Low back pain (LBP) carries a high risk of chronicization and disability, greatly impacting the overall demand for care and costs, and its treatment is at risk of scarce adherence. This work introduces a new scenario based on the use of a mobile health tool, the Dress-KINESIS, to support the traditional rehabilitation approach. The tool proposes targeted self-manageable exercise plans for improving pain and disability, but it also monitors their efficacy. Since LBP prevention is the key strategy, the (...) tool also collects real-patient syndromic information, shares valid educational messages and fosters self-determined motivation to exercise. Our analysis is based on a comparison of the performance of the traditional rehabilitation process for non-specific LBP patients and some different scenarios, designed by including the Dress-KINESIS’s support in the original process. The results of the simulations show that the integrated approach leads to a better capacity for taking on patients while maintaining the same physiotherapists’ effort and costs, and it decreases healthcare costs during the two years following LBP onset. These findings suggest that the healthcare system should shift the paradigm towards citizens’ participation and the digital support, with the aim of improving its efficiency and citizens’ quality of life. (shrink)

In this article I clarify the concepts of ‘pain’, ‘suffering’. ‘pains of body’, ‘pains of soul’. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis. treatment and research. Next, there is (...) the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfihing these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if anv, should override the right to refuse treatment where pain relief is of paramount concern. (shrink)

- First book to describe what pain means in vulnerable or special groups of people - Clinical applications described in each chapter - Provides insight into the nature of pain experience across the lifespan -/- This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. -/- Immediate pain warns (...) of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair. -/- Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. -/- This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management. -/- Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019. (shrink)

Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, (...) I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders. (shrink)

Introduction: The incidence of chronic low back pain (LBP) is very high in Bangladesh. There is a high prevalence of psychiatric diseases among chronic low back pain patients. But primary care physicians and specialists do not screen this association. The aims of this study were to evaluate the incidence and pattern of psychiatric diseases in chronic low back pain patients. Materials and methods: A prospective cross-sectional hospital-based study of 135 chronic low back pain patients using simple, (...) direct, standardized questionnaire including history and detailed psychiatric evaluation by a consultant psychiatrist from January to December 2014. Results: A total 69 chronic low back pain patients (51.1%) were diagnosed with psychiatric problems. Predominant group were female (65.9%), above 40 years of age (60.7%). Depression (44.9 %) and anxiety (31.9%) were the major psychiatric illness diagnosed (76.8%). Only 17.4 % patients expects complete cure. Fear of disease outcome was the commonest precipitating factor found (66.6%). With the adjuvant psychiatric management, 81.1% showed improvement clinically. Conclusion: Detecting the level of psychiatric illness among chronic low back pain patients at early stage will improve the treatment outcome. A referral system to psychiatrists by physicians needs to develop to screen the mental disorder symptoms to treat the problem. (shrink)

The ability to anticipate events, to foresight, is an adaptive advantage. We humans use it all the time. Animals have a limited access to it. Positioning foresight in human evolution is a complex subject (Suddendorf, 2013). Why and how are humans, and not chimpanzees, performant in anticipating events? We propose here to address that question with an evolutionary scenario that links self-consciousness to anxiety management (Menant, 2018). The scenario positions self-consciousness as “the capability to represent one’s own entity as (...) existing in the environment, like conspecifics are represented as existing” (making “thinking about oneself” possible). The scenario proposes that our pre-human ancestors were capable of some level of identifications with their conspecifics, and that its development has progressively brought our ancestors to represent themselves as existing in the environment like their conspecifics were represented, thus introducing self-consciousness. The scenario also proposes that identifications with suffering conspecifics have been the source of an important anxiety that had to be limited for evolution to continue. Some of our ancestors have not been able to limit that new anxiety. Their mental pain became unbearable. Their evolution was almost stopped, thus initiating the pan-homo split. Developing an ability to anticipate events has been a key contributor to anxiety limitation by providing information about the sufferings to come, and consequently allowing to limit and avoid them. In addition to that role of foresight in human evolution it is worth noticing that the associated chaining of mental events brings to propose foresight as an entry point to the concept of causality in human evolution. Regarding our chimpanzee cousins, the pan-homo split in the scenario positions them as not self-conscious, not capable of anticipation like humans are, and less anxious than humans. Continuations are proposed. (shrink)

Recent work by Stout and colleagues indicates that the neural correlates of language and Early Stone Age toolmaking overlap significantly. The aim of this paper is to add computational detail to their findings. I use an error minimisation model to outline where the information processing overlap between toolmaking and language lies. I argue that the Early Stone Age signals the emergence of complex structured representations. I then highlight a feature of my account: It allows us to understand the early evolution (...) of syntax in terms of an increase in the number and complexity of models in a cognitive system, rather than the development of new types of processing. (shrink)

We challenge an argument that aims to support Aesthetic Realism by claiming, first, that common sense is realist about aesthetic judgments because it considers that aesthetic judgments can be right or wrong, and, second, that becauseAesthetic Realism comes from and accounts for “folk aesthetics,” it is the best aesthetic theory available.We empirically evaluate this argument by probing whether ordinary people with no training whatsoever in the subtle debates of aesthetic philosophy consider their aesthetic judgments as right or wrong. Having shown (...) that the results do not support the main premise of the argument, we discuss the consequences for Aesthetic Realism and address possible objections to our study. (shrink)

The free energy principle is notoriously difficult to understand. In this paper, we relate the principle to a framework that philosophers of biology are familiar with: Ruth Millikan’s teleosemantics. We argue that: systems that minimise free energy are systems with a proper function; and Karl Friston’s notion of implicit modelling can be understood in terms of Millikan’s notion of mapping relations. Our analysis reveals some surprising formal similarities between the two frameworks, and suggests interesting lines of future research. We hope (...) this will aid further philosophical evaluation of the free energy principle. (shrink)

