It is largely unethical to sentence individuals who are addicted to drugs to prison. While substance use can be a crime, it must be treated differently from other crimes because addiction is a psychiatric disorder. Prisons are penal institutions. Legitimate goals of penal sanctions include retribution, deterrence, rehabilitation, and incapacitation.[i] Most of these goals do not speak to those with substance use disorder, and incarceration may be counterproductive given the wide availability of drugs and feeble rehabilitation efforts in (...) prison. Further, it may be the case that substance use disorder impairs an addict’s autonomy, calling into question his criminal culpability. Our understanding of substance use disorder has evolved and our prison sentencing practices must do the same. This paper will first provide background on substance use disorder as a psychiatric disorder. Then, the need to focus on rehabilitating rather than punishing those with substance use disorder who commit crimes will be explored. Finally, this paper will address whether an individual with substance use disorder can be considered culpable for any crime—regardless of severity—and whether that individual’s autonomy is impaired due to his addiction. I conclude that culpability should depend on whether the serious crime would have occurred in the absence of the drug addiction. In most cases, it is unethical to sentence an individual with substance use disorder to prison where other options such as home confinement are available. (shrink)

This review aimed at exploring the psychosocial disorders of Nigeria as a nation, its effect on the citizens and the remedy. Psychosocial disorder is a mental illness induced by life experiences, stress, as well as maladaptive cognitive and behavioural processes. The prevalence of these disorders include depression, schizophrenia, anxiety disorders, substance use disorder, personality disorder and autism spectrum disorders have rapidly increase over the past years in Nigeria with its negative impact on the socioeconomic status, (...) psychological well-being; peaceful coexistence and mental health of the entire society. These have precipitated some social anomalies such as bribery and corruption, antisocial behaviour, religious fanaticism, terrorism and so on. The study therefore recommends the need for government to implement effective mental health interventions program that would facilitate easy access to mental healthcare services in Nigeria. There is also an urgent need to improve the mental health awareness of Nigerians through education and public mental health campaign. (shrink)

Since the dawn of the internet, pornography has effectively become ubiquitous, pervasive, and increasingly normalised. Study findings show remarkable similarities in how the brain reacts to pornography, and other known addictive substances, and indicate that consuming pornography is comparable to consuming other known addictive substances. Moreover, two of the biggest risk factors for addiction are the substance’s availability and its easy accessibility, particularly in the case of younger persons. To date, pornography addiction has been conceptualised as a behavioural addiction. (...) However, the body of research data on pornography addiction does not provide conclusive support for behavioural addiction. The aim of this thesis is to put forward the idea that pornography can, and should, be conceptualised as an addictive substance, and, that when pornography is consumed, an addictive substance is consumed. In order to support this claim, there are many factors that must be addressed. I first clarify what pornography entails by exploring how it is conceptualised, what pornography ‘does’, and what it means to be a pornography consumer. Secondly, I examine the conceptualisations of substances, substance consumption and addiction, respectively, as well as the subsequent difference between substance and behavioural addiction. Thirdly, I give an inclusive overview of pornography addiction by not only examining the most recent perspectives of researchers, but also of pornography consumers. I conclude by suggesting how we should go about conceptualising pornography addiction, and then propose how the set of diagnostic criteria for pornography use disorder should be formulated for a future iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. I argue that, given the abundance of academic research on substance addiction, compared to the scarcity of research on behavioural addiction, conceptualising pornography as an addictive substance is more likely to create a sense of urgency for the future research of pornography addiction than would be the case if it is considered a potential behavioural addiction. Furthermore, I argue that the classification of pornography as an addictive substance, and the inclusion of pornography use disorder in a future iteration of the DSM, will raise awareness of the potential adverse effects of pornography consumption and, therefore, the harmful consequences of pornography use disorder. (shrink)

Anorexia nervosa is an eating disorder characterized by very restrictive eating or dieting leading to weight loss, a fear of weight gain, and a distorted body image. Several physiological mechanisms and behaviors that maintain and worsen symptoms of anorexia have addictive qualities that parallel that of substance use disorder. Similarities between anorexia nervosa and substance use disorder are explored, including other relevant diagnoses and phenomenons like reward deficiency syndrome. Related mechanisms and behaviors associated with anorexia and substance (...) use disorder include compulsion, the detrimental continuation of maladaptive behaviors, impaired control, and disorder-related changes in neurology. Conceptualizing anorexia nervosa as an addiction could assist in creating effective treatments for this disorder. (shrink)

In this paper, I examine Reinforcement Learning modelling practice in psychiatry, in the context of alcohol use disorders. I argue that the epistemic roles RL currently plays in the development of psychiatric classification and search for explanations of clinically relevant phenomena are best appreciated in terms of Chang’s account of epistemic iteration, and by distinguishing mechanistic and aetiological modes of computational explanation.

