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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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?

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)

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)

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)

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)

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)

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)

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)

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)

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)

Children are routinely treated paternalistically. There are good reasons for this. Children are quite vulnerable. They are ill-equipped to meet their most basic needs, due, in part, to deficiencies in practical and theoretical reasoning and in executing their wishes. Children’s motivations and perceptions are often not congruent with their best interests. Consequently, raising children involves facilitating their best interests synchronically and diachronically. In practice, this requires caregivers to (in some sense) manage a child’s daily life. If apposite, this management will (...) focus partly on a child’s well-being. To be ably executed, an account of children’s well-being will need to be articulated. This chapter focuses on the nature of children’s well-being. It has five sections. The first section clarifies the focus. The second section examines some hurdles to articulating a view of children’s well-being. The third section evaluates some accounts of children’s well-being. The fourth section addresses the view that children possess features essential to them that make their lives on balance prudentially bad for them. The fifth section sums things up. (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)

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)

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)

Moralising accounts of depression include the idea that depression is a sin or the result of sin, and/or that it is the result of demonic possession which has occurred because of moral or spiritual failure. Increasingly some Christian communities, understandably concerned about the debilitating effects these views have on people with depression, have adopted secular folk psychiatry’s ‘medicalising’ campaign, emphasising that depression is an illness for which, like (so-called) physical illnesses, experients should not be held responsible. This paper argues that (...) both moralising and medicalising models of depression are intellectually and practically (pastorally and therapeutically) problematic, gesturing towards more promising emphases. (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)

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)

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)

In this paper, I sketch out a novel theory of well-being according to which well-being is constituted by harmony between mind and world. The notion of harmony I develop has three aspects. First there is correspondence between mind and world in the sense that events in the world match the content of our mental states. Second there is positive orientation towards the world, meaning that we have pro-attitudes towards the world we find ourselves in. Third there is fitting (...) response to the world. Taken together these three aspects make up an ideal of being attuned to, or at home in, the world. Such harmony between mind and world constitutes well-being. Its opposite – being disoriented, ill-at-ease in, or hostile to the world – makes a life go poorly. And, as we shall see, many of the things that intuitively contribute to well-being are instantiating one or more of the three aspects of harmony. (shrink)

Addressing the question of how medicine should engage with people who consider their clinical disease condition to be importantly constitutive of their identity, this article focuses on one group—advocates for the fat acceptance (FA) or body positivity movement in American society. Drawing on philosophical analysis, I try to show that FA and physician communities represent different traditions within the larger culture and that whether obesity should be considered a disease is a culture battle. I argue that diseases (medical) and illnesses (...) (cultural) are 2 different designations of clinical symptoms and that both disease and illness designations can change over time or be uncertain. (shrink)

Some philosophers argue that martial arts training is maladaptive, contributes to psychological illness, and provides a social harm, whereas others argue that martial arts training is adaptive, contributes to psychological wellness, and provides a social benefit. This debate is important to scholars and the general public since beliefs about martial arts training can have a real impact on how we evaluate martial artists for job opportunities and career advancement, and in general, how we treat martial artists from different cultures in (...) our communities. This debate is also important for children and adults that have considered enrolling in martial arts training programs but remain uncertain about potential outcomes of training due to the lack of research in this area. This article therefore contributes to the literature on martial arts by (1) outlining a framework that characterizes psychological well-being in terms of five elements, (2) discussing how results from empirical research support the hypothesis that Muay Thai training can contribute to psychological well-being by contributing to all five component elements, (3) discussing the psychological benefits of martial arts training from the perspective of an Everlast Master Instructor, and (4) discussing how martial arts training involves the cultivation of combat-relevant affordances. (shrink)

Luck egalitarians think that considerations of responsibility can excuse departures from strict equality. However critics argue that allowing responsibility to play this role has objectionably harsh consequences. Luck egalitarians usually respond either by explaining why that harshness is not excessive, or by identifying allegedly legitimate exclusions from the default responsibility-tracking rule to tone down that harshness. And in response, critics respectively deny that this harshness is not excessive, or they argue that those exclusions would be ineffective or lacking in justification. (...) Rather than taking sides, after criticizing both positions I also argue that this way of carrying on the debate – i.e. as a debate about whether the harsh demands of responsibility outweigh other considerations, and about whether exclusions to responsibility-tracking would be effective and/or justified – is deeply problematic. On my account, the demands of responsibility do not – in fact, they can not – conflict with the demands of other normative considerations, because responsibility only provides a formal structure within which those other considerations determine how people may be treated, but it does not generate its own practical demands. (shrink)

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical services with (...) limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession. (shrink)