Hutto and Myin claim that teleosemantics cannot account for mental content. In their view, teleosemantics accounts for a poorer kind of relation between cognitive states and the world but lacks the theoretical tools to account for a richer kind. We show that their objection imposes two criteria on theories of content: a truth-evaluable criterion and an intensionality criterion. For the objection to go through, teleosemantics must be subject to both these criteria and must fail to satisfy them. We argue that (...) teleosemantics meets the truth-evaluable criterion and is not required to meet the intensionality criterion. We conclude that Hutto and Myin’s objection fails. (shrink)

Over the last fifteen years, an ambitious explanatory framework has been proposed to unify explanations across biology and cognitive science. Active inference, whose most famous tenet is the free energy principle, has inspired excitement and confusion in equal measure. Here, we lay the ground for proper critical analysis of active inference, in three ways. First, we give simplified versions of its core mathematical models. Second, we outline the historical development of active inference and its relationship to other theoretical approaches. Third, (...) we describe three different kinds of claim -- labelled mathematical, empirical and general -- routinely made by proponents of the framework, and suggest dialectical links between them. Overall, we aim to increase philosophical understanding of active inference so that it may be more readily evaluated. -/- This the final submitted version of the Introduction to the Topical Collection "The Free Energy Principle: From Biology to Cognition", forthcoming in Biology & Philosophy. (shrink)

In their landmark 2010 paper, “The weirdest people in the world?”, Henrich, Heine, and Norenzayan outlined a serious methodological problem for the psychological and behavioural sciences. Most of the studies produced in the field use people from Western, Educated, Industrialised, Rich and Democratic (WEIRD) societies, yet inferences are often drawn to the species as a whole. In drawing such inferences, researchers implicitly assume that either there is little variation across human populations, or that WEIRD populations are generally representative of the (...) species. Yet neither of these assumptions is justified. In many psychological and behavioural domains, cultural variation begets cognitive variation, and WEIRD samples are recurrently shown to be outliers. In the years since the article was published, attention has focused on the implications this has for research on extant human populations. Here we extend those implications to the study of ancient _H. sapiens_, their hominin forebears, and cousin lineages. We assess a range of characteristic arguments and key studies in the cognitive archaeology literature, identifying issues stemming from the problem of sample diversity. We then look at how worrying the problem is, and consider some conditions under which inferences to ancient populations via cognitive models might be provisionally justified. (shrink)

The world population is aging rapidly. Fear of falling among the elderly constitute a significant problem in health care. Among community-dwelling elderly, fear of falling is frequent, with prevalence ranging from 3% to 85% % in community-based epidemiologic studies. The aim of this review is to reveal the prevalence and risk factors of fear of falling (FOF) among elderly. The review has identified that age, sex, physical performance, comorbidity, a history of falls, hearing impairment, poor self-related health and depressive symptoms (...) affect fear of falling. The consequences that develop as a result of a fear of falling can include: loss of confidence, decreased quality of life, mobility or activity restriction and the development of deconditioning, leading to loneliness, depression, and anxiety, subsequent falls and physical, psychological and mental function declines. Maintenance of physical function and pain management might be important for older adults with fear of falling. (shrink)

Surrogacy is an encouraging management for many childless couples and can hypothetically resolve many unbearable pain that they are confronted. Initially surrogacy treatment was frowned upon, however, surrogacy is more popularly accepted now a day. But different country has different regulations on surrogacy. However, there are some degree of divergence between official discourse and actual practice of surrogacy throughout world. There are positive changes in attitude toward surrogacy has been seen for some countries as well. This editorial brief (...) about surrogacy around the world. (shrink)

As a response to the opioid epidemic in the United States, the Centers for Disease Control and Prevention (CDC) published the CDC Guideline for Prescribing Opioids for Chronic Pain in 2016. This document served as a means to reduce risks and address harms of opioid use by recommending that clinicians conduct periodic urine drug testing for patients on chronic opioid therapy. As an unintended result of this recommendation, providers began using unexpected urine drug test results as a reason to (...) dismiss patients from practice, both out of concern for their patients’ wellbeing as well as their own legal risks. Using Husserl’s and Heidegger’s phenomenology, we argue that this science-based, black-and-white practice does not heed the patient as a whole person. Instead, we recommend a more contextual, patient-centered approach that can help us to better understand and manage patient needs in such contexts. (shrink)

The essential difficulty about Computer Ethics' (CE) philosophical status is a methodological problem: standard ethical theories cannot easily be adapted to deal with CE-problems, which appear to strain their conceptual resources, and CE requires a conceptual foundation as an ethical theory. Information Ethics (IE), the philosophical foundational counterpart of CE, can be seen as a particular case of environmental ethics or ethics of the infosphere. What is good for an information entity and the infosphere in general? This is the ethical (...) question asked by IE. The answer is provided by a minimalist theory of deseerts: IE argues that there is something more elementary and fundamental than life and pain, namely being, understood as information, and entropy, and that any information entity is to be recognised as the centre of a minimal moral claim, which deserves recognition and should help to regulate the implementation of any information process involving it. IE can provide a valuable perspective from which to approach, with insight and adequate discernment, not only moral problems in CE, but also the whole range of conceptual and moral phenomena that form the ethical discourse. (shrink)