Prior research has demonstrated that antisocial behavior, substance-use disorders, and personality dimensions of aggression and impulsivity are indicators of a highly heritable underlying dimension of risk, labeled externalizing. Other work has shown that individual trait constructs within this psychopathology spectrum are associated with reduced self-monitoring, as reflected by amplitude of the error-related negativity (ERN) brain response. In this study of undergraduate subjects, reduced ERN amplitude was associated with higher scores on a self-report measure of the broad externalizing construct (...) that links these various indicators. In addition, the ERN was associated with a response-locked increase in anterior theta (4–7 Hz) oscillation; like the ERN, this theta response to errors was reduced among high-externalizing individuals. These findings suggest that neurobiologically based deficits in endogenous action monitoring may underlie generalized risk for an array of impulse-control problems. (shrink)

Currently there is such a cornucopia of conflicting theories in the field of addiction studies that it has become exceedingly difficult for treatment providers, therapists, and policymakers to integrate this vast field of knowledge into effective treatment. Since such a chaotic overabundance of treatment theories, styles, and definitions cloud the field of addictionology, many therapists claim their field is in need of a paradigm shift. In the last 20 years an integrative and compound model has emerged known as the biopsychosocial (...) model, but without a solid and comprehensive meta-framework, syncretistic confusion can result when therapists pick and choose techniques without direction or an overall rationale. To address this problem, Guy du Plessis applies integral theory as a conceptual framework for understanding addiction, as well as a meta-therapeutic framework for therapists. The integral foundation of addiction outlined in this book provides researchers, academics, treatment providers, policy makers, and therapists with a conceptual architectonic of addiction and its treatment that is integrative, inclusive, and practical. An Integral Foundation for Addiction Treatment belongs on the shelf of every addiction treatment therapist, and anyone else who is impacted or influenced by the topic. (shrink)

In my presentation I argue for the utility of a philosophical counseling method, called logic-based therapy (LBT), in the treatment of addicted populations. In the context of addiction treatment LBT could be also classified as a philosophical psychotherapy. Philosophical psychotherapy can be understood as an umbrella term for interventions designed to treat mental health disorders, with theoretical foundations that are philosophical. Philosophical psychotherapy would be distinct from philosophical counseling, as the latter does not directly treat mental health disorders. (...) I suggest that LBT has utility beyond philosophical counseling and is a viable intervention in the treatment of certain mental health disorders, like substance use disorders. I provide a brief overview of LBT and then discuss a LBT case study with a client suffering diagnosed with a substance use disorder. In the case study the client was advised to apply the moral philosophy of Friedrich Nietzsche as an uplifting philosophical framework to counteract his unproductive worldview and fallacious thinking. Considering that there is an ostensibly low efficacy rate for the treatment of addiction, articulating the value of philosophical psychotherapies in the context of addiction treatment can assist in the development of novel philosophically-based addiction treatment and recovery-oriented programs––thus expanding the treatment and recovery options available for those seeking recovery from addiction. (shrink)

In this essay I explore the notion of philosophy as a way of life as a recovery pathway for individuals in addiction recovery. My hypothesis is that philosophy as a way of life can be a compelling, and legitimate recovery pathway for individuals in addiction recovery, as one of many recovery pathways. I will focus on logic-based therapy applied in the context of addiction recovery. The aim of presenting a case study is to show how a client receiving LBT is (...) provided with techniques and a worldview that can contribute to a philosophically oriented recovery program. In the case study the client was advised to apply the moral philosophy of Friedrich Nietzsche as an uplifting philosophical framework to counteract his unproductive worldview and fallacious thinking. Considering that there is an ostensibly low efficacy rate for the treatment of addiction, articulating the value of philosophy as a way of life as a recovery pathway provides a conceptual and methodological framework for the development of novel philosophically-based addiction treatment and recovery-oriented programs—thus expanding the treatment and recovery options available for those seeking recovery from addiction. (shrink)

This article outlines an integrally informed model for addictionon treatment and recover that is being pioneered and developed at Tabankulu Secondary Addiction Recovery Center in Cape Town, South Africa. Tabankulu is the world’s first inpatient Addictionon treatment center to implement an integrally informed treatment model. The Integrated Recovery model is a comprehensive, balanced, multi-phased, and multi-disciplinary approach to the treatment of and recovery from addiction. Its philosophy is derived from integrang a 12 Step abstinence-based methodology, mindfulness-based interventions, positive psychology, and (...) Integral Theory. The case is made that addictionon treatment facilities, therapists working with this population, and recovering addicts will become more proficient, effective, and consequently have higher success rates by becoming integrally informed. (shrink)

Abstract This article proposes and outlines an integrally informed 12 Step-based therapy that is adapted for treating addicted populations. Integrated Recovery Therapy (IRT) as a therapeutic orientation is an Integral Methodological Pluralism to therapy for treating addiction. Its two main features are paradigmatic and meta-paradigmatic. The paradigmatic aspect refers to the recognition, compilation and implementation of various methodologies in a comprehensive and inclusive manner. The meta-paradigmatic aspect refers to IRT’s capacity to weave together, relate and integrate the various paradigmatic practices. (...) IRT is a meta-therapy derived from the Integrated Recovery Model, which is a comprehensive, balanced, multi-phased and multi-disciplinary clinical model designed for in-patient addiction treatment. As with the Integrated Recovery Model, IRT’s philosophy is derived from an integration of the 12-step abstinence-based philosophy, mindfulness, positive psychology, and Integral theory. It is suggested here that the application of IRT as a meta-therapy provides a truly comprehensive and integrated therapeutic orientation for therapists who treat addicted populations. -/- Keywords: Integrated Recovery Therapy, Integrated Recovery model; 12 Steps; mindfulness; Integral theory; positive psycholog. (shrink)

