Ketamine is a well-known and widely available general anesthetic from the 1960s that, in sub-anesthetic doses, has been adopted in a limited manner for the treatment of acute suicidality and treatment-resistant depression. Its short onset time and short duration of action make it feasible for use at outpatient clinics. In the US, it has a long history of off-label use and was officially approved for depression treatment in 2019. In Finland, it has been administered (...) to selected hospitalized patients in the public healthcare system since 2010 and became available at a private outpatient clinic very recently. In Norway, it has been administered off-label at a private clinic for approximately 500 patients since mid-2010s and at a public clinic for approximately 300 patients since 2020, with plans on opening more clinics in 2024. In the US, the treatment has been administered to hundreds of thousands of patients. -/- The retrospective ethnographic inquiry part of this study features a Finnish woman in her twenties who suffered from treatment-resistant depression, rooted in her insecure childhood and having been bullied at school, as well as income insecurity and excessive workload in adulthood. Eventually, she was violently raped, which induced an obvious post-traumatic stress disorder and exacerbated her depression, incapacitating her. In the course of approximately five years, she was prescribed ten different anti-depressive medications and seventeen other medications, including various antipsychotic medications and lithium. These failed to provide an anti-depressive effect but resulted in 'massive' adverse effects instead, including 60% weight gain and psychotic hallucinations. Eventually, esketamine spray treatment at a private outpatient clinic resolved her depression in a single session. A weekly re-administration process was ongoing. -/- In this case, repeated esketamine administration alleviated depression by producing accumulating corrective emotional experiences without the need to re-experience previous traumatizing events. In a few months to a year, the transient but accumulating anti-depressive effect typically leads to the resolution of depression in most cases, if the patients' living conditions no longer constantly re-traumatize them. It is necessary to adopt ketamine more widely as an emergency measure while more effective, non-addictive alternatives and complements are prepared for adoption. The cost of this specific pilot program implementation was unscalable, but costs can be reduced by approximately 90% by modifying the implementation details. Ketamine and its more effective alternative, 5-MeO-DMT, can serve a major role in facilitating a rebirth of public and private mental healthcare systems, with treatment efficacy multiplied and treatment costs simultaneously reduced. (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 (...) class='Hi'>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)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section (...) 2, we consider whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

Background: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Depression affects an estimated one in 15 adults (6.7%) (...) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Psychologist in diagnosing depression disease through its symptoms such as: a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide. The proposed expert system presents an overview about depression disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed depression disease diagnosis expert system was evaluated by psychologist students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for psychologist, patients with depression and newly graduated psychologist. (shrink)

Depression is a widespread and debilitating disorder, but developing effective treatments has proven challenging. Despite success in animal models, many treatments fail in human trials. While various factors contribute to this translational failure, standardization practices in animal research are often overlooked. This paper argues that certain standardization choices in behavioral neuroscience research on depression can limit the generalizability of results from rodents to humans. This raises ethical and scientific concerns, including animal waste and a lack of progress in (...) treating human patients. To address these issues, animal ethics committees can establish reasonable expectations for preclinical research and highlight the impact of standardization on generalizability. Such efforts can help improve translation from animal models to human patients and ultimately benefit those suffering from depression. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

This paper proposes that the question “What should I believe?” is to be answered in the same way as the question “What should I do?,” a view I call Equal Treatment. After clarifying the relevant sense of “should,” I point out advantages that Equal Treatment has over both simple and subtle evidentialist alternatives, including versions that distinguish what one should believe from what one should get oneself to believe. I then discuss views on which there is a distinctively (...) epistemic sense of should. Next I reply to an objection which alleges that non-evidential considerations cannot serve as reasons for which one believes. I then situate Equal Treatment in a broader theoretical framework, discussing connections to rationality, justification, knowledge, and theoretical vs. practical reasoning. Finally, I show how Equal Treatment has important implications for a wide variety of issues, including the status of religious belief, philosophical skepticism, racial profiling and gender stereotyping, and certain issues in psychology, such as depressive realism and positive illusions. (shrink)

Background: This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM). -/- Methods: This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the (...) DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies. -/- Results: In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = −0.236), anxiety (r = −0.243), and stress (r = −0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = −0.192), anxiety (r = −0.238), and stress (r = −0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = −0.251), anxiety (r = −0.257), and stress (r = −0.203) had a significant negative correlation with DQOL (P < 0.001). -/- Conclusion: MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life. (shrink)

Presenting the case against legalizing euthanasia, this paper refers mainly to two clinical facts. First that, in the majority of cases, a wish to die is a symptom of depression; and second, that depression affects rational decision making. Since a depressive individual is not fully competent, it is a mistake to resort to that individual's autonomy. One should recall that a subclinical depressive state is an object of treatment, and safeguards are necessary lest this state should be (...) an object of euthanasia or assisted suicide. (shrink)

According to the biomedical model of medicine, the subject of the illness event is the pathology rather than the person diagnosed with the disease. In this view, a body-self becomes a ‘patient’ body-object that can be enrolled in a therapeutic protocol, investigated, assessed, and transformed. How can it be possible for cancer patients to make sense of the opposite dimensions of their body-self and their body-diseased-object? Could a creative embodied approach enable the coping with trauma tied to the experience of (...) illness? By applying a phenomenological approach and auto-ethnographic analysis to the experience of cancer, this visual exploration provides support for rethinking the cancer event through a performative perspective. This work previews images and video material collected over ten years of haematological treatments, video dance performances and physical explorations. This work displays how processes of healing can be set in motion by creative embodied practices, physical explorations and unexpected journeys. By resisting the biomedical model and allowing the emergence of new meanings, it illustrates how dance and performative practices offer ground for transformation. (shrink)

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all of (...) us. The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests. (shrink)

