: What is mind? Not by explanatory appeal to substantial entities contained within mind, but instead by recourse to the contextually relevant patterns for understanding mind to a particular purpose. We have thereby attended to the gulf between heuristics and fundamentals, between psychological models and an onto-epistemic account of reality. Insufficient attention has been given to characterising the vital nature of Bateson's philosophical oeuvre to psychological practice. This article draws out Bateson's relevance to establishing foundational principles for a process psychology capable of reinvigorating psychological thought. (shrink)

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.

This conversational opinion article between two parties – Kate, a disability performance scholar and Sarah, an interdisciplinary artist-scholar with lived experience of disability – considers the dancing body as redeemer in the specific case of a dancer experiencing ‘chemo fog’, or Chemotherapy-Related Cognitive Impairment (CRCI) after undergoing oncological treatments for Hodgkin Lymphoma. This work draws on Pini’s own lived experience of illness (Pini & Pini, 2019) in dialogue with Maguire-Rosier’s study of dancers with hidden impairments (Gibson & Maguire-Rosier, 2020). In (...) an exploratory account based on an interview with one another, the authors ask: when our senses and perceptions of ourselves and the world we become are obfuscated, what is the nature of the new relationship between the performing self and its absent body/mind/world? How can we shape our narrative and articulate who we are, what we are doing or where we are going, if we are moving in the ‘fog’? Our discussion reveals how Pini’s dancing body elucidates healing, while recovering an agentic perspective in her experience of alienation and frustration tied to chemo fog and related impairments. With this work we offer an original perspective on how a dancing body can resist theoretical diagnosis. (shrink)

Van Fraassen's Judy Benjamin problem asks how one ought to update one's credence in A upon receiving evidence of the sort ``A may or may not obtain, but B is k times likelier than C'', where {A,B,C} is a partition. Van Fraassen's solution, in the limiting case of increasing k, recommends a posterior converging to the probability of A conditional on A union B, where P is one's prior probability function. Grove and Halpern, and more recently Douven and Romeijn, (...) have argued that one ought to leave credence in A unchanged, i.e. fixed at P(A). We argue that while the former approach is superior, it brings about a Reflection violation due in part to neglect of a ``regression to the mean'' phenomenon, whereby when C is eliminated by random evidence that leaves A and B alive, the ratio P(A):P(B) ought to drift in the direction of 1:1. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

Hegel reads the poet Novalis as an expression of terminal irony, a pathological case of Gemüt, where the conscious mind is alienated from reality and turns its negativity inwards on the contents of its own natural soul. The condition of self-feeling, presented in Hegel’s “Anthropology”, is a self-consumption that manifests itself somatically in the physical disease (consumption) from which Novalis dies. The poet’s literary production represents a pathological fixation that impedes the dynamic organicity of Hegelian Science. As such, Novalis’s mental (...) illness and death constitute an expression of romantic irony and an ongoing threat to Hegel’s philosophy. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and that which (...) belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

Many people report that reading first-person narratives of the experience of illness can be morally instructive or educative. But although they are ubiquitous and typically sincere, the precise nature of such educative experiences is puzzling—for those narratives typically lack the features that modern philosophers regard as constitutive of moral reason. I argue that such puzzlement should disappear, and the morally educative power of illness narratives explained, if one distinguishes two different styles of moral reason: an inferentialist style that generates the (...) puzzlement and an alternative exemplarist style that offers a compelling explanation of the morally educative power of pathographic literature. (shrink)

One bi-lingual - hungarian-ENGLISH - meditation and research about the Illness and the Living Being. Concentrated, of course, to the specific HUMAN reporting to them. The book investigates philosophically the issue of human illness and its organic pertinence to the meaning of human life starting from the recognition that the dangerous encounter with the experience of illness is an unavoidable – and as such crucial – experience of the life of any living being. As for us humans, there is probably (...) no mortal man who has never suffered of some – any! – kind of disease from his birth to the end of his life… Illness is therefore an experience or outright a danger of existence and its possibility, as well as a way of being that nobody has ever been and will ever be ontological or existentially exempted from. So, it may well be “arbitrary” or “accidental” which disease affects which being or person, when and to what degree, in what way, etc., but it is factually unavoidable that in the course of one’s entire life – from its very beginning to its very end – one would never fall ill in some respect. The paper discusses this issue by the ontological investigation of possibility. Together with the analyses about of the origins and history of the MEDICINE. -/- The english CONTENTS -/- Illness – A Possibility of the Living Being Prolegomena to the Philosophy of Human Illness ............................................. 127 -/- Excursus Sketchy considerations regarding the problems of Christian medicine and Christian healing ...................................................... 135 -/- A dialogue-attempt with Aristotle: Dynamis, energeia, entelecheia, and steresis ...................................................... 147 . (shrink)