In this paper I discuss the role played by Ernst Mach on Nietzsche’s thought. Starting from the contents of his Beiträge zur Analyse der Empfindungen, I’ll show the close similarities between their view on both human knowledge and the scientific world description. In his writing on science Nietzsche shares Mach’s critique to the 19th century mechanism and its metaphysical ground, as much as his way of defining the substantial notions such as matter, ego and free will. Moreover, my investigation will (...) make it clear that Mach cannot be seen as a direct source of Nietzsche’s thought, since the latter wrote many times on the same subjects long before his first reading one of his works. Rather, it is possible to consider the writings of Lange, Spir and Spencer as the first sources of Nietzsche’s views on the main themes Mach dealt with in his work from 1886. (shrink)

This paper discusses different frameworks for understanding imagination and metaphor in the context of research on the imaginative skills of children with autism spectrum disorder (ASD). In contrast to a standard linguistic framework, it advances an embodied and enactive account of imagination and metaphor. The paper describes a case study from a systemic therapeutic session with a child with ASD that makes use of metaphors. It concludes by outlining some theoretical insights into the imaginative skills of children with ASD that (...) follow from taking the embodied-enactive perspective and proposes suggestions for interactive interventions to further enhance imaginative skills and metaphor understanding in children with ASD. (shrink)

In this paper, I consider particular attempts by E. J. Lowe and Michael Gorman at providing an independence criterion of substancehood and argue that the stipulative exclusion of non-particulars and proper parts (or constituents) from such accounts raises difficult issues for their proponents. The results of the present discussion seem to indicate that, at least for the case of composite entities, a unity criterion of substancehood might have at least as much, and perhaps more, to offer than an independence criterion (...) and therefore ought to be explored further by neo-Aristotelians in search of a defensible notion of substancehood. I indicated briefly how such a unity criterion might be used by neo-Aristotelians to support the inclusion of hylomorphic compounds in the category of substance, given the traditional role of form as the principle of unity within the compound. (shrink)

This paper explores the possibility of AI-based addendum therapy for borderline personality disorder, its potential advantages and limitations. Identity disturbance in this condition is strongly connected to self-narratives, which manifest excessive incoherence, causal gaps, dysfunctional beliefs, and diminished self-attributions of agency. Different types of therapy aim at boosting self-knowledge through self-narratives in BPD. The suggestion of this paper is that human-to-human therapy could be complemented by AI assistance holding out the promise of making patients' self-narratives more coherent through improving the (...) accuracy of their self-assessments, reflection on their emotions, and understanding their relationships with others. Theoretical and pragmatic arguments are presented in favour of this idea, and certain technical solutions are suggested to implement it. (shrink)

‘Substance’ (substantia, zelfstandigheid) is a key term of Spinoza’s philosophy. Like almost all of Spinoza’s philosophical vocabulary, Spinoza did not invent this term, which has a long history that can be traced back at least to Aristotle. Yet, Spinoza radicalized the traditional notion of substance and made a very powerful use of it by demonstrating – or at least attempting to demonstrate -- that there is only one, unique substance -- God (or Nature) -- and that all (...) other things are merely modes or states of God. Some of Spinoza’s readers understood these claims as committing him to the view that only God truly exists, and while this interpretation is not groundless, we will later see that this enticing and bold reading of Spinoza as an ‘acosmist’ comes at the expense of another audacious claim Spinoza advances, i.e., that God/Nature is absolutely and actually infinite. But before we reach this last conclusion, we have a long way to go. So, let me first provide an overview of our plan. In the first section of this paper we will examine Spinoza’s definitions of ‘substance’ and ‘God’ at the opening of his magnum opus, the Ethics. Following a preliminary clarification of these two terms and their relations to the other key terms defined at the beginning of the Ethics, we will briefly address the Aristotelian and Cartesian background of Spinoza’s discussion of substance. In the second section, we will study the properties of the fundamental binary relations pertaining to Spinoza’s substance: inherence, conception, and causation. The third section will be dedicated to a clarification of Spinoza’s claim that God, the unique substance, is absolutely infinite. This essential feature of Spinoza’s substance has been largely neglected in recent Anglo-American scholarship, a neglect which has brought about an unfortunate tendency to domesticate Spinoza’s metaphysics to more contemporary views. The fourth section will study the nature of Spinoza’s monism. It will discuss and criticize the interesting yet controversial views of the eminent Spinoza scholar, Martial Gueroult, about the plurality of substances in the beginning of the Ethics; address Spinoza’s claim in Letter 50 that, strictly speaking, it is improper to describe God as “one”; and, finally, evaluate Spinoza’s kind of monism against the distinction between existence and priority monism recently introduced into the contemporary philosophical literature. The fifth and final section will explain the nature, reality, and manner of existence of modes. We therefore have an ambitious plan; let’s get down to business. (shrink)

This paper will set out in plain language the basic ontology of “Deleuze’s Spinoza”; it will then critically examine whether such a Spinoza has, or indeed could have, ever truly existed. In this, it will be shown that Deleuze’s reading of Spinoza involves the imposition of three interlocking, formal principles. These are (1) Necessitarianism, (2) Immanence, and (3) Univocity. The uncovering of Deleuze’s use of these three principles, how they relate to one another, and what they jointly imply in terms (...) of ontology, will occupy Part 1 of this paper. The critique of these principles from a Spinozist perspective, i.e. that their use by Deleuze is incompatible with Spinoza’s own metaphysics, will occupy Part 2 of this paper. (shrink)