Warts and verrucas are common skin conditions caused by the human papillomavirus (HPV) infection. They present as raised, rough, or bumpy growths on the hands, feet, or other areas subjected to friction or pressure. Plantar warts exhibit a rough surface with small black dots, while genital warts have a cauliflower-like appearance. Pain or itchiness may accompany these lesions. Factors such as close contact with infected individuals and immune compromise can impact the severity and spread of warts. Diagnosis is primarily (...) based on clinical examination, and referral to a dermatologist may be necessary for uncertain cases. Treatment options range from over-the-counter remedies to professional interventions. Persistent or symptomatic lesions should be evaluated by a healthcare professional. Improved understanding and effective management of warts and verrucas are essential for optimal patient outcomes. (shrink)

Is the history of philosophy primarily a contribution to PHILOSOPHY or primarily a contribution to HISTORY? This paper is primarily contribution to history (specifically the history of New Zealand) but although the history of philosophy has been big in New Zealand, most NZ philosophers with a historical bent are primarily interested in the history of philosophy as a contribution to philosophy. My essay focuses on two questions: 1) How did New Zealand philosophy get to be so good? And why, given (...) that is so good (a point I am at pains to establish), has it apparently had so slight a cultural impact within New Zealand itself? Did we get the wrong Anderson – the uninspiring William, who was Professor at Auckland, rather than his talented younger brother John, who had such a huge cultural influence as Professor of Philosophy at Sydney? Perhaps but that can only be part of the story since we managed to attract even bigger stars, (notably Karl Popper) as well as breeding bigger talents of our own (Prior, Baier, Bennett, Mulgan, Hursthouse, Waldron and many more). Do we export our best talent? Sometimes – but the stars that stay and the stars who arrive don’t seem to have much impact in New Zealand itself however brightly they shine in the international philosophical firmament. Is it too esoteric? Perhaps, but esoteric philosophy can still have a cultural impact, witness, Moore, Popper and the younger Anderson. Is it, like many of New Zealand’s cultural products (from romance novels to movies), primarily intended for an international audience? That’s a large part of the answer but only a part. Another part of the answer is that philosophy HAS had a cultural impact but that impact is not readily apparent. For NZ philosophers have been less keen to push their ideological barrows and more keen to produce critical thinkers, and critical thinkers don’t all think alike. The logician George Hughes was apparently a life-changing teacher not because he had a nostrum but because he taught people to think. As one of his students said ‘the only ism you believe in is the syllogism’. On the whole the history of New Zealand Philosphy is a ‘From Log Cabin to White House’ tale, ‘From colonial obscurity through struggle and adversity to philosophical excellence’. But there are shadows in the picture. Some departments have nearly come to grief through bureaucratic and political misadventures, and it is hard to resist the suspicion that there is often an element of hostility to philosophers on the part of both university bureaucrats and fellow-academics. I speculate as to why this is the case (we are too argumentative and don’t confine our argumentative tendencies to the cloister) but conclude with some upbeat reflections. on the future of New Zealand Philosophy. (shrink)

David Hume endorses three claims that are difficult to reconcile: (1) sympathy with those in distress is sufficient to produce compassion towards their plight, (2) adopting the general point of view often requires us to sympathize with the pain and suffering of distant strangers, but (3) our care and concern is limited to those in our close circle. Hume manages to resolve this tension, however, by distinguishing two types of sympathy. We feel compassion towards those around us because associative (...) sympathy causes us to mirror their pain and suffering, but our ability to enter into the afflictions of those remote from us involves cognitive sympathy and merely requires us to reflect upon how we would feel in their shoes. This hybrid theory of sympathy receives support from recent work on affective mirroring and cognitive pretense. Hume’s account should appeal to contemporary researchers, therefore, who are interested in the nature of moral imagination. (shrink)