Background: Increasing resistance of Pseudomonas aeruginosa to ciprofloxacin in ICU/burn units has created a problem in the treatment of infections caused by this microorganism. -/- Methods: Fifty P. aeruginosa strains were isolated from burn patients hospitalized in the Kerman Hospital during May 1999-April 2000 and were tested for in-vitro sensitivity to different antibiotics by disc diffusion breakpoint assay. The isolates were subjected to minimum inhibitory concentration (MIC) test by agar dilution method. Existence of the plasmids was also investigated in (...) the isolates. -/- Results: Thirty-four patients infected with ciprofloxacin strains showed MIC of 8 mg/ml [p<0.001]. Sixteen patients were infected with sensitive strains exhibiting MIC range of 0.0125-0.125 ± 0.033 mg/ml. The isolates were also also resistant to other antibiotics [p<0.001]. Plasmid isolation and agarose gel electrophoresis (0.7%) revealed three plasmid bands in strains 8 and 16, and one band in strain 35. -/- Conclusion: The emergence of ciprofloxacin resistance of P. aeruginosa in burn patients is alarming since this antibiotic has only recently been introduced onto the market in Iran. One important observation was that some isolates exhibited cross resistance to other antibiotics. Furthermore, some strains were carriers of plasmids which might have acted as the potential source of acquired resistance in the hospital setting. -/- . (shrink)

A community based cross-sectional study was carried out by a self-structured questionnaire on 168 participants aged between 18 and 60 years at two arsenic prone area of Bangladesh to determine the association between extent of depression and socio-demographic as well as illness characteristics in arsenicosis population. The mean age ± SD was 42 ± 10.15 years. Female respondents were almost twice (63.1%) than the males (36.9%) in this study. Most of the respondents (94.0%) were shallow tube well water user. (...) Among them most (80.0%) of the respondents were detected as arsenic contaminated water consumer over more than six months. Study estimated that almost half (44.3%) of the participants had suffered from mild to moderate depression in the moderate arsenicosis group. Less than quarter (20.8%) participants suffered severe depression in severe arsenicosis group. Quarter (26.7%) had mild arsenicosis with no depression. This difference was not significant. Gender had significant influence on proportion of level of depression. Females significantly suffered more from depressive symptoms than males. More than two third of the female respondents suffered from some kind of depressive symptoms; where less than one third of the males were suffered from depressive symptoms. Age has no significant relation with depression. Respondents who were 48 years and above age group had highest percentages of severe depressive symptoms (35.8%). This age group also suffered from highest percentage of mild to moderate depression (37.1%). Though most of the respondent (85.1) had no diabetes and hypertension. Respondents with physical illness suffered more from some sorts of depression than those without illness, but the result is not statistically significant. We understood that depression has health challenges in adult arsenicosis patients. Therefore, physicians should take account depression in their treatment management when deal with arsenicosis patients. (shrink)

The methodological differences of understanding, versus explaining, have been at the centre of a century-long methodenstreit debate (and disagreement) among philosophers and scientists. Karl Jaspers managed to import this discussion to the realm of psychiatry and psychopathology in a significant, but unresolved, manner. Side-tracked by the advent of various changes in psychiatry during the 20th century, phenomenology and philosophy of psychiatry have made a comeback in the last decades and, since then, developed new contributions to this subject. Quite similarly, the (...) study of time experience, standing on the shoulders of notorious philosophers, has too witnessed a similar renaissance, with groundbreaking developments across several conditions, including depression. The present essay is essentially exploratory, but during its development, after addressing the concepts of the methodenstreit debate, and tackling both meaningful and causal connections behind time dysperception in depression, I argue that understanding, at least in this context and at present time, is not entirely reducible to causal explanations, for some things are only gained in understanding, such as the feeling of being understood and the implications it carries for a therapeutic relationship and the treatment plan. (shrink)

Sertraline is one of the most commonly prescribed antidepressants. Major depressive disorder (MDD) is characterized by spontaneous thoughts that are laden with negative affect-a "malignant sadness". Prior neuroimaging studies have identified abnormal resting-state functional connectivity (rsFC) in the spontaneous brain networks of MDD patients. But how antidepressant medication acts to relieve the experience of depression as well as adjust its associated spontaneous networks and mood-regulation circuits remains an open question. In this study, we recruited 22 drug-naïve MDD patients along (...) with 35 normal controls and investigated whether the functional integrity of cortical networks associated with spontaneous thoughts is modulated by sertraline treatment. We attempted to predict post-treatment effects based upon what we observed in the pre-treatment rsFC of drug-naïve MDD patients. In the result, we demonstrated that (1) after the sertraline treatment, the medial temporal lobe of default network (DNMTL) and mood regulation pathway-the fronto-parietal control network (FPCN), the thalamus, and the salience network (SN)-were restored to normal connectivity, relative to the pre-treatment condition; however, the altered connections of FPCN-core DN (DNCORE), FPCN-SN, and intra-FPCN among MDD patients remained impaired; (2) thalamo-prefrontal connectivity provides moderate predictive power (r2 = 0.63) for the effectiveness of sertraline treatment. In summary, our findings contribute to a body of evidence that suggests salubrious effects of sertraline treatment primarily involve the FPCN-thalamus-SN pathway. The pre-treatment rsFC in this pathway could serve as a predictor of sertraline treatment outcome. (shrink)

This paper addresses a family of issues surrounding the biological phenomenon of resistance and its representation in realist ontologies. The treatments of resistance terms in various existing ontologies are examined and found to be either overly narrow, internally inconsistent, or otherwise problematic. We propose a more coherent characterization of resistance in terms of what we shall call blocking dispositions, which are collections of mutually coordinated dispositions which are of such a sort that they cannot undergo simultaneous realization within a single (...) bearer. A definition of ‘protective resistance’ is proposed for use in the Infectious Disease Ontology (IDO) and we show how this definition can be used to characterize the antibiotic resistance in Methicillin-Resistant Staphylococcus aureus (MRSA). The ontological relations between entities in our MRSA case study are used alongside a series of logical inference rules to illustrate logical reasoning about resistance. A description logic representation of blocking dispositions is also provided. We demonstrate that our characterization of resistance is sufficiently general to cover two other cases of resistance in the infectious disease domain involving HIV and malaria. (shrink)

Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted (...) a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases. (shrink)

Autoethnographic accounts of mental illness (MI) are sparse in academic scholarship, despite generating valuable insights into how MI can be experienced and coped with in real-life contexts. First-person accounts from men are especially lacking, possibly linked to historic trend for masculine stoicism stifling male MI discussions. Some scholarships explore video-gaming as a positive, escapist aid benefiting individuals experiencing major depressive disorder (MDD). However, no research exists presenting in-depth perspectives on possible positive effects, self-identified and articulated by actors engaging with gaming (...) to cope with MDD. This research adopts a novel qualitative perspective, representing an in-depth autoethnographic examination of my experiences playing the personal computer game DeusEx, during a period of my life where I was under treatment for MDD. My positions as both a psychologist specializing in research prioritizing feminist theory as applied to understand men, masculinities, and mental health, and someone themselves recurrently treated for MDD over longer than 22 years, construct a unique dual-positionality perspective. Explicit discussions of my MDD experiences and my experiences concerning the value of video-gaming as a positive, escapist aid during MDD are presented, alongside personal deconstructions of the lasting influences of hegemonic masculinity upon men speaking up about MI. Arguments are presented for future scholars utilizing autoethnographic methods to generate realist perspectives, normalizing mental health discussions, particularly the sharing of underrepresented male experiences. Implications for future scholarship, building upon learnings generated by this research, are developed and put forward. (shrink)

Objective: The objective of this study was to evaluate the clinical efficacy and appropriateness of colistin therapy in patients with hematological malignancies. -/- Methods: Age, gender, type of hematologic malignancy, and potential carbapenem-resistant microorganism risk factors were all noted in this retrospective study. In empirical and agent-specific treatment groups, differences in demographic features, risk factors, treatment responses, and side effects were compared. -/- Results: Sixty-three patients were included, 54% were male, and the median age was 49. In (...) the last three months, the hospitalization rate history was 68%, and four patients had a hospitalization history in the ICU. Carbapenem-resistant K. pneumoniae colonization was present in 22 patients (35%). Gram-negative microorganisms were isolated in 34 patients (54%). The carbapenem, quinolone, and colistin resistance rates were 82%, 76%, and 4% respectively. Clinical and microbiological response rates were 60% and 69%. 7 and 28-day mortality rates were 17% and 35%. There was no significant difference in demographic data and comorbidities in empirical (n=48) and agent-specific (n=15) treatment groups. The rate of carbapenem and glycopeptide treatments before colistin was higher in the empirical treatment group (p = 0.004; p = 0.001). The rate of starting combined antibiotics was higher in the empirical treatment group (p = 0.016). Two of the patients developed renal failure in the first week after treatment. -/- Conclusion: The use of empirical colistin may be unavoidable given the risk considerations. Shortly, colistin-resistant strains may also be a factor affecting treatment success negatively. (shrink)

From our perspective, we believe that it is necessary to abandon the idea that all those who suffer from SI or SA are mentally ill, which causes them to be stigmatized and subjected to psychiatric treatment, when what they need is a different vision of life as well as adaptive strategies to employ a new philosophy. Public policies should consider implementing programs that reinforce cognitive flexibility in addition to character strengths.

Importance: Patients with remitted major depressive disorder (MDD) were previously found to display abnormal functional magnetic resonance imaging connectivity (fMRI) between the right superior anterior temporal lobe (RSATL) and the subgenual cingulate cortex and adjacent septal region (SCSR) when experiencing self-blaming emotions relative to emotions related to blaming others (eg, "indignation or anger toward others"). This finding provided the first neural signature of biases toward overgeneralized self-blaming emotions (eg, "feeling guilty for everything"), known to have a key role in cognitive (...) vulnerability to MDD. It is unknown whether this neural signature predicts risk of recurrence, a crucial step in establishing its potential as a prognostic biomarker, which is urgently needed for stratification into pathophysiologically more homogeneous subgroups and for novel treatments. -/- Objective: To use fMRI in remitted MDD at baseline to test the hypothesis that RSATL-SCSR connectivity for self-blaming relative to other-blaming emotions predicts subsequent recurrence of depressive episodes. -/- Design, setting, and participants: A prospective cohort study from June 16, 2011, to October 10, 2014, in a clinical research facility completed by 75 psychotropic medication-free patients with remitted MDD and no relevant comorbidity. In total, 31 remained in stable remission, and 25 developed a recurring episode over the 14 months of clinical follow-up and were included in the primary analysis. Thirty-nine control participants with no personal or family history of MDD were recruited for further comparison. -/- Main outcomes and measures: Between-group difference (recurring vs stable MDD) in RSATL connectivity, with an a priori SCSR region of interest for self-blaming vs other-blaming emotions. -/- Results: We corroborated our hypothesis that during the experience of self-blaming vs other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence. The recurring MDD group showed higher connectivity than the stable MDD group (familywise error-corrected P < .05 over the a priori SCSR region of interest) and the control group. In addition, the recurring MDD group also exhibited RSATL hyperconnectivity with the right ventral putamen and claustrum and the temporoparietal junction. Together, these regions predicted recurrence with 75% accuracy. -/- Conclusions and relevance: To our knowledge, this study is the first to provide a robust demonstration of an fMRI signature of recurrence risk in remitted MDD. Additional studies are needed for its further optimization and validation as a prognostic biomarker. (shrink)