I begin by arguing that, for Kant, the pure category of substance has both a general content that is in play whenever we think of any entity as a substance as well as a more specific content that arises in conjunction with the thought of what Kant calls a positive noumenon. Drawing on this new “Dual Content” account of the pure category of substance, I offer new answers to two contested questions: What is the relation of the (...) pure category to phenomenal substance? What, if any, epistemic gains can we achieve when we apply the pure category to noumena? Regarding the first question, I argue that while phenomenal substance does not qualify as a substance according to the Inner-Simple Conception, it does qualify as one according to the Subsistence-Power Conception. Regarding the second question, I argue that, in the case of the substantiality of positive noumena, Kant’s account allows for justified conditional beliefs involving the Inner-Simple Conception. In the case of negative noumena, it allows for justified existential beliefs involving the Subsistence-Power Conception. (shrink)

Psychedelics are currently being studied intensively for the treatment of various psychiatric disorders. Ayahuasca, a plant-based extract originating from the Amazonian area, is traditionally consumed in ritualistic group events. The related indigenous traditions date back hundreds of years and have amassed vast amounts of knowledge on the therapeutic use of psychedelic and non-psychedelic plant-based substances. -/- These traditions require a prospective ceremony facilitator to undergo years of intensive training to acquire knowledge, mental power or self-confidence, stability, sensitivity, intuitive treatment (...) outcome prediction skills, musical skills, and sufficient physical strength. These qualities of a facilitator, in the presence of integrity and love, largely determine treatment outcomes. -/- In Europe, predominantly in the first decade of the 2000s and in the early 2010s, some individuals began building connections with diverse indigenous groups and syncretic churches of the Amazonia in an attempt to find cures for their treatment-resistant psychiatric conditions. Small circles of other patients in need of similar treatment formed around them. This led to the formation of decentralized, diverse local ceremony cultures that either followed the principles of the traditional lineages of their origin or synthesized various influences. -/- These unofficial ceremony contexts appeared to complement official healthcare systems, offering efficient methods unavailable in the medical context and correcting the consequences of medical malpractice and neglect. These ceremony contexts appeared highly communal, were largely based on volunteering, and contained mechanisms for self-correcting possible emerging issues. They seemed to function as systems for collecting, preserving, storing, and distributing knowledge of psychedelic therapy methods; in other words, systems for knowledge base building and innovation. -/- doi: 10.13140/RG.2.2.27385.85602. (shrink)

In this book, Yitzhak Y. Melamed offers a new and systematic interpretation of the core of Spinoza’s metaphysics. In the first part of the book, he proposes a new reading of the metaphysics of substance in Spinoza. Against Curley's influential reading, he argues that for Spinoza modes both inhere in and are predicated of God. Using extensive textual evidence, he shows that Spinoza considered modes to be God's propria. Against the claim that it is a category mistake to consider (...) things as properties, he argues that the distinction between things and properties has been thoroughly undermined both in the early modern period and in contemporary metaphysics (in bundle theories, and some versions of trope theory). He goes on to clarify Spinoza’s understanding of infinity, mereological relations, infinite modes, and the flow of finite things from God’s essence. In the second part of the book, Melamed relies on this interpretation of the substance-mode relation and the nature of infinite modes and puts forward two interrelated theses about the structure of the attribute of Thought and its overarching role in Spinoza's metaphysics. First, he shows that Spinoza had not one, but two independent doctrines of parallelism. The Ideas-Things Parallelism stipulates an isomorphism between the order of ideas in the attribute of Thought and the order of things in nature. The Inter-Attributes Parallelism establishes an isomorphism among the order of modes in each of the infinitely many attributes. He shows that these two doctrines are independent of each other and that each has different implications. Relying on this clarification of the doctrines of parallelism, Melamed develops his final main thesis. Here he argues that, for Spinoza, ideas have a multifaceted (in fact, infinitely faceted) structure that allows one and the same idea to represent the infinitely many modes which are parallel to it in the infinitely many attributes. Thought turns out to be coextensive with the whole of nature. Spinoza cannot embrace an idealist reduction of Extension to Thought because of his commitment to the conceptual separation of the attributes. Yet, within Spinoza's metaphysics, Thought clearly has primacy over the other attributes insofar as it is the only attribute which is as elaborate, as complex, and, in some senses, as powerful as God. (shrink)

Yitzhak Melamed here offers a new and systematic interpretation of the core of Spinoza's metaphysics. In the first part of the book, he proposes a new reading of the metaphysics of substance in Spinoza: he argues that for Spinoza modes both inhere in and are predicated of God. Using extensive textual evidence, he shows that Spinoza considered modes to be God's propria. He goes on to clarify Spinoza's understanding of infinity, mereological relations, infinite modes, and the flow of finite (...) things from God's essence. In the second part of the book, Melamed relies on this interpretation of the substance-mode relation and the nature of infinite modes and puts forward two interrelated theses about the structure of the attribute of Thought and its overarching role in Spinoza's metaphysics. First, he shows that Spinoza had not one, but two independent doctrines of parallelism. Then, in his final main thesis, Melamed argues that, for Spinoza, ideas have a multifaceted structure that allows one and the same idea to represent the infinitely many modes which are parallel to it in the infinitely many attributes. Thought turns out to be coextensive with the whole of nature. Spinoza cannot embrace an idealist reduction of Extension to Thought because of his commitment to the conceptual separation of the attributes. Yet, within Spinoza's metaphysics, Thought clearly has primacy over the other attributes insofar as it is the only attribute which is as elaborate, as complex, and, in some senses, as powerful as God. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of mistaken moral (...) self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