(Spanish) RESUMEN: La libertad absoluta postulada por Viktor Emil Frankl y Jean-Paul Sartre, la Shoah y la creencia en un dios omnipotente, bueno y justo parecen contradecirse. La pregunta por el sentido del sufrimiento de las víctimas del Holocausto (la verdadera catástrofe, el mayor crimen contra la humanidad), simbolizado por Auschwitz, y como punto de inflexión en la historia, es terriblemente dolorosa y parece no tener una respuesta filosófica ni teológica. A mi juicio, es importantísimo distinguir entre las víctimas inocentes (...) de la Shoah que perecieron y las víctimas inocentes que sufrieron un verdadero infierno y perdieron a sus seres queridos, pero que lograron sobrevivir. Ambas son víctimas, por supuesto, pero así como encontrarle un posible sentido al sufrimiento de las víctimas masacradas y gaseadas podría suponer un insulto a su sufrimiento y agonía –en especial, al horror que sufrieron los niños–, el horrible sufrimiento de los supervivientes pudo dar, tal vez, de alguna manera, un sentido a sus vidas después de la liberación de los campos de concentración y exterminio, ya fuera como voz, como protesta o como simple supervivencia. Frankl apuesta por un sentido último (que abraza el sentido del sufrimiento de las víctimas), y Sartre, aunque parezca no apostar por sentido alguno, volcó su vida al compromiso político después de la Segunda Guerra Mundial, y ello parece vislumbrar una minúscula pizca de sentido después de la barbarie. La filosofía de Frankl es un sí a la vida incluso en las situaciones más extremas, un grito casi nietzscheano que exalta el valor de la vida más allá de cualquier sufrimiento. Frankl, padre de la logoterapia y superviviente del Holocausto, abre una puerta a Dios al hablar de un dios inconsciente, una dimensión suprahumana y una fe incondicional, y define la religión como espiritualidad y como la búsqueda del hombre por el sentido último. Según Frankl, la libertad no se contradice con Dios, y la religión existe no a raíz de la barbarie, sino a pesar de la barbarie. El existencialismo sartreano es una filosofía de la libertad radical y de la responsabilidad. El hombre está condenado a ser libre. El ser humano es un ser en el que la existencia precede a la esencia. Somos totalmente responsables de lo que somos. Sartre afirma que la libertad humana es incompatible con Dios. En un mundo sin Dios, la moral la construyen los hombres, con sus propias decisiones y sus acciones, y la existencia y el sufrimiento de las víctimas no tienen sentido alguno. Sartre define al hombre como libertad, responsabilidad, angustia y contingencia. Frankl define al hombre como libertad, responsabilidad, espiritualidad y búsqueda de sentido. Con esta tesis me propongo entrar en la resbaladiza dimensión del dolor, la desesperación, el sentido y sinsentido del sufrimiento de las víctimas (teniendo presente los horrores de Auschwitz, que en teología y filosofía ha simbolizado desde la liberación de los campos la muerte de Dios y la muerte de la moral). Es verdad que no solo los hombres, mujeres y niños judíos fueron víctimas de la barbarie alemana, pero, como reza el mensaje de Elie Wiesel en la exposición permanente del Block 27 del Auschwitz-Birkeanu State Museum: "Not all victims were Jewish in this place, but all Jews were victims". La Shoah no es un episodio dentro de la Segunda Guerra Mundial, sino un punto de inflexión en la historia de la humanidad, y es una catástrofe que nos concierne a todos, hombres y mujeres judíos y no judíos, religiosos e irreligiosos, creyentes e increyentes, como seres libres, responsables y morales que somos –o que deberíamos ser. Muchas de las víctimas del Holocausto, en medio de la desesperación, entraron en las cámaras de gas orando, aferrándose a la esperanza de que ese final espeluznante no era un punto final. Con esta tesis no me propongo de ninguna manera responder a la eterna pregunta de si Dios existe o no, sino que propongo interpretar ese grito hacia Dios como un desesperado anhelo de esperanza. También me propongo encontrar una coherencia en las posturas de estos dos grandes pensadores para quienes la libertad y la responsabilidad definen al hombre: Frankl (quien apuesta por una dimensión suprahumana donde existe un sentido último en el que el sufrimiento de las víctimas tiene que tener algún sentido, aunque ese sentido sea completamente incomprensible en la dimensión humana) y Sartre (el existencialista ateo por excelencia, para quien el mundo, la existencia y el sufrimiento son absolutamente contingentes). En el primer capítulo expongo la logoterapia y el existencialismo sartreano: describo las tres dimensiones del hombre y las tres búsquedas de sentido propuestas por Frankl, y expongo las cinco consecuencias de "l'existence précède l'essence", centrándome en la libertad y la responsabilidad, y hablo del suicidio. El segundo capítulo está dedicado al dios inconsciente frankleano, la dimensión suprahumana, la búsqueda por el sentido último y la fe incondicional. En el tercer capítulo ilustro la libertad sin Dios sartreana, la ontología sartreana, el ateísmo sartreano y el humanismo sartreano, y hablo sobre la responsabilidad, la mauvaise foi, la contingencia, la situation y la angustia. El cuarto capítulo es necesariamente histórico (sin dejar de ser filosófico): me pregunto por la muerte de Dios después de Auschwitz, argumento y defiendo la unicidad del Holocausto (la Shoah es un punto de inflexión en la historia de la humanidad), describo las masacres antes de los campos de exterminio (Einsatzgruppen, Ordnungspolizei y Wehrmacht), el gigantesco complejo de Auschwitz (Stammlager, Auschwitz-Birkenau y Monowitz-Buna), reflexiono sobre Dios y el mal (centrándome en los niños de Auschwitz), describo los días de Frankl en Auschwitz, hablo de Dios como esperanza, de la inmortalidad y la escatología, de la crueldad de Dios, de la relación entre el cristianismo y el antisemitismo, del islam y el antisemitismo, critico el silencio de Dios, hablo de la muerte de Dios y del juicio contra Dios. En el quinto capítulo expongo la moral frankleana (una moral que atañe al hombre y no a Dios), basándome en su teoría del amor y en su única obra de teatro (Synchronisation in Binkerwald), y la moral sartreana (una moral que atañe a una humanidad sin Dios), recordando a Dostoyevsky, analizando la famosa cita de Garcin en Huis clos "L'enfer, c'est les Autres", criticando el marxismo de Sartre y cuestionando (con la mirada de Frankl y Sartre) el verso de Brecht "Erst kommt das Fressen, dann kommt die Moral"; al final del capítulo incluyo una reflexión propia y las críticas frankleana y sartreana sobre la impunidad de los verdugos y colaboradores después del Holocausto (con el permiso de Dios). Después de la Conclusión, añado un Apéndice sobre las vidas de Frankl y Sartre, para poder entender mejor su obra. PALABRAS CLAVE: logoterapia, existencialismo