Exemption from blameworthiness is often bound to implicit or explicit claims of diminished agency, or even non-agency. This poses a dilemma in navigating moral relationships affected by mental illness. While it is crucial for assessments of responsibility to be responsive to the significance of mental illness, must this responsiveness come at a cost to symmetrical moral relations? In this paper we argue, contra recent critiques, that Strawsonian accounts of responsibility are able to navigate this dilemma, and can accommodate significant exculpation (...) on the basis of mental illness while maintaining symmetrical relations. We understand this to be part of the larger recognition that while we have certain fundamental entitlements within our moral relationships, it is also possible to be over-entitled, and to expect too much of others. Our account draws, in particular, on the moral significance of difficulty. Difficulty is inherently scalar, and in drawing on this explanatory framework we explicate a theory of both excuse and exemption by degree. We argue for a significant realm of excuse on the basis of mental illness that is fully compatible with symmetrical relations. However, we also acknowledge the limits of this accommodation on Strawsonian grounds, and argue that these limits are justified and appropriate. (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose (...) the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

In an era of dramatic technological progress, the consequent economic transformations, and an increasing need for an adaptable workforce, the importance of education has risen to the forefront of the social discourse. The concurrent increase in the awareness of issues pertaining to social justice and the debate over what this justice entails and how it ought to be effected, feed into the education policy more than ever before. From the nexus of the aforementioned considerations, a concern over the so-called education (...) gap has emerged, with worldwide efforts to close it. I analyse the premises behind such efforts and demonstrate that they are founded upon fundamentally flawed ideas. I show that in a society in which education is delivered equitably, education gaps emerge naturally as a consequence of differentiation due to talents, the tendency for matched mate selection, and the heritability of intellectual traits. Hence, I issue a call for a refocusing of efforts from the ill-founded idea of closing the education gap, to the understanding of the magnitude of its unfair contributions, as well as to those social aspects which can modulate it in accordance to what a society deems fair according to its values. (shrink)

An essay review of Havi Carel, 'Phenomenology of Illness' (OUP 2015).

In some quarters within philosophy of medicine, more particularly in the phenomenological approaches, naturalism is looked upon with suspicion. This paper argues, first, that it is necessary to distinguish between two expressions of this attitude towards naturalism: phenomenological approaches to illness disagree with naturalism regarding various theoretical claims and they disapprove of naturalism on an ethical level. Second, this paper argues that both the disagreement with and the disapproval of naturalism are to a large extent confused. It then offers some (...) proposals to set up an agenda for future collaboration. (shrink)

In her book, Illness as Metaphor, Susan Sontag focuses on metaphors and myths on diseases such as cancer and tuberculosis, which occur in different historical periods. Sontag argues that the metaphors produced related to illness overhaul illness and the things that define illness now have become metaphors produced related to them rather than their concrete and physical aspects. Illness becomes not just an illness, but a phenomenon defined by evil, mystery, fear, evil, madness, passions, wealth and poverty, temporal loginess or (...) speed, and a set of metaphors or myths that are spatially identified with the space. Metaphors and myths turn into means of socially stigmatizing the illness itself rather than giving a meaning to illness. The disease literally turns into a situation that needs to be hidden in order to avoid social stigma. The explanation of mass diseases through metaphors and myths has been seen since ancient times and this understanding of mass diseases continues to exist today. As a matter of fact, the Covid-19 pandemic has also ceased to be the subject of only medical science since it first emerged, and it has turned into an issue that concerns many areas from politics to economics, from sociology to psychology. The metaphors generated on the Covid-19 disease, which we have witnessed its reflections in many areas from the discourses of daily life to the discourse of politicians, from art to literature, have a similar function with the metaphors attributed to diseases like cancer and tuberculosis that Sontag discussed. Covid-19 is not only seen as a disease, but as a disease defined by a series of metaphors such as mysterious, evil, invisible enemy, insidious danger, and democratic virus. The metaphors generated on the disease cause the struggle against the disease itself to be explained with various metaphors. The metaphors derived from Covid-19 such as "invisible enemy" and "biological war" cause the struggle against it to be turned into a military terminology, and the metaphor of "Chinese virus" is a means of social stigmatization / marginalization by racializing the virus directly. This study tackles the issue of how Covid-19, which is the subject of medical science, has become the subject of unscientific myths and metaphors attributed to the disease, and that the disease is perceived through metaphors rather than itself in the context of Susan Sontag's thought. In the study, answers for the questions of what kind of effects appeared due to the stigmatizing power of metaphors derived from the Covid-19 and whether the metaphors are the outcomes of the strategy for coping with the pandemic will be sought. (shrink)