In his “Farewell to Substance: A Differentiated Leave-Taking”, Peter Simons reaches the provocative conclusion that the concept of substance, as it is employed by metaphysicians, has become obsolete, since in the end there may be nothing at all which answers to it. No harm is done, Simons allows, if we continue to retain an everyday notion of substance, as long as we are aware of the limitations of this practice: there is no reason in general to expect (...) that what is salient from our specifically human point of view will retain a special place in light of our most considered scientific and metaphysical theories of the world. In this paper, I argue that, contrary to Simons’ pessimistic outlook, the concept of substance continues to retain its importance for metaphysics. Among the primary explanatory roles played by the concept of substance in metaphysics is its use in designating certain kinds of entities as occupying a privileged position relative to a particular ontology. But disputes over substancehood can also target the criteria themselves relative to which an ontologically privileged position is awarded to certain taxonomic categories. In these uses, we see the concept of substance employed in an absolute, a relational and a comparative sense, to designate items as substances simpliciter, as the substances of something else, or as more or less deserving of substance status. (shrink)

The mental risk poses a high threat to the individuals, especially overseas demographic, including expatriates in comparison to the general Arab demographic. Since Arab countries are renowned for their multicultural environment with half of the population of students and faculties being international, this paper focuses on a comprehensive analysis of mental health problems such as depression, stress, anxiety, isolation, and other unfortunate conditions. The dataset is developed from a web-based survey. The detailed exploratory data analysis is conducted on the dataset (...) collected from Arab countries to study an individual’s mental health and indicative help-seeking pointers based on their responses to specific pre-defined questions in a multicultural society. The proposed model validates the claims mathematically and uses different machine learning classifiers to identify individuals who are either currently or previously diagnosed with depression or demonstrate unintentional “save our souls” (SOS) behaviors for an early prediction to prevent risks of danger in life going forward. The accuracy is measured by comparing with the classifiers using several visualization tools. This analysis provides the claims and authentic sources for further research in the multicultural public medical sector and decision-making rules by the government. (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)

Aims: The Research Diagnostic Criteria for Temporomandi¬bular Disorders (RDC/TMD) Axis I diagnostic algorithms were demonstrated to be reliable but below target sensitivity and specificity. Empirical data supported Axis I algorithm revisions that were valid. Axis II instruments were shown to be both reliable and valid. An international consensus workshop was convened to obtain recommendations and finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: A comprehensive search of published TMD diagnostic literature was followed by review (...) and consensus via a formal structured process by a panel of experts for revision of the RDC/TMD. Results: The recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for pain diagnoses and valid criteria for the most common pain-related TMDs and for one intra-articular disorder. The Axis II protocol retains selected RDC/TMD screening instruments augmented with new instruments to better assess the interactions between pain and psychosocial functioning. A comprehensive classification system is also presented. Conclusion: The recommended evidence-based DC/TMD protocol is appropriate for use in both the clinical and research settings. Simple Axis I and II screening tests augmented by validated Axis I and Axis II instruments allow for identification of simple to complex TMD patients. (shrink)

Aphantasia is a condition characterised by a deficit of mental imagery. Since several psychopathologies are partially maintained by mental imagery, it may be illuminating to consider the condition against the background of psychological disorder. After outlining current findings and hypotheses regarding aphantasia and psychopathology, this paper suggests that some support for defining aphantasia as a lack of voluntary imagery may be found here. The paper then outlines potentially fruitful directions for future research into aphantasia in general and its relation to (...) psychopathology in particular, including rethinking use of the SUIS to measure involuntary imagery, whether aphantasia offers protection against addiction, and whether hyperphantasia is a potential risk factor for maladaptive daydreaming, among others. (shrink)

William Smith’s recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith’s argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act was created. This (...) reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy. (shrink)

Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful in his harmful dysfunction analysis. Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield’s HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. For instance, one (...) can conceive of cases where simultaneous disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder. I argue that the sense of harm that Wakefield should employ in the HDA is dispositional, similar to the sense of harm used when describing a vile of poison: “Be careful! That’s poison. It’s harmful.” I call this harm in the damage sense. Using this sense of harm enables the HDA to avoid Feit’s arguments, and thus it should be preferred to other senses when analyzing harmful dysfunction. (shrink)