sartreano, búsqueda de sentido, libertad, responsabilidad, moral, angustia, sufrimiento, supervivientes, víctimas, contingencia, espiritualidad, religión, Dios, esperanza, antisemitismo, culpa, Auschwitz, Holocausto, Shoah. /// (English) ABSTRACT: The absolute freedom defended by Viktor Emil Frankl and Jean-Paul Sartre, the Shoah and the belief in an omnipotent, benevolent and just God seem to contradict each other. The question of the meaning of the victims' suffering of the Holocaust (the true catastrophe, the biggest crime against humanity), simbolised by Auschwitz and as a turning point in History, is terribly painful and doesn't seem to have an answer. In my opinion, it's crucial to distinguish between the innocent victims of the Shoah who perished and the innocent victims who sufferend a real hell and lost their loved ones, but managed to survive. Both are victims, of course, but just as finding a possible meaning to the suffering of the massacred and gassed victims could result in an insult to their suffering and agony –especially to the horror that the children suffered– the gigantic suffering of the survivors could, maybe, somehow, give a meaning to their lives after the liberation of the concentration and extermination camps, either as a voice, as a protest, or as a simple survival. Frankl believes in an ultimate meaning (that embraces the meaning of the victims' suffering), and Sartre, even if it appears not to embrace any meaning, turned his life to political engagement after War World II, and that attitude seems to give a tiny glimpse of meaning after the barbarity. Frankl's philosophy says yes to life even in the most extreme situations, and it's a Nietzschean-like scream that exalts the value of life beyond any monstrous suffering. Frankl, the father of logotherapy and a Holocaust survivor, opens a door to God when he talks about an unconscious God, a supra-human dimension and an unconditional faith; he defines religion as spirituality and as man's search for ultimate meaning. According to Frankl, freedom is not contradictory with God, and religion exists not because of the barbarity but in spite of the barbarity. Sartrean existentialism is a philosophy of radical freedom and responsibility. Men are condemned to be free. We are beings where the existence precedes the essence. We are completely responsible of what we are. Sartre argues that human freedom is incompatible with God. In a godless world, morality is constructed by people, with their own choices and actions, and human existence and the suffering of the victims don't have any meaning. Sartre defines man as freedom, responsibility, Angst and contingency. Frankl defines man as freedom, responsibility, spirituality and search for meaning. With this dissertation I attempt to enter in the slippery dimension of the pain, despair, meaning and meaninglessness of the victims' suffering (having in mind the horrors of Auschwitz, that in theology and in philosophy have simbolised, since the liberation of the camps, the death of God and the death of morality). It's true that not only Jewish men, women and children were victims of the German barbarity, but, as Elie Wiesel's message from the permanent exhibition from Block 27 of the Auschwitz-Birkeanu State Museum reads: "Not all victims were Jewish in this place, but all Jews were victims". The Shoah is not an episode inside War World II, but a turning point in the history of humankind, and a catastrophe that embraces us all, Jewish and not not Jewish men and women, religious and not religious, believers and not believers, as the free, responsible and moral beings that we all are –or that we should be. A lot of the victims, in the midst of their desperation, entered into the gas chambers praying, holding to the hope that their horrifying end was not the ultimate end. With this dissertation I do not attempt to answer the eternal question of the existence of God, rather, I will try to interpret that scream to God as a longing for hope. I also intend to find a coherence between the thought of these two great thinkers for whom freedom and responsibilty define man: Frankl (who argues that there is a suprahuman dimension where an ultimate meaning exists and where the victims' suffering has to have a meaning, even if this meaning is completely incomprehensible in the human dimension) and Sartre (the atheist existentialist par excellence, for whom the world, human existence and suffering are absolutely contingent). In the first chapter I expose logotherapy and Sartrean existentialism: I describe the three dimensions of man, the three searches for meaning, the five consequences of "l'existence précède l'essence" and I speak about suicide. The second chapter delves into the unconscious God, the supra-human dimension, the ultimate meaning and the unconditional faith. In the third chapter I expose the freedom without God defended by Sartre, Sartre's ontology, Sartre's atheism, Sartre's humanism, and his ideas about responsibility, mauvaise foi, contingency, situation, and Angst. The fourth chapter is necessarily historical (while being philosophical too): I wonder about the death of God after Auschwitz, I argue and defend the uniqueness of the Holocaust (the Shoah is a turning point in the history of humankind), I describe the massacres before the extermination camps (Einsatzgruppen, Ordnungspolizei y Wehrmacht), the gigantic Auschwitz camp complex (Stammlager, Auschwitz-Birkenau y Monowitz-Buna), I reflect on God and evil (focusing on the children of Auschwitz), I describe Frankl's days in Auschwitz, I talk about God as hope, about immortality and escathology, I discuss God's cruelty, the relationship between Christianity and antisemitism and Islam and antisemitism, I question the silence of God, and I talk about the death of God and about the trial against God. In the fifth chapter I talk about the Franklean morality (a morality that concerns man and not God), on the basis of his love theory and his only work of theater (Synchronisation in Binkerwald), and the Sartrean morality (a morality that concerns a humanity without God), remembering Dostoyevsky, analysing Garcin's famous quote in Huis clos "L'enfer, c'est les Autres", crticizing Sartre's marxism and questioning (with Frankl's and Sartre's eyes) Brecht's verse "Erst kommt das Fressen, dann kommt die Moral"; at the end of the chapter I include my own reflection (and Frankl and Sartre's critique) about the impunity of the executioners and collaborators after the Holocaust (with God's permission). After the Conclusion, I add an Appendix about the lives of Frankl and Sartre, which helps understanding better their work. KEYWORDS: logotherapy, existentialism, search for meaning, freedom, responsibility, morality, Angst, suffering, survivors, victims, contingency, spirituality, religion, God, hope, antisemitism, guilt, Auschwitz, Holocaust, Shoah. (shrink)