This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mental illness with an eye towards identifying the assumptions upon which each model is based, and exploring the model’s advantages and limitations in clinical contexts. Major Depressive Disorder is used as an example to illustrate these points. The second aim is to address the question of what conceptual-theoretical framework for thinking about mental illness is most likely to facilitate the discovery (...) of causes and treatments of mental illness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)

Does having a mental disorder, in general, affect whether someone is morally responsible for an action? Many people seem to think so, holding that mental disorders nearly always mitigate responsibility. Against this Naïve view, we argue for a Nuanced account. The problem is not just that different theories of responsibility yield different verdicts about particular cases. Even when all reasonable theories agree about what's relevant to responsibility, the ways mental illness can affect behavior are so varied that a more nuanced (...) approach is needed. (shrink)

Theory of illness causation is an important issue in all biomedical sciences, and solid etiological explanations are needed in order to develop therapeutic approaches in medicine and preventive interventions in public health. Until now, the literature about the theoretical underpinnings of illness causation research has been scarce and fragmented, and lacking a convenient summary. This interdisciplinary book provides a convenient and accessible distillation of the current status of research into this developing field, and adds a personal flavor to the discussion (...) by proposing the etiological stance as a comprehensive approach to identify modifiable causes of illness. (shrink)

Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mental illness? (5) Why is mental illness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mental illness?

The starting point of our considerations is the two books published in 2010: "Ill Fare the Land" by late Tony Judt and "Not for Profit" by Martha Nussbaum. The authors of both books share the conviction that neoliberal changes in the world of global capitalism radically impoverish culture and their consequences may be dramatic and irreversible. In our paper we would like to emphasize the dangers to solidarity and social cohesion posed by neoliberal postulates. We also claim that promoting the (...) neoliberal ideology in the context of higher education and institutions of civic society endangers the very democracy understood as reasonable pluralism (in John Rawls' terminology), consisting in rationality, plurality of opinions, lifestyles, and conceptions of good, as well as consensus as the aim of social and political practices. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

One of the main tasks for an account of the Christian doctrine of the atonement is to explain how and in what ways the salvifically relevant work of Christ heals the damage wrought by human sin on our souls, our relationships with one another, and our relationship with God. One kind of damage often neglected in philosophical treatments of the atonement, but discussed at some length in Eleonore Stump’s forthcoming At-one-ment, is what she, following St. Thomas Aquinas, calls the stain (...) on the soul. The stain on the soul comprises the “moral leftovers” of serious evil, damage to the soul that goes beyond the guilt, shame, and separation from God brought about by sin and that lingers in a person even after she has repented and been forgiven. In this paper, I critically examine Stump’s account of how the work of Christ deals with the problem of the stain on the soul. I offer reasons for thinking that if the stain is exactly as she describes it, then it is indelible; and then I explore possible ways forward for her account of the atonement. (shrink)

Definying illness is not an easy process, nor from medical perspective nor from theological one or individual perspective. However, the most important and truely significant seems to be the latter; how the contemporary man defines illnesses and how he uses this process to redefine his true being. Nowadays we face an obvious spiritual crisis meant to urge each of us to start a new process of redefining our spiritual identity. This paper is intented to remind us of the essence of (...) our being on the one hand and of the Christian duty to fight against illness on the other hand, to bear permanently with us the model of Jesus, of the Holly Parents, who were subject to deseases also out of reasons that are related to God’s iconomy. The limits of medicine are visible there where miracles start to reveal themselves and the healing of the body symbolizes and announces the healing of the entire Being. (shrink)