‘Substance’ (substantia, zelfstandigheid) is a key term of Spinoza’s philosophy. Like almost all of Spinoza’s philosophical vocabulary, Spinoza did not invent this term, which has a long history that can be traced back at least to Aristotle. Yet, Spinoza radicalized the traditional notion of substance and made a very powerful use of it by demonstrating – or at least attempting to demonstrate -- that there is only one, unique substance -- God (or Nature) -- and that all (...) other things are merely modes or states of God. Some of Spinoza’s readers understood these claims as committing him to the view that only God truly exists, and while this interpretation is not groundless, we will later see that this enticing and bold reading of Spinoza as an ‘acosmist’ comes at the expense of another audacious claim Spinoza advances, i.e., that God/Nature is absolutely and actually infinite. But before we reach this last conclusion, we have a long way to go. So, let me first provide an overview of our plan. In the first section of this paper we will examine Spinoza’s definitions of ‘substance’ and ‘God’ at the opening of his magnum opus, the Ethics. Following a preliminary clarification of these two terms and their relations to the other key terms defined at the beginning of the Ethics, we will briefly address the Aristotelian and Cartesian background of Spinoza’s discussion of substance. In the second section, we will study the properties of the fundamental binary relations pertaining to Spinoza’s substance: inherence, conception, and causation. The third section will be dedicated to a clarification of Spinoza’s claim that God, the unique substance, is absolutely infinite. This essential feature of Spinoza’s substance has been largely neglected in recent Anglo-American scholarship, a neglect which has brought about an unfortunate tendency to domesticate Spinoza’s metaphysics to more contemporary views. The fourth section will study the nature of Spinoza’s monism. It will discuss and criticize the interesting yet controversial views of the eminent Spinoza scholar, Martial Gueroult, about the plurality of substances in the beginning of the Ethics; address Spinoza’s claim in Letter 50 that, strictly speaking, it is improper to describe God as “one”; and, finally, evaluate Spinoza’s kind of monism against the distinction between existence and priority monism recently introduced into the contemporary philosophical literature. The fifth and final section will explain the nature, reality, and manner of existence of modes. We therefore have an ambitious plan; let’s get down to business. (shrink)

Descartes maintained substance dualism, the thesis that no substance has both mental and material properties. His main argument for this thesis, the so-called separability argument from the Sixth Meditation (AT VII: 78) has long puzzled readers. In this paper I argue that Descartes’ independence conception of substance (which Descartes presents in article 51 of the Principles) is crucial for the success of the separability argument and that Descartes used this conception of substance to defend his argument (...) for substance dualism from an important objection. (shrink)

Recent evidence shows significant potential for therapies involving psychedelic substances such as psilocybin and MDMA to improve clinical outcomes for patients experiencing various mental disorders. However, research to date focuses almost exclusively on adults. I argue that adolescents should be included in research into psychedelic therapies. First, I demonstrate the pressing need for novel interventions to address the growing mental health burden of adolescents, and I draw on empirical evidence to show that research into psychedelic therapies presents an opportunity (...) to address this shortfall. Secondly, I argue that psychedelics pose low risk to young patients, particularly relative to existing psychiatric medications. I then address two major concerns specific to adolescent contexts. First, I address the risks of using psychedelic substances at earlier stages of physiological and cognitive development. I note that the lack of understanding of the risks underscores the need for including adolescents in research. I then address the added complexity of consent in the adolescent context. I highlight some additional concerns that should be addressed in an “enhanced” informed consent process for adolescents and defend the view that capable adolescents should be able to consent to psychedelic interventions. I ultimately hold that including adolescents in emerging psychedelic research has the potential to substantiate innovative treatments that could improve their clinical outcomes, long-term mental health and quality of life. (shrink)

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we (...) discuss the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

According to the theory of intrinsic value and moral standing known as the “substance view,” all human beings have intrinsic value, full moral standing and, with these, a right to life. The substance view has been defended by numerous contemporary philosophers who use the theory to argue that the standard human fetus has a right to life and, ultimately, that abortion is prima facie seriously wrong. In this paper, I identify three important errors committed by some of these (...) philosophers in their defense of the theory---what I refer to as the “extratheoretical-proposition error,” “quantitative-differences error,” and “non-normative-answer error”---and conclude that these errors render their defense inadequate. (shrink)

This paper argues that Spinoza held substances other than God to be inconceivable. It uses this claim to develop a novel response to the Problem of Other Substances, the problem of explaining why some of Spinoza’s proofs for God’s existence cannot be used to prove the existence of a non-divine substance instead.

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to go (...) a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

Autism spectrum disorder is characterised by differences in unimodal and multimodal sensory and proprioceptive processing, with complex biases towards local over global processing. Many of these elements are implicated in versions of the rubber hand illusion, which were therefore studied in high-functioning individuals with ASD and a typically developing control group. Both groups experienced the illusion. A number of differences were found, related to proprioception and sensorimotor processes. The ASD group showed reduced sensitivity to visuotactile-proprioceptive discrepancy but more accurate proprioception. (...) This group also differed on acceleration in subsequent reach trials. Results are discussed in terms of weak top-down integration and precision-accuracy trade-offs. The RHI appears to be a useful tool for investigating multisensory processing in ASD. (shrink)

The ancient theory of substance and accident is supposed to make sense of complex unities in a way that respects both their unity and their complexity. On Hume’s view such complex unities are only fictitiously unities. This result follows from his thoroughgoing critique of the theory of substance. I will characterize the theory Hume is critiquing as it is presented in Locke, presupposing what Bennett calls the “Leibnizian interpretation.” Locke uses the word ‘substance’ in two senses. Call (...) substance in the first sense “individual substance” and in the second sense “pure substance.” I will discuss the seven main parts of Hume’s view: (I) that we have no idea of pure substance, (II) that there is no complex individual substance, except in a loose sense, (III) that the fiction of complex individual substance arises in a way parallel to that of the fiction of identity through time, and (IV) results in the fiction of pure substance, (V) that simple qualities and perceptions satisfy the definition of individual substance, (VI) that there is no such thing as inherence, and (VII) that there is no such thing as pure substance. Hume’s views on substance are often mentioned without being discussed in detail. Kemp Smith, Stroud, and Garrett, for example, mostly summarize various claims of Hume in the course of expounding on his theory of the idea of personal identity. In contrast, I will attempt to present a systematic treatment of Hume on substance as a refutation of Locke. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery (...) can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