The possible significance of compromised exposure to positive stimuli during an individual's early childhood could contribute to impoverished positive memory development and subsequently dysregulated emotional responses to such valence of stimuli in adulthood. This could potentially explain dampened positive emotional responses of depressed individuals as reported in imaging studies of the brain's mesolimbic reward pathways. This paper provides emphasis and suggestions for a preliminary exploration of positive cartoon stimuli as a new tool in therapeutic targets for depression treatment (...) and research that cater to a subgroup of depressive individuals who had experienced childhood trauma and stressful episodes as their primary causes of the disorder. Cartoon stimuli as a form of visual and interactive therapy may provide a compensatory and restorative component for the emotional losses and insults on an otherwise healthy childhood positivity required for normal and balanced neuropsychological development and growth. Unfortunately, such readily available resources for therapy have hardly been considered and utilized. The potential benefit of exposure to cartoon stimuli may extend beyond the method of positive mood induction and further addresses the need for both implicit and explicit comfort, understanding, emotional and situational relatedness that compensate for the lack of such stimulation during an early stressful life. Through evoking childlike positive associations, it is hypothesized that depression could reduce in severity and the threshold for activation of response to positive stimuli and themes lowered, thereby restoring negative and positive mood imbalances. (shrink)

Understanding the autonomic nervous system and homeostatic changes associated with emotions remains a major challenge for neuroscientists and a fundamental prerequisite to treat anxiety, stress, and emotional disorders. Based on recent publications, the inter-relationship between respiration and emotions and the influence of respiration on autonomic changes, and subsequent widespread membrane potential changes resulting from changes in homeostasis are discussed. We hypothesize that reversing homeostatic alterations with meditation and breathing techniques rather than targeting neurotransmitters with medication may be a superior method (...) to address the whole body changes that occur in stress, anxiety, and depression. Detrimental effects of stress, negative emotions, and sympathetic dominance of the autonomic nervous system have been shown to be counteracted by different forms of meditation, relaxation, and breathing techniques. We propose that these breathing techniques could be used as firstline and supplemental treatments for stress, anxiety, depression, and some emotional disorders. (shrink)

Beginning with the influential discussion of the dialectic of progress found in Amy Allen’s The End of Progress, this paper outlines some difficulties encountered by critical theories of normative justification drawing on the early Frankfurt School. Characterizing Adorno and Horkheimer’s critical social theory as a dialectical reflection eschewing questions of normative foundations, I relate their well-known treatment of the dialectic of enlightenment reason and myth to their critique of capitalist society as a negative totality. By exploring the concepts of (...) historical development used by Adorno and Horkheimer to describe both the progressive domination of capitalism, and the formation and cultivation of reflective consciousness, I trace the importance of progression and its inseparable relationship to regression in these early versions of critical theory. The dialectical social theory found here recognizes the persistence of social contradictions on both a methodological level and on the level of theory’s development and expression, a connection potentially obscured by a division of historical progress according to its temporal orientation. Particularly in Adorno’s later work, an opposition to the negative social totality requires notions of cultivation and learning which work against the prevailing forms of conceptual thinking, including the concern for the stability of rational foundations. (shrink)

Monkeypox, an infectious disease caused by the Orthopoxvirus, was identified in humans in 1970. It has recently emerged as a global health concern due to outbreaks beyond its endemic regions in Central and West Africa. This review examines the current state of medical treatments for monkeypox as of 2024, focusing on antiviral agents, immunotherapies, and supportive care measures. Monkeypox manifests with symptoms including fever, rash, and lymphadenopathy, with severe cases more common in immunocompromised individuals. Antiviral therapies such as tecovirimat and (...) brincidofovir are central to treatment strategies, with tecovirimat demonstrating efficacy in alleviating symptoms and reducing viral shedding. Emerging treatment strategies involve novel lipid-based formulations and combination therapies that integrate antivirals with immune-modulating agents. Supportive care remains essential, involving analgesics and antibiotics for secondary infections, while the MVA-BN vaccine plays a critical role in prevention. Research emphasizes the need for a deeper understanding of viral pathogenesis and host immune responses to improve therapeutic and preventive measures. Despite significant advancements, challenges remain, including potential antiviral resistance, disparities in healthcare access, and the necessity for enhanced diagnostic and surveillance capabilities. This review highlights the imperative for ongoing research, international collaboration, and investment in healthcare infrastructure to advance the management and prevention of monkeypox and to prepare for future outbreaks. (shrink)

Mental health challenges can be described via the application of multiple lenses, from clinical-medical perspectives, to social and community-based, to further understandings in the context of public health. While these challenges can represent multiple issues to the scientific community at-large, especially because of the translational issues attached to the application of research and practice to the sphere of community services, it is useful to understand that the triad ethics, evidence, and experience can be instrumental in navigating the complexity of the (...) issue-at-hand. Furthermore, the work of researchers and practitioners is rooted in a solid understanding of the specific needs of psychiatric patients, particularly from the perspective of possible misunderstandings, ostracization, and stigmatization of psychiatric issues and related presentation, affect, and behaviours. Years of research have indicated how a proper interaction between resources at the level of scientific research and the community is a fundamental cornerstone for a practice rooted in both science and true care for individuals affected by mental health disorders. In this presentation we will discuss the case of the Centro Salute Mentale (Mental Health Centre, CSM) of Verona. (shrink)

This compilation focuses on success stories—cases of courage, innovation, and the application of knowledge and power in overcoming illness and suffering. It features thirteen ethnographic case studies that describe how people were able to alleviate or overcome serious issues including alcoholism, severe anxiety and depression, suicidal behavior, and psychotic disorders caused by ignorance, neglect, violence, war, and sexual abuse. It is a tribute to the possibility of healing.