In this article I aim to make progress towards the philosophical goal of ascertaining what, if anything, all mental illnesses have in common, attempting to unify a large sub-set of them that have a relational or interpersonal dimension. One major claim is that, if we want a promising theory of mental illness, we must go beyond the dominant western accounts of mental illness/health, which focus on traits intrinsic to a person such as pain/pleasure, lethargy/liveliness, fragmentation/integration, and falsehood/authenticity. A second major (...) claim is that the relational facets of mental illness are plausibly understood theoretically in terms of a person’s inability to identify with others or to exhibit solidarity with them, relational values that are salient in the African philosophical tradition. I show that these two extrinsic properties well explain several intuitive instances of mental illness, including, amongst several others, being abusive, psychopathic, narcissistic, histrionic, paranoid, and phobic. (shrink)

It often seems incorrect to say that psychiatric conditions are diseases, and equally incorrect to say that they are not. This results in what would seem to be an unsatisfactory stalemate. The present essay examines the considerations that have brought us to such a stalemate in our discussions of autism. It argues that the stalemate in this particular case is a reflection of the fact that we need to find the logical space for a position that rejects both positive and (...) negative answers. It then suggests one way in which we might find such space, by applying Michael Dummett’s notion of semantic disharmony. (shrink)

Can there be a global demos? The current debate about this topic is divided between two opposing camps: the “pessimist” or “impossibilist” camp, which holds that the emergence of a global demos is either conceptually or empirically impossible, and the “optimist” or “possibilist” camp, which holds that the emergence of a global demos is conceptually as well as empirically possible and an embryonic version of it already exists. However, the two camps agree neither on a common working definition of a (...) global demos, nor on the relevant empirical facts, so it is difficult to reconcile their conflicting outlooks. We seek to move the debate beyond this stalemate. We argue that existing conceptions of a demos are ill-suited for capturing what kind of a global demos is needed to facilitate good global governance, and we propose a new conception of a demos that is better suited for this purpose. We suggest that some of the most prominent conceptions of a demos have focused too much on who the members of a demos are and too little on what functional characteristics the demos must have in order to perform its role in facilitating governance within the relevant domain. Our new proposal shifts the emphasis from the first, “compositional” question to the second, “performative” one, and provides a more “agency-based” account of a global demos. The key criterion that a collection of individuals must meet in order to qualify as a demos is that it is not merely demarcated by an appropriate membership criterion, but that it can be organized, democratically, so as to function as a state-like agent. Compared to the existing, predominantly “compositional” approaches to thinking about the demos, this agency-based approach puts us into a much better position to assess the empirical prospects for the emergence of a global demos that can facilitate good global governance. (shrink)

Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have (...) good reason to believe that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children? (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

This paper raises a slightly uncomfortable question: are some delusional subjects responsible for their delusions? This question is uncomfortable because we typically think that the answer is pretty clearly just ‘no’. However, we also accept that self-deception is paradigmatically intentional behavior for which the self-deceiver is prima facie blameworthy. Thus, if there is overlap between self-deception and delusion, this will put pressure on our initial answer. This paper argues that there is indeed such overlap by offering a novel philosophical account (...) of self-deception. The account offered is independently plausible and avoids the main problems that plague other views. It also yields the result that some delusional subjects are self-deceived. The conclusion is not, however, that those subjects are blameworthy. Rather, a distinction is made between blameworthiness and ‘attributability’. States or actions can be significantly attributable to a subject—in the sense that they are expressions of their wills—without it being the case that the subject is blameworthy, if the subject has an appropriate excuse. Understanding delusions within this framework of responsibility and excuses not only illuminates the ways in which the processes of delusional belief formation and maintenance are continuous with ‘ordinary’ processes of belief formation and maintenance, it also provides a way of understanding the innocence of the delusional subject that does not involve the denial of agency. (shrink)

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has (...) the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care. (shrink)

When are we morally obligated as a society to help the homeless, and is coercive interference justified when help is not asked for, even refused? To answer this question, we propose a comprehensive taxonomy of different types of homelessness and argue that different levels of autonomy allow for interventions with varying degrees of pressure to accept help. There are only two categories, however, where paternalism proper is allowed, be it heavily qualified. The first case is the homeless person with severely (...) diminished autonomy as a result of mental illness, and the second case is the homeless person who runs a risk of serious and imminent harm to self. In the first case, namely, that of soft paternalism, we argue that coercive intervention in the case of a refusal to accept help should be focused on the provision of housing that meets basic needs—needs that we outline in the article. In the case of imminent and severe harm to self, the case of hard paternalism, we argue that forced intervention can only be allowed if it is temporary and local, namely focused on getting someone out of harm’s way. (shrink)