The neurotransmitters GABA and glutamate have been suggested to play a role in Major Depressive Disorder (MDD) through an imbalance between cortical inhibition and excitation. This effect has been highlighted in higher brain areas, such as the prefrontal cortex, but has also been posited in basic sensory cortices. Based on this, magnetic resonance spectroscopy (MRS) was used to investigate potential changes to GABA+ and glutamate+glutamine (Glx) concentrations within the occipital cortex in MDD patients (n = 25) and healthy controls (n (...) = 25). No difference in occipital GABA+ or Glx concentrations, nor in the GABA+/Glx ratio, was found between groups. An analysis of an extended MDD patient and unmatched control dataset (n = 90) found no correlation between metabolite concentrations and depressive symptoms. These results were integrated with prior studies through metabolite-specific meta-analyses, revealing no difference in occipital GABA and Glx concentrations between patients and controls. An effect of publication year on GABA group differences was found, suggesting that previously reported results may have been artifacts of measurement accuracy. Taken together, our results suggest that, contrary to some prior reports, MRS measurements of occipital GABA and Glx do not differ between MDD patients and controls. (shrink)

In view of the publication of the DSM-V researchers were asked to discuss the theoretical implications of the definition of mental disorders. The reasons for the use, in the DSM-III, of the term disorder instead of disease are considered. The analysis of these reasons clarifies the distinction between the general definition of disorder and its implicit, technical meaning which arises from concrete use in DSM disorders. The characteristics and limits of this technical meaning are discussed and contrasted to (...) alternative definitions, like Wakefield’s harmful/dysfunction analysis. It is shown that Wakefield’s analysis faces internal theoretical problems in addition to practical limits for its acceptance in the DSM-V. In particular, it is shown that: a) the term dysfunction is not purely factual but intrinsically normative/evaluative; b) it is difficult to clarify what dysfunctions are in the psychiatric context (the dysfunctional mechanism involved being unknown in most cases and the use of evolutionary theory being even more problematic); c) the use of conceptual analysis and commonsense intuition to define dysfunctions leaves unsatisfied empiricists; d) it is unlikely that the authors of the DSM-V will accept Wakefield’s suggestion to revise the diagnostic criteria of any single DSM disorder in accordance with his analysis, because this is an excessively extensive change and also because this would probably reduce DSM reliability. In conclusion, it is pointed up in which sense DSM mental disorders have to be conceived as constructs, and that this undermines the realistic search for a clear-cut demarcation criterion between what is disorder and what is not. (shrink)