In the last decade alone, a growing body of preliminary evidence suggests that classic psychedelics (CPs) can rapidly and durably ameliorate symptoms and cognitive deficits associated with depression. However, the mechanisms by which CPs work in the brain are not well understood. Rodent translational research, in which experimental findings from rodents are translated to humans, is fundamental in achieving this goal. This chapter focuses on a representative subset of human and rodent studies investigating CPs for depression, including the (...) various lines of research that have been initiated to understand how they work. Our aim is to show that in addition to epistemic challenges that scientists face in translating findings from rodents to humans, there is also mismatch between experimental approaches used to investigate CPs in humans and rodents. We thus show current experimental practices are not conducive to mechanistic discovery. We end with a set of positive proposals to expedite the drive to translate CPs into effective treatments for depression. -/- Keywords: classic psychedelics, psychiatry, clinical trials, collaboration, extrapolation, major depressive disorder, open science, philosophy of science, rodent models, scientific practice, translation, validity . (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things (...) and spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

In a recent Response published in the Journal of Medical Ethics,1 Buturovic provides two criticisms of my argument in ‘Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?’2 First, Buturovic argues that my argument effectively ‘erases the distinction between healthy adults and patients (whether somatic or psychiatric) essentially implying that PAS [physician-assisted suicide] should be available to all, for all reasons or, ultimately no reason’ (Buturovic,1 pg. 1). Second, Buturovic argues that opening the doors to medical assistance (...) in dying (MAID) for psychiatric patients could have a number of undesirable implications. In particular, Buturovic highlights the potential negative implications for relations of trust in medicine—psychiatry in particular—along with potential effects on the rate of organ donation. I would here like to respond to these two criticisms. In short, my response to Buturovic’s first argument is that the slope is not nearly as slippery as Buturovic suggests. The reason for this is that the plausibility of Buturovic’s argument rests on a significant misinterpretation of my argument, along with an important equivocation in her own. Buturovic argues that, under the three criteria that I propose for the provision of MAID—sufficient decision-making capacity, demonstrated treatment resistance, and a lack of substantially negative implications for existing standards of psychiatric treatment and research—the provision of MAID for trivial reasons, even no reason at all, is justifiable. The main problem with this argument is that I propose no such positive criteria. My argument is that none of the three arguments addressed in my previous paper are sufficient to justify the exclusion of any and all psychiatric patients from access to MAID. I do not claim, in other words, that any individual …. (shrink)

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of (...) these disorders in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment. (shrink)

Hunger strikes are commonly repressed in prison and seen as disruptive, coercive, and violent. Hunger strikers and their advocates insist that incarcerated persons have a right to hunger strike, which protects them against repression and force-feeding. Physicians and medical ethicists generally ground this right in the right to refuse medical treatment; lawyers and legal scholars derive it from incarcerated persons’ free speech rights. Neither account adequately grounds the right to hunger strike because both misrepresent the hunger strike as noncoercive (...) and nonviolent. I articulate an alternative, dual account of the right to hunger strike. On the remedial argument, the right to hunger strike should be legally protected as a right to petition for redress, in light of incarcerated people’s structural vulnerability to abuse and given inadequate grievance mechanisms. The constructive argument derives the right to hunger strike from the right to resist oppression and stresses the normative permissibility of the use of coercive tactics to defend one’s liberty interests in the face of carceral oppression. -/- . (shrink)

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical (...) ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity—as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires. (shrink)

Despite extensive evidence for its effectiveness, ECT remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against ECT, and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.

Psychiatric research is in crisis because of repeated failures to discover new drugs for mental disorders. Lack of measurement validity could partly account for these failures. If researchers do not actually measure the effects of drugs on the disorders they aim to investigate, one should expect suboptimal treatment outcomes. I argue that this is the case, focusing on depression, and fear & anxiety disorders. In doing so, I show how psychiatric research illustrates a more general phenomenon that I (...) call “validity drift.” A validity drift occurs when, in the course of developing new measurement procedures, researchers end up studying something different from what they originally aimed to study. I analyze the different ways in which scientists attempt to validate procedures for measuring mental disorders for the purpose of testing drugs in animal models. I show how those validation efforts might fail, thereby leading to validity drifts. Overall, this analysis highlights the complex interplay between the development of new measurement procedures, their calibration, and scientific theories of the target phenomena. (shrink)

The aim of my paper is to review the discussion concerning various difficulties which surround the definition of depression and the methods of diagnosing and treating the disease against the background of the now dominant reductionist paradigm in psychiatry, as well as to answer the question whether a new approach to psychiatric disorders proposed by philosophers of psychiatry working within the phenomenologically inspired embodied and enactive paradigm indeed offers a solution to these difficulties. I present the issues specific to (...) the subject of depression in light of the more general problems related to biological psychiatry that have recently caused much debate. In the second part of the paper, I consider enactive, phenomenological and embodied theories of depression and the possibilities of new methods of treatment. My goal is to assess whether these theories indeed add anything important to the conceptions that are already present in psychiatry. I conclude that even if the embodied philosophy of psychiatry does not solve many of the problems faced by modern psychiatry, it can, nevertheless, provide a useful theoretical basis for future changes. (shrink)

Self-medication of antibiotics is an irrational use of drugs, contributing to microbial resistance, increasing healthcare costs and higher mortality and morbidity. This study aimed to assess self-medication with antibiotics without a medical prescription in the community of Libya. This is a cross-sectional study conducted from June to December 2022 and the total number of participants was 200. The design of the study and sample size were modified according to the proficiency of pharmacists and the medical and non-medical population of Libya. (...) The questionnaire was developed in English and Arabic language and was distributed through social media platforms. The questions were used after a thorough literature search and assessing the validity and reliability. The significant signs regarding reasons for the treatment by self-medication drugs of antibiotics, because of its various drugs of antibiotic by pharmacist (n=80, 40.0%) and family (n=90, 45.0%) compared with experience and physicians by used prescription was 13 (6.50%) and significant sings regarding by nasal congestion self-medication of various antibiotics (n=100, 50.0%). This sign must be practiced based on a previous physician’s prescription. The antibiotics are often self-administered as patients feel that they will save money and time but this can lead to substantial adverse drug reactions, antibiotic resistance, treatment failure and drug-related toxicity. This study respondent's medical and non-medical public of Libya who should be relatively informed and educated about the risk of treatment by self-medication of antibiotics with the development of resistance. (shrink)