This paper is based on a criterion recently proposed by Richard Fumerton for demarcating philosophy of mind and cognitive science. I suggest to extend it to a demarcation criterion between philosophy and science in general, and put it in the context of the historical changes of boundaries between the philosophical and the scientifi c fi eld. I point to a number of philosophical claims and approaches that have been made utterly obsolete by the advancement of science, and conjecture that a (...) similar thing may happen in the future with today’s philosophy of mind: under the supposition that cognitive science manages to progress very successfully in a certain direction, our concepts for mental states could change, and the type of philosophical interest we put in them, thus reshaping thewhole debate on the subject. (shrink)

Introduction: Liposomal bupivacaine (LB) is a long-acting analgesic that, due to its liposomal formulation, purportedly extends its analgesic effect up to 72 hours. However, the clinical efficacy of LB appears mixed. This systematic review seeks to evaluate the effectiveness of liposomal bupivacaine in improving postoperative outcomes compared to ropivacaine (ROPI), another commonly used long-acting analgesic. -/- Materials and Methods: Prospective and randomized controlled trials (RCTs) evaluating the efficacy of LB compared to ROPI were selected for review. Primary outcomes included hospital (...) length of stay (LOS) and postoperative opioid consumption measured in oral morphine equivalents (OME). Secondary outcomes included analgesic cost. -/- Results: 14 studies met the review criteria. We found that LB and ROPI are equivalent in managing postoperative pain. 8 of the 14 trials reported equal efficacy between LB and ROPI as determined by OME post-procedure and 10 of the 14 trials reported similar LOS after surgery. These findings remained consistent across multiple surgical procedures and multiple drug administrative modalities. -/- Conclusion: Our systematic review found that LB was not superior to ROPI in reducing postoperative OME use and hospital LOS. The only consistent finding was the significantly increased cost of LB compared to that of ROPI. Therefore, the use of LB over ROPI cannot be justified. (shrink)

Drawing from Bakhtin and Habermas, I will show how the different voices in Gordimer's novel seem to be enacting a democratic public sphere in which no voice is granted authority over others – a public sphere which carries the promise of countering the social and political hierarchies established by the racist South African regime. The promise, however, turns out to be an illusion. As I will demonstrate, the possibility of an Enlightenment bourgeois public sphere which the novel seems to be (...) gesturing at is being irreparably undermined by racism. In a country where the Enlightenment aspiration to universalism and equality before the law are glaringly contravened by racism, Rosa Burger is painfully aware of her inability to fully access the predicament of the blacks. As such, Burger’s daughter remains only Burger’s daughter, and the children of Soweto the children of Soweto; at no point in the novel do they truly intermingle. Despite the fact that both are fighting racism – and the novel is devoted to the “coming-of-age” of both kinds of children – Rosa Burger remains only the daughter of a Bürger at the end of the novel, not the daughter of South Africa, much less to say the daughter of Black South Africa. She has finally “come into her own,” but the “self” she manages to realize is at best that of a disillusioned bourgeois individual (that of a disillusioned Bürger, so to speak) – a “self” that recalls Hegel’s “beautiful soul.” To appropriate György Lukács’s language, Bürger’s Daughter could be described as “modern bourgeois literature bear[ing] witness against bourgeois society.”. (shrink)

Theories have been formulated to address the problem of evil [“The concept of Evil”. Stanford Encyclopedia of Philosophy]. We look here at a possible origin of human evil in pre-human times by using an evolutionary scenario for self-consciousness based on identifications with conspecifics [“Proposal for an evolutionary approach to self-consciousness”. Menant 2014]. The key point is that these identifications have also taken place with suffering or endangered conspecifics, thus creating in the minds of our ancestors a huge anxiety increase, a (...) mental pain unbearable if not limited. To limit it our ancestors could have reduced the sufferings and dangers, or reduced the identification, or limited the conspecificity. Reducing the sufferings and dangers was straightforward as it also brought in evolutionary advantages (collaboration, imitation, communication, ToM, ...), with some pleasant feeling coming with the reduction of anxiety. But the two other possibilities may have produced very different outcomes. Reducing the identifications and limiting the conspecificity did reduce the mental pain and correspondingly produce some pleasure. But it has also lowered the emotional attachment to conspecifics as well as the care given to them. Conspecifics were then left alone with their sufferings. And as the process led to less mental pain, our ancestor were naturaly led to associate some pleasure to these sufferings of conspecifics. All this may have introduced in the mind of our ancestors the possibility to reduce anxiety and mental pains also by accepting and valorizing the sufferings of others, thus making evil deeds a potential source of pleasure. We propose these mechanisms as possible sources of psychology of evil in human evolution. These mechanisms now belong to our human nature where evil projects can become a means for limiting the unconscious anxiety present in our human minds. Such positioning of self-consciousness and human evil under a common evolutionary nature is new and needs more developments. Continuations are proposed. (shrink)

Why are pains bad for us? A natural answer is that it is just because of how they feel (or their felt-qualities). But this answer is cast into doubt by cases of people who are unbothered by certain pains of theirs. These pains retain their felt-qualities, but do not seem bad for the people in question. In this paper, I offer a new response to this problem. I argue that in such cases, the pains in question have become “just more (...) of the same,” and for this reason have ceased to be bad for the relevant individuals. It is because they (implicitly) recognise this that they are unbothered by such pains. (shrink)

This study used a partial least squares structural equation modelling (PLS-SEM) to estimate curriculum management's direct and indirect effects on university graduate programmes' viability. The study also examined the role of institutional effectiveness in mediating the nexus between the predictor and response variables. This is a correlational study with a factorial research design. The study's participants comprised 149 higher education administrators (23 Faculty Deans and 126 HODs) from two public universities in Nigeria. A structured questionnaire designed by the researchers (...) was used for data collection. The questionnaire was duly validated with an acceptable scale and item content validity indices. The dimensionality of the instrument was determined using exploratory factor analysis (EFA). Convergent validity was based on Average Variance Extracted (AVE), whereas discriminant validity was based on Fornell-Lacker criteria and the Hetero-Trait Mono-Trait (HTMT) ratio. Acceptable composite reliability estimates of internal consistency were reached for the three sub-scales. Following ethical practices, the questionnaire was physically administered to respondents and retrieved afterwards. Smart PLS (version 3.2.9) and SPSS (version 26.0) programs were used for all the statistical analyses. This study uncovered significant direct and indirect effects of curriculum management on the viability of graduate programmes. Institutional effectiveness significantly impacted graduate programmes’ viability while mediating the nexus between curriculum management and graduate programmes’ viability. Curriculum management and institutional effectiveness jointly explained a significant proportion of graduate programmes’ viability variance. The result of this study proved that graduate programmes’ viability depends, to a great extent, on how much curriculum is managed and how effective institutions are with their services. The result of this study can enable institutions seeking to run viable graduate programmes to re-evaluate their curriculum management practices and the effectiveness of their services. (shrink)