Although enactive approaches to cognition vary in terms of their character and scope, all endorse several core claims. The first is that cognition is tied to action. The second is that cognition is composed of more than just in-the-head processes; cognitive activities are externalized via features of our embodiment and in our ecological dealings with the people and things around us. I appeal to these two enactive claims to consider a view called “direct social perception” : the idea that we (...) can sometimes perceive features of other minds directly in the character of their embodiment and environmental interactions. I argue that if DSP is true, we can probably also perceive certain features of mental disorders as well. I draw upon the developmental psychologist Daniel Stern’s notion of “forms of vitality”—largely overlooked in these debates—to develop this idea, and I use autism as a case study. I argue further that an enactive approach to DSP can clarify some ways we play a regulative role in shaping the temporal and phenomenal character of the disorder in question, and it may therefore have practical significance for both the clinical and therapeutic encounter. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum (...) Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Tschumi believes that the quality of architecture depends on the theoretical factor it contains. Such a view led to the creation of architecture that would achieve visibility and comprehensibility only after its interpretation. On his way to creating such an architecture he took on a purely philosophical reflection on the basic building block of architecture, which is space. In 1975, he wrote an essay entitled Questions of Space, in which he included several dozen questions about the nature of space. The (...) questions he formulated could be regarded as analogous to the situation in the philosophy of the time, in which the interest in questioning the most obvious forms of understanding the world and intellectual categories increased. The research on space is an area common to many fields of natural sciences, humanities and artistic creation, but it also deals with other problems, such as issues of experience. The concept of space-time continuum proposed by Hermann Minkowski drew attention to the identity of time and space with the events taking place. Probably regardless of the postulates of physicists commenting on Einstein’s discoveries, also in philosophy it increased the importance of the concept of the event which became dominant in Heidegger’s latest work Contributions of Philosophy. Of the event. Furthermore, Tschumi’s reflections on space entered into relation with the problem of experience, which aroused the interest of a group of French philosophers trying to assimilate Georges Bataille’s concept of “inner experience”. Both Tschumi and Derrida referred to Bataille because his views could be used not only to modify the concept of the subject, but also to change the understanding of what constitutes the area of architecture. The discussion on experience has led to the recognition that the subject is not sovereign, but actually a form of what is on their outside. Such insights make it possible to treat the area of the Parc de La Villette as existing mainly when it is organised by its users. The decisive features of the Park are its assumptions, according to which it is a variety of active void that leads to agreeing new social relations with it. The park does not force to participate in already existing moral or political communities, but tries to move into an unknown future in which the scope of free functioning of individuals will be increased. Doubts about the principles of functioning of the individual self and its discovery as a whole composed of non-coherent parts, as well as its dependence on its own depth full of disordered forces, influenced the understanding of architecture as a set of contradictions whose source is a fundamental void anticipating the empty phenomenal space. The use of this phenomenal void in architecture, as well as the rejection of the whole and unity, had a specific political purpose and drew its inspiration from political analyses. In the Parc de La Villette, metaphysics and politics were brought closer together because the philosophy of void was used to create new conditions for community action. It can be argued that the source of this philosophy was the perception of errors in existing societies dependent on the shortcomings of traditional metaphysics. Spacing (espacement) was one of the key terms in Derrida’s philosophy, which was also combined with the concepts of différance and chôra. The study of the nature of space, especially its transition from the level of pure possibility to the level of sensual phenomenon, also contributes to understanding how well designed space can have an impact on its audience. This explanation is based on Tschumi’s assumption that the space of the Parc de La Villette contradicts the integrating approaches and instead exposes contradictions, but it does so in a way that combines incompatible properties into a single piece of architecture. The specificity of such integration is similar to the invention of a musical phrase, which is an ideological message: moral and political. Such a thesis may raise doubts, however, if both the clearly adopted assumptions and those deduced from the work allow for their ↪Quart Nr 2(52)/2019 logically ordered presentation then to a limited extent it may be assumed that the work has achieved a connection between a specific philosophy of space and its practical application. Derrida combined the problem of spatiality with the problem of transcendental imagination in Kant’s philosophy, who in the first version of Critique of Pure Reason assumed that pure imagination precedes the appearance of time and space, even in their transcendental forms. The imagination in such a situation can be described as a factor activating time and space, which indicates what function is played by movement in this activity. This leads us to recognize that the ultra originary source of pure forms of sensual intuition is movement, which in early Greek philosophy was identified with void and its lack of resistance to phenomena occurring in it. Derrida’s philosophy in search of a certain super-transcendental source of time and space pointed to différance which, like void or the chôra, does not have material features or even any other form of being. Différance is the primary cause of the disruption of motionlessness and the introduction of activity into motionless time and space, thus its activity can be described as spacing (espacement). Derrida’s discoveries in this respect are not entirely original, because Hegel already pointed out when examining the present that it is primarily a differential relation (differente Beziehung), which, being seemingly neutral, influences the present with supernatural force and makes it unidentifiable with itself. Differente Beziehung must similarly influence the originary space, negating its initial character by multiplying its divisions and expanding its boundaries. Différance acts by revealing contradictions wherever there is apparent undifferentiation. Tschumi, composing the Parc de La Villette as a variety of void and a set of incompatible layers, followed the rules of différance or the chôra: he made void visible together with its saturation with contradictions. If space can be considered to be the result of the activity of difference, such activity has a certain regularity, which influences the behaviour of its observers. Differences or contradictions fall into a certain rhythm, which can be considered a manifestation of transcendent order. The problem is that what can be considered the source of such order, namely the logos or God, is partly disorder and error. According to descriptions contained in Timaeus, the world is a combination of forces that drive to order with forces of erroneous necessity that resounds in every order and forces it to return to disorder. Derrida denied the possibility of understanding différance as a theological value, even if it were a negative or apophatic theology, but no categorical denial could be perfect. The assumption that différance or the chôra are not endowed with any substance properties cannot deny their activity, and thus a certain force. Already since Democritus, philosophy has multiplied the names of such a force and the contradictory variety of its manifestations, never forgetting also the necessity for reason to withdraw from the possibility of giving its correct characteristics. Such a withdrawal may be interpreted as an expression of respect and, in certain situations, as a cult of the force that precedes reasonableness. The Parc de La Villette, which is an artistic divagation about the contradictions and forces behind them, can be considered as a place of their sublimation, and therefore as a variation of the temple of what differs from order and disorder. (shrink)

Substance-abusing women are vulnerable to specific kinds of epistemic injustice, including stigmatization and discrimination. This article examines the development of the epistemic agency of female substance abusers by asking: How does the use of a formal discussion protocol in community rehabilitation interaction alleviate epistemic injustice and strengthen the epistemic agency of substance abusers? The data were collected in a Finnish rehabilitation center by videotaping six group discussions between social workers, peer support workers, and rehabilitation clients with (...) class='Hi'>substance abuse problems. Of these data, one recorded group discussion between four female participants—two rehabilitation clients, a peer support worker, and a social adviser—was used in this paper. Using conversational analysis, the findings indicate that, through the collaborative activities of sharing experiential knowledge about substance abuse and discussing the experiences of abuse in the rehabilitation interaction, substance abusers can develop novel ways to strengthen their epistemic agency by enhanced self-awareness. The discussion protocol is an epistemic tool that professionals and clients can learn to use in ethically and epistemologically successful ways in interaction. The use of a discussion protocol is an example of social professionals’ clinical knowledge of intensifying collaboration and sharing experiential knowledge in community rehabilitation and other substance abuse services. (shrink)

Mind, Brain, and Free Will, Richard Swinburne’s stimulating new book, covers a great deal of territory. I’ll focus on some of the positions Swinburne defends in the philosophy of mind. Many philosophers are likely to have reservations about the arguments he uses to defend them, and others will think his basic position is unmotivated. My goal in this brief discussion is to articulate some of the reasons why.