Microbial biofilm created huge burden in treatment of both community and hospital infections. A biofilm is complex communities of bacteria attached to a surface or interface enclosed in an exopolysaccharide matrix and protected from unfavorable conditions such as presence of antibiotics, host defense or oxidative stresses. Biofilms are often considered hot spot for horizontal gene transfer among same or different bacterial species. Furthermore, bacteria with increased hydrophobicity facilitate biofilm formation by reducing repulsion between the extracellular matrix and the bacterium. (...) There is a marked increase in the rate of persons nonresponsive to antibiotic therapy for infections of the Urinary Tract (UTIs), burns and upper respiratory tract due to biofilm formations. It is estimated that 90% of nosocomial infections are mediated by biofilm. The role of biofilm in infections has become so great that the treatment of such antibiotic resistance infections is proving difficult and costly to health care systems. The biofilm related infections varied from dental plaque, destruction of prosthetic valve to death of cystic fibrosis patients. This review aims to provide a summary of role of bacterial biofilm and its clinical implications for the patients. (shrink)

Delusions are deeply evidence-resistant. Patients with delusions are unmoved by evidence that is in direct conflict with the delusion, often responding to such evidence by offering obvious, and strange, confabulations. As a consequence, the standard view is that delusions are not evidence-responsive. This claim has been used as a key argumentative wedge in debates on the nature of delusions. Some have taken delusions to be beliefs and argued that this implies that belief is not constitutively evidence-responsive. Others hold fixed (...) the evidenceresponsiveness of belief and take this to show that delusions cannot be beliefs. Against this common assumption, I appeal to a large range of empirical evidence to argue that delusions are evidence-responsive in the sense that subjects have the capacity to respond to evidence on their delusion in rationally permissible ways. The extreme evidence-resistance of delusions is a consequence of powerful masking factors on these capacities, such as strange perceptual experiences, motivational factors, and cognitive biases. This view makes room for holding both that belief is constitutively evidence-responsive and that delusions are beliefs, and it has important implications for the study and treatment of delusions. (shrink)

Numerous agricultural wastes are impractically discarded every day, and one of these is rice bran. This study investigated the production of a biodegradable straw made of cassava starch and powdered rice bran. It aimed to determine the effectiveness of the different treatments of Cassava Starch-Rice Bran in terms of water resistance, tensile strength, and biodegradability. An experimental design was used in conducting the study. There were three treatments made in making CSRB straws: the first, with more rice bran; the second, (...) with the same cassava starch and rice bran ratio; and the third, with more cassava starch. These treatments produced three replicates each. The straws were placed in a dehydrating machine for 24 hours at a temperature of 60° Celsius. The straws were then coated with beeswax after being removed from their respective molders. The CSRB straws were found to be water resistant due to the beeswax coating applied, although it had a weak tensile strength even with the presence of beeswax. The rate of biodegradability of the CSRB straw was fast due to it being made up of organic materials. The results revealed that straws made from Cassava Starch and Powdered Rice Bran are effective in terms of water resistance and biodegradability. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing a proposed expert system. The main (...) goal of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

The application and practice of virtue ethics raises an important question: How do we become virtuous? The pessimistic mainstream view is that virtue can only be cultivated in children who still have malleable characters and virtuous predispositions. This paper argues that even adults can cultivate virtues. We can cultivate virtues by using the empirically tested techniques of cognitive behavioural therapy (CBT) – if they work in the treatment of difficult problems like depression or phobias, then they should also (...) work to ameliorate our character. This paper develops an account of cognitive behavioural virtue. To this purpose, it first introduces CBT’s theoretical framework, second it shows how this framework naturally integrates with Aristotelian rather than Stoic virtue theory, third it proposes how CBT’s techniques can be applied in the cultivation of virtue. Finally, it examines some of the proposal’s theoretical consequences and shows its advantages over competing accounts, notably Stichter’s account of virtue cultivation as skill acquisition. (shrink)

Social justice demands that we attend carefully to the epistemic terrains we inhabit as well as to the epistemic resources we summon to make our lived experiences tangible to one another. Not all epistemic terrains are hospitable—colonial projects landscaped a good portion of our epistemic terrain long before present generations moved across it. There is no shared epistemicterra firma,no level epistemic common ground where knowers share credibility and where a diversity of hermeneutical resources play together happily. Knowers engage one another (...) on a politically saturated,unlevel knowing fieldwhere members of dominant groups work to forcibly maintain their epistemic home-terrain advantage. I use the metaphor of the unlevel knowing field to capture these oppressive epistemic structures. The unlevel knowing field is a hungry place where all knowledge that fails to nurture and sustain dominant ways knowing risks being dragged onto the dominator's epistemic home turf to be mined, coopted, consumed, or destroyed. Knowledge and willful ignorance circulate with equal vigor in this hungry world. From the standpoint of oppressed/resisting peoples, the unlevel knowing field is a minefield, an epistemic twilight zone, which must be traversed with considerable care and endless attention. The harms epistemic injustice produces are not disembodied harms. Repeated acts of injustice weather our bodies, dull our minds, weaken our hearts, and traumatize the spirit of our communities. They create public-health precarities and invite mental, emotional, physical, and spiritual illness into our being. Epistemic oppression is a cruel thief. It is disorienting, exhausting, and deadly. It triggers anger, anxiety, depression, and resistance. It steals our time, energy, and attention away from more beautiful things. (shrink)