Our philosophical understanding of mental illness is being shaped by neuroscience. However, it has the paradoxical effect of igniting two radically opposed groups of philosophical views. On one side, skepticism and denialism assume that, lacking clear biological mechanisms and etiologies for most mental illnesses, we should infer they are constructions best explained by means of social factors. This is strongly associated with medical nihilism: it considers psychiatry more harmful than benign. On the other side of the divide, naturalism and (...) reductionism are on the look for failures in the biological functioning of the organism whenever a genuine mental illness occurs. Psychiatry as currently practiced, accordingly, exhibits the gaps of an ongoing research programme; a yet to be completed neuroscience would link mental illnesses with identifiable biological mechanisms. Both sides of this divide claim to be fostered by scientific discoveries and advances in neuroscience, when taken at face value. Against this background, we argue instead for a modest view. To that end, we draw attention to some nuances in the scientific realism debate. While contending that neuroscientific theories and models aim to provide true representations of their target systems, and can justifiably claim to have attained some, we argue that our confidence should not be placed beforehand in specific features of these scientific representations. Hence, it would be unwarranted to extract morals for psychiatry from posits (or their absence) in neuroscientific explanations of mental illnesses. To illustrate our position, we examine some recent discoveries in neuroscience concerning bipolar disorder. We conclude by linking our topic to a broader issue in the philosophy of medicine: insofar as psychiatry is a biomedical specialty, its classifications of health and disease are guided by pragmatic concerns, as well as by scientific discoveries. (shrink)

This paper explores the position that moral enhancement interventions could be medically indicated in cases where they provide a remedy for a lack of empathy, when such a deficit is considered pathological. In order to argue this claim, the question as to whether a deficit of empathy could be considered to be pathological is examined, taking into account the difficulty of defining illness and disorder generally, and especially in the case of mental health. Following this, Psychopathy and a fictionalised mental (...) disorder are explored with a view to consider moral enhancement techniques as possible treatments for both conditions. At this juncture, having asserted and defended the position that moral enhancement interventions could, under certain circumstances, be considered medically indicated, this paper then goes on to briefly explore some of the consequences of this assertion. First, it is acknowledged that this broadening of diagnostic criteria in light of new interventions could fall foul of claims of medicalisation. It is then briefly noted that considering moral enhancement technologies to be akin to therapies in certain circumstances could lead to ethical and legal consequences and questions, such as those regarding regulation, access, and even consent. (shrink)

The philosophical literature on reasoning is dominated by the assumption that reasoning is essentially a matter of following rules. This paper challenges this view, by arguing that it misrepresents the nature of reasoning as a personal level activity. Reasoning must reflect the reasoner’s take on her evidence. The rule-following model seems ill-suited to accommodate this fact. Accordingly, this paper suggests replacing the rule-following model with a different, semantic approach to reasoning.

Very plausibly, there is something important missing in our lives if we are thoroughly ignorant or misled about reality – even if, as in a kind of Truman Show scenario, intervention or fantastic luck prevents unhappiness and practical failure. But why? I argue that perfectionism about well-being offers the most promising explanation. My version says, roughly, that we flourish when we exercise our self-defining capacities successfully according to their constitutive standards. One of these self-defining capacities, or capacities whose exercise (...) reveals who we are, is Reason, our capacity for normative self-governance. I argue that in its practical use, Reason formally aims at competently realizing self-chosen valuable ends that are in harmony with each other, or valuable achievements. In its theoretical use, it formally aims at competently grasping fundamental enough subject matters, or a kind of understanding. Because success by reason’s own standards requires many things to go right, there are many different ways in which we can fall short. Some of them amount to partial success. But some, like incompetent inquiry that fails to yield understanding of its target, or taking inefficient means to a worthless end, are robust failures that amount to epistemic or agential unflourishing, and thus to a form of ill-being. (shrink)

Open Access: Social media participation undermines individual autonomy in ways that ought to concern ethicists. Discussions in the philosophical literature are concerned primarily with egregious conduct online such as harassment and shaming, keeping the focus on obvious ills to which no one could consent; this prevents a wider understanding of the risks and harms of quotidian social media participation. Two particular concerns occupy me: social media participation carries the risks of (1) negatively formative experiences and (2) continuous partial attention due (...) to our habituation to the variable rewards that social media platforms provide. Although social media offer benefits as well as risks, self-knowledge of whether one benefits more than one suffers from one’s social media participation is vexed by the very processes involved in participating. We are not as free to leave social media as we are to enter. I conclude with a consideration and rejection of the objections that the ubiquity of the practice indicates implied consent to risks, and that users of social media can simply choose not to use such communication technologies at all. I argue that we cannot be said to consent to enter into social media usage meaningfully, even implicitly, and we do not all have equally easy options to avoid the contexts that provide the stimuli of persistent desires. (shrink)

Theories of well-being that give an important role to satisfied pro-attitudes need to account for the fact that, intuitively, the scope of possible objects of pro-attitudes seems much wider than the scope of things, states, or events that affect our well-being. Parfit famously illustrated this with his wish that a stranger may recover from an illness: it seems implausible that the stranger’s recovery would constitute a benefit for Parfit. There is no consensus in the literature about how to (...) rule out such well-being-irrelevant pro-attitudes. I argue, first, that there is no distinction in kind between well-being-relevant and irrelevant pro-attitudes. Instead, well-being-irrelevant pro-attitudes are the limiting cases on the scale measuring how much of a difference pro-attitudes make to the subject’s well-being. Second, I propose a particular scalar model according to which the well-being-relevance of pro-attitudes is measured by either their hedonic tone, or by the subject’s conative commitment. (shrink)