Pain asymbolia is a rare condition caused by brain damage, usually in adulthood. Asymbolics feel pain but appear indifferent to it, and indifferent also to visual and verbal threats. How should we make sense of this? Nikola Grahek thinks asymbolics’ pains are abnormal, lacking a component that make normal pains unpleasant and motivating. Colin Klein thinks that what is abnormal is not asymbolics’ pains, but asymbolics: they have a psychological deficit making them unresponsive to unpleasant pain. I (...) argue that an illuminating account requires elements of both views. Asymbolic pains are indeed abnormal, but they are abnormal because asymbolics are. I agree with Klein that asymbolics are incapable of caring about their bodily integrity; but I argue against him that, if this is to explain not only their indifference to visual and verbal threat, but also their indifference to pain, we must do the following: (i) take asymbolics’ lack of bodily care not as an alternative to, but as an explanation of their pains’ missing a component, and (ii) claim that the missing component consists in evaluative content. Asymbolia, I conclude, reveals not only that unpleasant pain is composite, but that its ‘hedomotive component’ is evaluative. (shrink)

Perceptualists say that having a pain in a body part consists in perceiving the part as instantiating some property. I argue that perceptualism makes better sense of the connections between pain location and the experiences undergone by people in pain than three alternative accounts that dispense with perception. Turning to fellow perceptualists, I also reject ways in which David Armstrong and Michael Tye understand and motivate perceptualism, and I propose an alternative interpretation, one that vitiates a pair (...) of objections—due to John Hyman—concerning the meaning of ‘Amy has a pain in her foot’ and the idea of bodily sensitivity. Perceptualism, I conclude, remains our best account of the location of pains. (shrink)

We suggest that pain processing has a modular architecture. We begin by motivating the (widely assumed but seldom defended) conjecture that pain processing comprises inferential mechanisms. We then note that pain exhibits a characteristic form of judgement independence. On the assumption that pain processing is inferential, we argue that its judgement independence is indicative of modular (encapsulated) mechanisms. Indeed, we go further, suggesting that it renders the modularity of pain mechanisms a default hypothesis to be (...) embraced pending convincing counterevidence. Finally, we consider what a modular pain architecture might look like, and question alleged counterevidence to our proposal. (shrink)

The paradox of pain refers to the idea that the folk concept of pain is paradoxical, treating pains as simultaneously mental states and bodily states. By taking a close look at our pain terms, this paper argues that there is no paradox of pain. The air of paradox dissolves once we recognize that pain terms are polysemous and that there are two separate but related concepts of pain rather than one.

Philosophers disagree about what the folk concept of pain is. This paper criticises existing theories of the folk concept of pain, i.e. the mental view, the bodily view, and the recently proposed polyeidic view. It puts forward an alternative proposal – the polysemy view – according to which pain terms like “sore,” “ache” and “hurt” are polysemous, where one sense refers to a mental state and another a bodily state, and the type of polysemy at issue reflects (...) two distinct but related concepts of pain. Implications with respect to issues in philosophy of pain are also drawn. (shrink)

Imperativism is the view that the phenomenal character of the affective component of pains, orgasms, and pleasant or unpleasant sensory experience depends on their imperative intentional content. In this paper I canvass an imperativist treatment of pains as reason-conferring states.

[Penultimate draft] I present the perceptualist/representationalist theories of pain in broad outline and critically examine them in light of a competing view according to which awareness of pain is essentially introspective. I end the essay with a positive sketch of a naturalistic proposal according to which pain experiences are intentional but not fully representational. This proposal makes sense of locating pains in body parts as well as taking pains as subjective experiences.

The surface grammar of reports such as ‘I have a pain in my leg’ suggests that pains are objects which are spatially located in parts of the body. We show that the parallel construction is not available in Mandarin. Further, four philosophically important grammatical features of such reports cannot be reproduced. This suggests that arguments and puzzles surrounding such reports may be tracking artefacts of English, rather than philosophically significant features of the world.

Recent work on signaling has mostly focused on communication between organisms. The Lewis–Skyrms framework should be equally applicable to intra-organismic signaling. We present a Lewis–Skyrms signaling-game model of painful signaling, and use it to argue that the content of pain is predominantly imperative. We address several objections to the account, concluding that our model gives a productive framework within which to consider internal signaling.

The paper aims at clarifying the distinctions and relations between pain and suffering. Three negative theses are defended: 1. Pain and suffering are not identical. 2. Pain is not a species of suffering, nor is suffering a species of pain, nor are pain and suffering of a common (proximate) genus. 3. Suffering cannot be defined as the perception of a pain’s badness, nor can pain be defined as a suffered bodily sensation. Three positive (...) theses are endorsed: 4. Pain and suffering are categorically distinct: pain is a localised bodily episode, suffering is a non-localised affective attitude. 5. Suffering can be expressed, pains cannot. As a consequence, we can have compassion for the suffering of others, not for their pains. 6. The relation between pain and suffering is akin to the relation between danger and fear, injustice and indignation, wrongdoing and guilt: suffering is the correct reaction to pain. One upshot is that both the influential view that the experience of pain is incorrigible and the influential view that the ordinary conception of pain is paradoxical are false. (shrink)

This is a piece written for interdisciplinary audiences and contains very little philosophy. It looks into whether, or in what sense, pains and pleasures are emotions.