‘Gender disappointment’ is regularly reported by those whose child’s sex does not match the sex that they, the parent, desired. With symptoms ranging from mere fleeting sadness to documented cases of serious depression, alienation from one’s child, and emotional suffering, it is clear that so-called ‘gender disappointment’ is a serious issue, that has, as yet, seen little philosophical attention (though see Hendl and Browne 2020). In this chapter I explore gender disappointment, not from the perspective of a parent who (...) ended up with the child of the wrong sex at birth, but rather, from the perspective of a different kind of gender disappointment: the transgender person who grew up and only then disappointed their parents by turning out to be the ‘wrong’ gender. This perspective, I argue, reveals a great deal about the shared gender essentialism at the heart of patriarchal and cissexist ideology. Moreover, I will argue that it reveals the underlying propertarian relationship of parents to their children under contemporary capitalism – a troubling relationship that legitimates the treatment of children as objects to be designed and controlled as commodities at the whims of parents. In this way I disagree with Whyman when he writes that “a preference for having a child of one sex over the other should be considered one of those irrational things of which some sense can nevertheless be made – like aesthetic taste” (Whyman 2021, 113-114). I argue, to the contrary, that the desire for a child of one particular gender is not akin to a mere unproblematic aesthetic preference. Instead, and following the rich feminist tradition of thinking about the patriarchal origins of sexual desire, I argue that we must see these desires as troubling reflections of dominant patriarchal and cissexist ideology, underwritten by a particular neoliberal capitalist mode of production. Moreover, we can seek to change those desires. (shrink)

The present narrative review seeks to unravel where we are now, and where we need to go to delineate the active ingredients in psychotherapy delivered by conversational agents (e.g., chatbots). While psychotherapy delivered by conversational agents has shown promising effectiveness for depression, anxiety, and psychological distress across several randomized controlled trials, little emphasis has been placed on the therapeutic processes in these interventions. The theoretical framework of this narrative review is grounded in prominent perspectives on the active ingredients in (...) psychotherapy. Based on search terms derived from various theoretical perspectives, we conducted a systematic literature search of four scientific databases and identified 17 studies. Across the selected studies, three themes emerged: relationship variables, emotional venting, and cognitive factors. While methodological issues compromise the epistemic value of this evidence base, core questions also remain to be answered. Such questions include, but are not limited to, whether humans can form affectionate bonds to inanimate beings and whether these kind of mental health treatments should be understood as psychotherapy or something else. Researchers should therefore be cautious when applying theories of psychotherapy in the realm of conversational agents. We conclude the paper by introducing recommendations for future research, which we hope will help instigate methodologically sound studies in this field. (shrink)

Some argue that robots could never be sentient, and thus could never have intrinsic moral status. Others disagree, believing that robots indeed will be sentient and thus will have moral status. But a third group thinks that, even if robots could never have moral status, we still have a strong moral reason to treat some robots as if they do. Drawing on a Kantian argument for indirect animal rights, a number of technology ethicists contend that our treatment of anthropomorphic (...) or even animal-like robots could condition our treatment of humans: treat these robots well, as we would treat humans, or else risk eroding good moral behavior toward humans. But then, this argument also seems to justify giving rights to robots, even if robots lack intrinsic moral status. In recent years, however, this indirect argument in support of robot rights has drawn a number of objections. In this paper I have three goals. First, I will formulate and explicate the Kant-inspired indirect argument meant to support robot rights, making clearer than before its empirical commitments and philosophical presuppositions. Second, I will defend the argument against a number of objections. The result is the fullest explication and defense to date of this well-known and influential but often criticized argument. Third, however, I myself will raise a new concern about the argument’s use as a justification for robot rights. This concern is answerable to some extent, but it cannot be dismissed fully. It shows that, surprisingly, the argument’s advocates have reason to resist, at least somewhat, producing the sorts of robots that, on their view, ought to receive rights. (shrink)

According to the `grammatical account', scalar implicatures are triggered by a covert exhaustification operator present in logical form. This account covers considerable empirical ground, but there is a peculiar pattern that resists treatment given its usual implementation. The pattern centers on odd assertions like #"Most lions are mammals" and #"Some Italians come from a beautiful country", which seem to trigger implicatures in contexts where the enriched readings conflict with information in the common ground. Magri (2009, 2011) argues that, to (...) account for these cases, the basic grammatical approach has to be supplemented with the stipulations that exhaustification is obligatory and is based on formal computations which are blind to information in the common ground. In this paper, I argue that accounts of oddness should allow for the possibility of felicitous assertions that call for revision of the common ground, including explicit assertions of unusual beliefs such as "Most but not all lions are mammals" and "Some but not all Italians come from Italy". To adequately cover these and similar cases, I propose that Magri's version of the Grammatical account should be refined with the novel hypothesis that exhaustification triggers a bifurcation between presupposed (the negated relevant alternatives) and at-issue (the prejacent) content. The explanation of the full oddness pattern, including cases of felicitous proposals to revise the common ground, follows from the interaction between presupposed and at-issue content with an independently motivated constraint on accommodation. Finally, I argue that treating the exhaustification operator as a presupposition trigger helps solve various independent puzzles faced by extant grammatical accounts, and motivates a substantial revision of standard accounts of the overt exhaustifier "only". (shrink)