Depression is a common and devastating instance of ill-being which deserves an account. Moreover, the ill-being of depression is impacted by digital technology: some uses of digital technology increase such ill-being while other uses of digital technology increase well-being. So a good account of ill-being would explicate the antecedents of depressive symptoms and their relief, digitally and otherwise. This paper borrows a causal network account of well-being and applies it to ill-being, particularly depression. Causal networks are found to provide a (...) principled, coherent, intuitively plausible, and empirically adequate account of cases of depression in every-day and digital contexts. Causal network accounts of ill-being also offer philosophical, scientific, and practical utility. Insofar as other accounts of ill-being cannot offer these advantages, we should prefer causal network accounts of ill-being. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the treatment (...) process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Since Shelly Kagan pointed out the relative neglect of ill-being in philosophical discussions, several philosophers have contributed to an emerging literature on its constituents. In doing so, they have explored possible asymmetries between the constituents of ill-being and the constituents of positive well-being. This paper explores some possible asymmetries that may arise elsewhere in the philosophy of ill-being. In particular, it considers whether there is an asymmetry between the contribution made to prudential value by equal quantities of goods and bads. (...) It then considers a similar question about the contributions made to moral value by equal quantities of ill-being and positive well-being. The paper explores some of the difficulties involved in assessing these questions. It ends by considering broader differences, both practical and theoretical, between the significance of ill-being and of positive well-being. (shrink)

This paper surveys some philosophical issues with the language surrounding mental illness, but is especially focused on pejoratives relating to mental illness. I argue that though 'crazy' and similar mental illness-based epithets (MI-epithets) are not best understood as slurs, they do function to isolate, exclude, and marginalize members of the targeted group in ways similar to the harmfulness of slurs more generally. While they do not generally express the hate/contempt characteristic of weaponized uses of slurs, MI-epithets perpetuate epistemic injustice by (...) portraying sufferers of mental illness as deserving minimal credibility. After outlining the ways in which these epithets can cause harm, I examine available legal and social remedies, and suggest that the best path going forward is to pursue a reclamation project rather than aiming to censure the use of MI-epithets. (shrink)

This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies Rawls’ (...) general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

Predictive processing theorists have claimed PTSD and depression are maladaptive and epistemically distorting because they entail undesirably wide gaps between top-down models and bottom-up information inflows. Without denying this is sometimes so, the “maladaptive” label carries questionable normative assumptions. For instance, trauma survivors facing significant risk of subsequent attacks may overestimate threats to circumvent further trauma, “bringing forth” concretely safer personal spaces, to use enactive terminology, ensuring the desired gap between predicted worries and outcomes. The violation of predictive processing can (...) go in the opposite direction too, as when depression coincides with energy-depletion, and hence objectively strenuous situations in which things look farther away because they are (accurately anticipated to be) harder to reach. These examples partly encapsulate what predictive processing theorists call “active inference,” yet with differences. In the first case, actions fruitfully obviate predictions rather than fulfilling them. In the second, mental models do not dysregulate bodily processes, making coping harder. Instead, problems (e.g., personal obstacles, gastric illness) deplete energy, eliciting a depressive and adaptive slow-down. Some predictive proponents apply correspondence criteria when alleging mismatches between internal models and the world, while incongruously asserting that the brain did not evolve to see things veridically, but to execute actions. An alternative is to adopt pluralistic, pragmatic epistemologies suited to the complexity of mind. The upshot is that mental outlooks can depart from the norm without epistemically being distorted and that mismatches between anticipatory worries and outcomes, when they actually exist, can be a measure of adaptive and epistemic success. (shrink)

According to subjectivism about ill-being, the token states of affairs that are basically bad for you must be suitably connected, under the proper conditions, to your negative attitudes. This article explores the prospects for this family of theories and addresses some of its challenges. This article (i) shows that subjectivism about ill-being can be derived from a more general doctrine that requires a negatively valenced relationship between any welfare subject and the token states that are of basic harm to that (...) subject and (ii) responds to some objections, including the objection that subjectivists about ill-being cannot plausibly explain the badness of pain. (shrink)

In this paper, I discuss the question whether objective criteria could be provided for judging something to be a mental illness. I consider the two most prominent objectivist or naturalistic accounts of mental illness, evolutionary and bio-statistical account, which offer such a criterion by relying on the notion of biological function. According to such suggestions, illness is a condition in which there is dysfunciton in some feature of an organism. In this context, I consider different accounts for ascribing functions in (...) biologyand their relationship with the suggested accounts of illnesses. Special focus is placed on the objections according to which the ascription of functions, as envisaged in naturalistic accounts of illness, is incompatible with actual medical and psychiatric practice. I conclude that these objections are legitimate insofar we want to an account of illness that preserves the current practice of ascribing illness. However, the question remains, could a theory that tries to capture the actual medical practice be value-neutral, since our ordinary conception of illness is permeated with value judgments that indirectly enter into medical practice. In that respect, it seems that the requirement for pure objectivity is too strong and thus, it is not reasonable to expect that naturalistic accounts can satisfy it. (shrink)

