Stuart F. Spicker

Mental Health: Philosophical Perspectives

HANNAH S. DECKER, Freud in Germany. Revolution and reaction in science, 1893-1907, New York, International Universities Press, 1977, (Psychological Issues, vol. 11, no. 1, monograph 41), 8vo, pp. xi, 361, [no price stated]. The reception of Freud and his new psycho-analysis by different countries makes an interesting study. The author is concerned here only with Germanys reaction, and is dealing with a challenge to the established order, as was the case elsewhere. It follows that the process is of great complexity, the most significant factor being Victorian attitudes towards sexuality and childhood, predominantly repression and hypocrisy concerning the former. This book is concerned mainly with the medical reception of psycho-analysis, but the second portion investigates the early interaction of experimental psychology and psycho-analysis, which reveals interesting differences. The third section concerns the response of the educated German public, and finally the author discusses certain significant nineteenth-century intellectual trends vital to the reception of psychoanalysis in Germany. The text is well written and documented, but the author, being committed to the technique, is not able to be critical enough of it.

New Knowledge in the Biomedical Sciences

What do you do to start reading new knowledge in the biomedical sciences? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. Its not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this new knowledge in the biomedical sciences.

The Lived-Body as Catalytic Agent: Reaction at the Interface of Medicine and Philosophy

Throughout the history of Occidental philosophy one generation after another (including philosophers as well as physicians) has had to suffer the tyranny of spiritualistic metaphysics, what Edmund Husserl, the founder of 20th century phenomenological philosophy, called “historically degenerate” metaphysics.1 I hasten to qualify this assertion by adding that such suffering, in my judgment, need not be alleviated by the questionable practice of euthanasia on the part of contemporary philosophers, although one may well make the case that negative euthanasia2 is justified in the case of a speculative metaphysics which has produced little more than an emptily formal ontology. Yet this harsh judgment need not entail the conclusion that Metaphysics uberhaupt, to which some physicians and philosophers have, regrettably, an aversion, be henceforth rejected and abandoned. Indeed, it is one of the aims of this essay to make plausible and palatable the claim that Metaphysics or First Philosophy is in fact intimately bound to Medicine3 at their interface — the lived human body — and that this is at once identical with the initial aspirations of both philosophy and medicine, qualified by the exclusion of what Husserl called “all speculative excesses.” 4

Invulnerability and Medicine’s “Promise” of Immortality: Changing Images of the Human Body during the Growth of Medical Knowledge

Historians in all likelihood would not easily reach a consensus if asked to locate temporally the transition to contemporary medicine, since various criteria could be selected in terms of which contemporary medicine (1900+) might be identified as having come into being (I am, of course, referring neither to “modern” nor to Oriental medicine). In order to avoid this debate, however interesting it may prove to be, and thereby to by-pass this certain challenge from medical historians, I simply confess my bias at the outset: the origin of contemporary medicine is typically and not inappropriately identified by the general public as having its origins in the discovery of new knowledge concerning the cellular and sub-cellular mechanisms that govern organic pathology, i.e., infection in the body, as well as even more recent knowledge of the appropriate use of particular instruments invented, developed, and refined for a wide variety of surgical and other technological interventions, which, it turns out, is virtually synonymous with the emergence of contemporary medical power — having passed through a very extended epoch of “medico-technical powerlessness” [“medisch-technische onmacht”] (Dutch [17], p.2).

The Bearing of Prognosis on the Ethics of Medicine: Congenital Anomalies, the Social Context and the Law

In their retrospective evaluation of clinical rounds in medical ethics at Children’s Hospital Medical Center in Boston, Melvin Levine, Lee Scott and William Curran surveyed the most frequently recurring issue which emerged in these sessions over a five-year period. Among some 17 issues and topics the question ‘Who should decide?’ emerged most frequently (37%). ‘Acting on uncertain prognosis’ involved only 6% of the cases and ranked in the 16th position ([24], p. 204). The point of interest here is the tendency of the researchers to qualify the topic of prognosis with the term ‘uncertain’. The underlying assumption is clear: prognostications are typically uncertain since they are based on what Dr. Mark Siegler calls ‘subjective appraisals’ ([43], p. 857). There is a tendency to assume that prognoses are in principle highly uncertain. This prevailing attitude perhaps accounts for the fact that many physicians consider prognoses as not really helpful and at times even harmful. This latter view is supported by arguments in Dr. Siegler’s essay “Pascal’s Wager and the Hanging of Crepe” [43].