[What It’s Like, or What It’s About? The Place of Consciousness in the Material World] Summary: The book is both a survey of the contemporary debate and a defense of a distinctive position. Most philosophers nowadays assume that the focus of the philosophy of consciousness, its shared explanandum, is a certain property of experience variously called “phenomenal character,” “qualitative character,” “qualia” or “phenomenology,” understood in terms of what it is like to undergo the experience in question. Consciousness as defined in (...) terms of its phenomenal aspect is often called “phenomenal consciousness.” The major issue that occupies most thinkers is whether this phenomenal character happens to be a physical property, or whether it is rather sui generis. Those who believe the former are materialists; those who conclude the latter are dualists. As the currently dominant metaphysic is materialism – also sometimes called physicalism – the challenge appears to be to slot phenomenal properties among the physical properties that ultimately make up the world. David Chalmers argued powerfully that we can go very far in situating many mental properties in the physical world – namely, the properties that can be understood in functional terms – but that phenomenal properties resist such a treatment. Chalmers calls this “the hard problem” of consciousness. But there are also some quite powerful positive arguments for dualism. The two most influential ones are the modal argument, also offered by Chalmers, and the knowledge argument invented by Frank Jackson. Chalmers invites us to conceive of creatures that are exactly like human beings – physically, functionally, behaviorally – only bereft of phenomenal consciousness. If such creatures are conceivable, says Chalmers, they are metaphysically possible. And if they are metaphysically possible, materialism is false. Jackson, for his part, suggests we imagine Mary who has spent her entire life inside a black-and-white room and has seen the world through a black-and-white TV screen. But she also happens to know everything there is to know about the physics of color. And yet, Jackson suggests that once Mary is finally released from her room and sees a lawn outside, she learns something new: that this is what it is like to experience green color. The current work on consciousness is by and large characterized by attempts to answer these two dualistic arguments. I try to make sense of the positions within the domain of philosophy of consciousness by means of two major distinctions that mutually intersect. First, there is a distinction between dualism and materialism. An apparent third alternative currently on offer, the so-called Russellian monism, is unstable, collapsing into either dualism (panpsychism) or materialism (Russellian physicalism). Materialism comes in two main flavors: either the a posteriori physicalism, which detects an epistemic gap between phenomenal and physical truths, hence denying that the former could be derived from the latter; or the a priori physicalism, which does not acknowledge any such obstacle. The second major distinction is between phenomenism and representationalism. It’s true that Ned Block, who introduced this contrast, meant to distinguish between two kinds of materialism. But I believe that the distinction actually intersects the one between materialism and dualism. We thus arrive at a table with six slots, representing six main positions in the philosophy of consciousness: (1) dualist phenomenism (Chalmers, the early Jackson, and Tyler Burge); (2) dualist representationalism (René Descartes); (3) aposteriori materialist phenomenism (Block); (4) a posteriori materialist representationalism (Michael Tye, Fred Dretske, David Rosenthal); (5) a priori materialist phenomenism (David Lewis); and (6) a priori materialist representationalism (Daniel Dennett, Derk Pereboom). However, this scheme is in fact somewhat misleading. It is true that Dennett is usually classified as an apriori materialist (or, more precisely an apriori materialist representationalist), but I believe that needs to be corrected. In order to understand why, I first analyze varieties of materialist representationalism in detail, in particular various construals of phenomenal character in terms of representation, or intentionality, which includes a discussion of the identity of its content (the issue of externalism). By contrast, Dennett rejects the concept of phenomenal character. Consciousness has no intrinsic, publicly inaccessible properties. On that ground, Dennett builds an empirical, fully functionalist theory of consciousness, which he also tries to integrate within a general Darwinian framework. From that point of view, one can contrast Dennettian and representationalist views on the issue of animal consciousness. In addition to his rejection of phenomenal character, Dennett also abstains from the regular metaphysical departure point of regular materialism. He does not so much ask how an enigmatic property of consciousness fits an antecedently characterized world, but rather how far we can investigate all aspects of the world, including consciousness, using the scientific method. He is thus a methodological naturalist, rather than a metaphysical materialist. While this approach removes obstacles to the science of consciousness, it does not solve what might be called “the hardest problem” – of intentionality, not phenomenal consciousness. The hardest problem consists in the fact that our intentional discourse involves conflicting commitments that prevent a coherent metaphysic of representational states. However, it does not follow that we should give up on this discourse as a theoretical means of reduction as well as a practical tool of explanation. But it might be that intentional discourse is a somewhat pseudo one. (shrink)

In uttering a sentence we are often taken to assert more than its literal meaning — though we sometimes assert less. Robyn Carston and others take this phenomenon to show that what is said or asserted by a speaker on an occasion of utterance is usually a contextuallyenriched version of the semantic content of the sentence. I shall argue that we can resist this conclusion if we recognize that what we think we are asserting, or take others to be asserting, (...) involves selective attention to one of the ways a sentence could be true and neglects others. Most of the time people converge in their selective attention and so communication is not impaired. Though in the case of sentences involving predicates of taste, people’s attention to different aspect of the truth conditions leads to seemingly intractable disputes. I will propose a treatment of such cases on which speakers mean the same by a sentence, assert no more than its semantic content, hold conflicting opinions about its truth-value, and are both right. (shrink)

The scientific successes of the last 400 years strongly suggest a picture on which our scientific theories exhibit a layered structure of dependence and determination. Economics is dependent on and determined by psychology; psychology in its turn is, plausibly, dependent on and determined by biology; and so it goes. It is tempting to explain this layered structure of dependence and determination among our theories by appeal to a corresponding layered structure of dependence and determination among the entities putatively treated by (...) those theories. In this paper, I argue that we can resist this temptation: we can explain the sense in which, e.g., the biological truths are dependent on and determined by chemical truths without appealing to properly biological or chemical entities. This opens the door to a view on which, though there are more truths than just the purely physical truths, there are no entities, states, or properties other than the purely physical entities, states, and properties. I argue that some familiar strategies to explicate the idea of a layered structure of theories by appeal to reduction, ground, and truthmaking encounter difficulties. I then show how these difficulties point the way to a more satisfactory treatment which appeals to something very close to the notion of ground. Finally, I show how this treatment provides a theoretical setting in which we might fruitfully frame debates about which entities there really are. (shrink)