Since 1900, debates about the justification of punishment have also been debates about the cause of crime. In the early twentieth century, the rehabilitative ideal of punishment viewed mental illness and dysfunction in individuals as the cause of crime. Starting in the 1970s, retributivism identified the immorality of human agents as the source of crime, which dovetailed well with the “tough-on-crime” political milieu of the 1980s and 1990s that produced mass incarceration. After surveying these historical trends, Wirts argues for a (...) social critical view that crime is best understood as a product of an unjust society, not faulty human beings. This view should take the lessons learned by the critiques of rehabilitation, however, and resist the tendency to reduce human beings to recipients of social services. (shrink)

The caution of diagnosing someone with Suicide Behavior Disorder derives from the fact that in some scenarios, suicide can still be deemed a “rational” choice and expression of free will rather than a disease. For example, euthanasia, suicide attacks, people with mental illness but being able to take into account the weight of the illness, etc. There exists a blurry line between the considerations of suicide as a choice or an illness. Perhaps, whether it is an illness or a choice (...) is largely dependent on the context and targeted subject. It is not hard to see whether (or when) this very delimitation works is very much cultural by its nature. (shrink)

The illness immersion condition prevents patients from enjoying everything worth living life for. In any case, according to Frank, this condition could represent one of the most insightful experiences towards understanding the meaning of life. Using the metaphor of phoenix taken from May, Frank identified four kinds of embodiments through which the phoenix can reveal itself in a patient after an illness immersion experience: the phoenix that could ever be and the phoenix that might have been; the recurrent and cumulative (...) phoenix and the reluctant phoenix. Based on these considerations, a qualitative study was conducted in order to give voice to the different phoenix embodiments focusing on several autobiographies of patients afflicted with severe or terminal illness. The analysis highlights several similarities that the different phoenixes shared ; however, a deep difference emerged in their worldview which proves able to lead them towards different epiphanies. These evidences reveal that every sick person should be understood, stimulated and accompanied throughout his lived experience of illness by an expressly designed and dedicated care. (shrink)

Background: Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of ‘disease’, ‘disorder’, ‘disability’, etc., has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of use (...) or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one’s own perception of self. -/- Aims: All existing philosophical definitions of disease struggle with coherency, causing much confusion and strife, and leading to inconsistencies in real-world practice. Hence, there is a real need for an alternative. -/- Materials & Methods: In the present article I analyse the variety of contemporary views of disease, showing them all to be inadequate and lacking in firm philosophical foundations, and failing to meet the desideratum of patient driven care. -/- Results: Illuminated by the insights emanating from the said analysis, I introduce a novel approach with firm ethical foundations, which foundations are rooted in sentience, that is the subjective experience of sentient beings. -/- Discussion: I argue that the notion of disease is at best superfluous, and likely even harmful in the provision of compassionate and patient-centred care. -/- Conclusion: Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded. (shrink)

Kant’s conception of mental illness is unlikely to satisfy contemporary readers. His classifications of mental illness are often fluid and ambiguous, and he seems to attribute to human beings at least some responsibility for preventing mental illness. In spite of these apparent disadvantages, I argue that Kant’s account of mental illness can be illuminating to his views about the normative dimensions of human cognition. In contrast to current understandings of mental illness, Kant’s account is what I refer to as “non-pathological.” (...) That is, most mental illnesses are for Kant continuous with normally functioning cognition. Someone with a healthy reason can easily fall into mental illness and someone with mental illness can (perhaps not as easily) re-establish healthy reason. By accepting a non-pathological definition of mental illness, it follows for Kant that humans have more agency and responsibility regarding their mental health than current views allow, which explains why several of his writings aim to prescribe a “diet of the mind” (2:271). Contrary to popular readings of Kant as a champion of reason’s power, Kant’s conception of mental illness shows that he recognizes how fragile human reason can be. (shrink)

In this paper I analyze a view that is increasingly spreading among philosophers and even physicians. Many of them believe that it is right to apply the principle of responsibility for illness in the allocation of health care. I attempt to show that this idea is unacceptable.