Intuition and the Process of Medical Diagnosis: The Quest for Explicit Knowledge in the Technological Era

Bertrand Russell once remarked that “Philosophy, like all other studies, aims primarily at knowledge. The knowledge it aims at is the kind of knowledge which gives unity and system to the body of the sciences, and the kind which results from a critical examination of the grounds of our convictions, prejudices and beliefs” ([10], p. 154). It is unlikely that Russell had medicine in mind when he referred to “all other studies”, for it has always been a commonplace that attending physicians aim primarily at the restoration and preservation of health rather than at knowledge. As it is an indispensable part of this principal aim, however, physicians—since the days of the ancient school of Hippocrates of Cos—have been concerned with diagnosis, and in this sense at least gnosis still preoccupies members of the medical profession. For the practicing physician, the time between a patient’s complaint and the initiation of a therapeutic regimen is occupied by a search for knowledge, though at this point it is a more utilitarian, pragmatic, or practical knowledge than Russell had in mind.

Ethics in Diagnosis: Bodily Integrity, Trust-Telling, and the Good Physician

In addition to the acquisition of differential knowledge on the part of a physician, medical diagnosis depends on the subtleties of the patient-physician encounter, the prevailing nosological and conceptual systems in which this encounter occurs, the current status of biomedical research, and the physician’s reliance on the accuracy, reliability, and validity of the available laboratory analyses. Indeed, one can also make the case that the process of medical diagnosis tacitly involves the normative presuppositions of the medical context, the uncertainties of questionable diagnoses that may lead to ill-effects (including the physician’s failure to obtain peer and family approval rooted in a lack of confidence in his or her diagnostic competence), the values of other health care practitioners involved in a patient’s case, the diagnostic modalities available in the clinical setting in which specific medical acts take place, and even postmortem procedures [8] (when no treatment is possible) as propaedeutic to future diagnoses that are often forgotten but critical to public health problems like today’s AIDS epidemic.

Research Risks, Randomization, and Risks to Research: Reflections on the Prudential Use of “Pilot” Trials

I should like to begin my comment and response to Professor Engelhardt by following his method, and ask you briefly to consider an episode from the history of the acquisition of scientific knowledge — but from a slightly different perspective and for somewhat other reasons than Dr. Engelhardt’s excursion into the past. That is, we might take a moment to reflect on the compelling concerns of the past, which, over time, have led to this volume with its principal themes and which make them important enough to warrant our extensive time and energy as we speak and write to the multifarious issues germane to the general topic — the use of human beings in research [39] [42]. For these many issues have been and still are being treated not only in Israel and the United States, but throughout the world wherever support for such research is available. I turn, then, to the early 17th century. The two methods which we have now stated have many features of resemblance, but there are also many distinctions between them. Both are methods of elimination. This term... is well suited to express the operation, analogous to this, which has been understood since the time of Bacon to be the foundation of experimental inquiry, namely, the successive exclusion of the various circumstances which are found to accompany a phenomenon in a given instance, in order to ascertain what are those among them which can be absent consistently with the existence of the phenomenon. The Method of Agreement stands on the ground that whatever can be eliminated is not connected with the phenomenon by any law. The Method of Difference has for its foundation, that whatever cannot be eliminated is connected with the phenomenon by a law. Of these methods, that of Difference is more particularly a method of artificial experiment ([33], p. 256). John Stuart Mill — A System of Logic (1843)

Causes, Effects, and Side Effects: Choosing Between the Better and the Best

Through the history of Western thought, philosophers and physicians have explored the nature of causation and the general relation that obatains between effects and causes. They have sought to discover causal relationships and even causal laws. Physicians have, however, not conducted themselves as pure scientists. They have, instead, attended to causes through a grid of value judgments embedded in particular practices of curing and caring. As has been argued in comparisons of law and medicine, these non-epistemic goals direc the language of causation in applied disciplines [4].

The Execution of Euthanasia: The Right of the Dying to a Re-Formed Health Care Context

At risk of overstatement a physician and historian of medicine, Chester R. Burns, the past President of the Society for Health and Human Values, remarked that “Contemporary man is transforming death from a taboo to an obscenity” ([5], p. 3). As he rightly observes, there are books, articles, symposia, editorials, societies, panel discussions, political caucuses expressing ideologies and hospices. Distinguishing as we should the phenomenon of death from the concept and language in which the concept reveals itself, it is the latter which is in danger of becoming indecent, impure, and even obscene. The phenomenon of death was never taboo. However, only the explicit bringing to consciousness of the latent affect associated with the phenomenon was forbidden. Indeed, in many quarters the topic is still very much taboo, in spite of the fact that many of us move in circles where the phenomenon of death is “discussed.” We should not, after all, assume that our particular social nexus is typical. In truth it is more correct to say that authentic and open talk about death is still taboo and, especially in academic circles, at times even obscene. The reality, in short, is expressed by the conjunctive.