It is widely held that it is only contingent that the sensation of pain is disliked, and that when pain is not disliked, it is not intrinsically bad. This conjunction of claims has often been taken to support a subjectivist view of pain’s badness on which pain is bad simply because it is the object of a negative attitude and not because of what it feels like. In this paper, I argue that accepting this conjunction of (...) claims does not commit us to this subjectivist view. They are compatible with an objectivist view of pain’s badness, and with thinking that this badness is due to its phenomenal quality. Indeed, I argue that once the full range of options is in view, the most plausible account of pain is incompatible with subjectivism about value. (shrink)

According to pure imperativism, pain experiences are experiences of a specific phenomenal type that are entirely constituted by imperative content. As their primary argument, proponents of imperativism rely on the biological role that pain experiences fulfill, namely, the motivation of actions whose execution ensures the normal functioning of the body. In the paper, I investigate which specific types of action are of relevance for an imperative interpretation and how close their link to pain experiences actually is. I (...) argue that, although imperative theories constitute an apparently promising version of strong intentionalism, they cannot provide an imperative content that meets their own criteria of both sufficiency and necessity. I further argue that this issue cannot be solved by impure imperative theories either. (shrink)

Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and (...) this state is type identical to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific 'emotion circuit', physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state. (shrink)

What is the best way to account for the badness of pain and what sort of theory of welfare is best suited to accommodate this view? I argue that unpleasant sensory experiences are prudentially bad in the absence of contrary attitudes, but good when the object of positive attitudes. Pain is bad unless it is liked, enjoyed, valued etc. Interestingly, this view is incompatible with either pure objectivist or pure subjectivist understandings of welfare. However, there is a kind (...) of welfare theory that can incorporate this view of the badness of pain and which is very, very close to being a form of subjectivism. Moreover, this hybrid account of welfare is entirely compatible with the deep motivations of subjectivism. I therefore argue that those who lean towards welfare subjectivism should adopt this account of pain, and that we should revise our understanding of subjectivism to count such theories as subjective. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is at (...) odds with this conceptualisation. By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)

This paper examines perfectionist attempts to explain the prudential badness of pain (its badness for those who experience it). It starts by considering simple perfectionist explanations, finding them wanting, before considering the most sophisticated perfectionist attempt to explain prudential badness: Gwen Bradford’s tripartite perfectionism. The paper argues that Bradford’s view, though an improvement on earlier perfectionist proposals, still does not satisfactorily explain the full set of prudentially bad pains. It ends by showing how this provides grounds for a general (...) kind of pessimism about perfectionism and the badness of pain and how this case undermines a general purported advantage of perfectionism over the objective list theory. (shrink)

Discussions concerning the modularity of the pain system have been focused on questions regarding the cognitive penetrability of pain mechanisms. It has been claimed that phenomena such as placebo analgesia demonstrate that the pain system is cognitively penetrated; therefore, it is not encapsulated from central cognition. However, important arguments have been formulated which aim to show that cognitive penetrability does not in fact entail a lack of modularity of the pain system. This paper offers an alternative (...) way to reject the modularity of the pain system, which is independent from, but consistent with, the presence of cognitive penetration. It is proposed that, given the current knowledge regarding the functioning and the structure of the pain system, there are good reasons to accept that certain central cognitive mechanisms are part of the pain system. It is argued that such a ‘cognitive constitution’ of the pain system entails that the pain system is not modular. (shrink)

The chapter revisits the relationship between restorative justice and punishment through the eyes of Classical Greek philosophy and tragedy, the School of Collectivists, and contemporary thinkers. The extant literature sees restorative justice either as alternative punishment or an alternative to punishment. This chapter puts forward the notion of restorative punishment by deconstructing the concept of pain, and by reconstructing a new vision through the notion of catharsis. The chapter then takes a bold step in proposing a philosophical framework to (...) justify the normative thinking underpinning its proposed concept of restorative punishment and pain. (shrink)

That pain and suffering are unwanted is no truism. Like the sadist, the masochist wants pain. Like sadism, masochism entails an irrational, abnormal attitude toward pain. I explain this abnormality.

Reductive representationalist theories of consciousness are yet to produce a satisfying account of pain’s affective component, the part that makes it painful. The paramount problem here is that that there seems to be no suitable candidate for what affective experience represents. This article suggests that affective experience represents the Darwinian fitness effects of events. I argue that, because of affective experience’s close association with motivation, natural selection will work to bring affect into covariance with the average fitness effects of (...) types of event, and that this covariance makes fitness effects a promising candidate for what affect represents. I also argue that this account is to be preferred to Cutter and Tye’s recent proposal that affect represents harmfulness, and answer an objection that Aydede and Fulkerson recently offered against representational accounts of affect. (shrink)

In this chapter I explore what painful art can tell us about the nature and importance of human welfare. My goal is not so much to defend a new solution to the paradox of tragedy, as it is to explore the implications of the kinds of solutions that I find attractive. Both nonhedonic compensatory theories and constitutive theories explain why people seek out painful art, but they have troublesome implications. On some narrow theories of well-being, they imply that painful art (...) is bad for us. Accordingly, we may rightly wonder if it rational for people to watch melodramas or to listen to love songs. One might think that we should generally avoid unpleasant works of art. This implication flirts with absurdity. I show how it can be avoided by making a distinction between well-being and worth. (shrink)

It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard (...) to the qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)