The prominent philosopher Bernard Williams (1985) opened his Ethics and the Limits of Philosophy with: “It is not a trivial question, Socrates said: what we are talking about is how one should live” (p. 1) and asked whether Socrates’ question is the proper starting point for moral philosophy. In this paper, I will explore an effect of a very specific life event: a “cliff-edge” retirement. I will look at the concept of ground projects and show how cliff-edge retirements create ill-shaped (...) projects reflecting the loss of important workplace benefits such as purposeful work and social collaborations. This type of retirement prematurely closes the ground project before its natural conclusion. I will argue that attempts to recover it will likely prove difficult, inauthentic and will not remedy the project’s wrongful shape. (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person (...) and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

This article argues in favor of modifying the medical model of severe psychiatric disturbances that underlies calling them "mental illness." The key reason for this proposal is that numerous specialists other than physicians as well as non-specialists contribute to the process of assisting a person recover from what the author suggests might better be called "extraordinary functional disability." There is little uniformity in existing definitions under state laws, but all involve three types of intervention: civil commitment; civil determination of legal (...) competency; and standing to be subject to criminal law. Physicians typically make relevant determinations in each of these areas; but non-physicians are the principal care-givers once a determination has been made. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role and (...) integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

The main aim of this paper is to illustrate human–nature relations from a comparative study of the contexts of later Merleau-Ponty and the Zhuangzi. I argue that the Zhuangzi has its own phenomenology of the natural world, which is worth comparing to Merleau-Pontian later phenomenology. To compare the arguments on human–nature relations in the contexts of later Merleau-Ponty and the Zhuangzi in detail, first, I briefly compare the cultural philosophies of nature in ancient Greece and China and their possible influences (...) on our contemporary understanding of nature. Second, I compare the concept of “flesh” of Merleau-Ponty with the concept of “vital energy” in the Zhuangzi and point out the main roles of these concepts in their respective theories of the natural world. Third, I use the “reversibility thesis” created by Merleau-Ponty to analyze the ontological significance of illness in the arguments of Merleau-Ponty and the Zhuangzi. Fourth, inspired by Merleau-Pontian and Zhuangzian ideas about language and expression, I expound on a view of illness as a primordial language of nature and its possible role in mediating human–nature relations. Ultimately, I conclude that the comparative study of thoughts on human–nature relations in the literatures of later Merleau-Ponty and the Zhuangzi can help us reconsider and readjust our main attitudes toward nature, illness and nonhuman beings in the contemporary postpandemic era. (shrink)

Abstract: The study investigates philosophically the issue of human illness and its organic pertinence to the meaning of human life starting from the recognition that the dangerous encounter with the experience of illness is an unavoidable – and as such crucial – experience of the life of any living being. As for us humans, there is probably no mortal man who has never suffered of some – any! – kind of disease from his birth to the end of his life… (...) Illness is therefore an experience or outright a danger of existence and its possibility, as well as a way of being that nobody has ever been and will ever be ontologically or existentially exempted from. So, it may well be “arbitrary” or “accidental” which disease affects which being or person, when and to what degree, in what way, etc., but it is factually unavoidable that in the course of one’s entire life – from its very beginning to its very end – one would never fall ill in some respect. The paper discusses this issue by the ontological investigation of possibility. (shrink)

This dossier emerges as an attempt to understand our current plight in which we necessarily failed. Some figures were transformed in escapist lines that brought confrontation within our reach in face of these "blockaded access future", where the body – the personal and the aggregate, in different communal places – screams at the top of lungs or remains silent in a fierce pursuit of life, cutting off these pandemic geographies of feverish horizons. It is in this abysmal situation that geographical (...) representations are reestablished, coupled with experienced landscapes, lost territories, and all those original space-time projects. (shrink)

Quality of will accounts of moral responsibility hold that ill will is necessary for blameworthiness. But all such accounts are false to ordinary moral practice, which licenses blame for agents who act wrongly from epistemically unreasonable ignorance even if the act is not ill willed. This should be especially concerning to Strawsonians about moral responsibility, who think the genuine conditions of blameworthiness are derived from the standards internal to our practice. In response, I provide a theory of moral blameworthiness on (...) which ill will is not necessary for blameworthiness. On the view I defend, “Rational Capacitarianism,” agents are blameworthy whenever they act wrongly from an unreasonable attitude which is attributable to them, where an attitude is attributable to an agent just in case she has the capacity to assess reasons for and against the attitude and modulate the attitude in light of these assessments. Acting from unreasonable ignorance is just a special case of acting from an unreasonable attitude. My theory contrasts both with both quality of will accounts of blameworthiness and the Capacitarian view, which specifies that agents who act wrongly from ignorance are culpable if they could and should have known better. On Capacitarianism, a variety of awareness-relevant capacities are pertinent, including memory; on my view it is only failures of rational capacities that render the agent culpable, because only failures of rational capacities are attributable to the agent. (shrink)