Theoretical medicine最新文献

Intersubjectivity, the cooperation of two or more minds, is basic to human behavior, yet eludes the grasp of psychiatry. This paper traces the dilemma to the "problem of other minds" assumed with the epistemologies of modern science. It presents the solution of Wittgenstein's later philosophy, known for his treatment of other minds in terms of "human agreement in language." Unlike recent studies of "Wittgenstein's psychology," this one reviews the Philosophical Investigations' "private language argument," the crux of his mature views on mind. It reads that argument as recording his shift from the modern egocentric paradigm of mind to an intersubjective one. The paper contrasts the merits of Wittgenstein's reduction of subject and object to grammar with the problems of Freud's metapsychological reduction. It shows how Wittgenstein's intersubjective method avoids the excesses of behaviorism and phenomenology, offering a specifically human way to adapt mechanistic and interpretive means to the communicative ends of psychiatry.

The medical specialty of psychiatry should possess a basic science in which pathologies are considered deviations from normal brain physiology. Historically, psychoanalytic pathogenesis was considered separately from brain physiology. It was not scientific because observations could not be refuted. Countering this, Eli Robins's legacy stemmed partly from his having been damaged by a psychoanalyst. It eschewed pathogenesis. Attempting to integrate psychiatry with medicine more generally, Robins and colleagues refocused on empiricism, although they acknowledged the brain's centrality. Here I hold that the term biology used in the context of psychiatry should broadly encompass social facets of organismal function. The term "sociophysiology" may best describe the central basic science of psychiatry because it alludes to brain functions used for the person's social realm. Disruptions of such functions result in deviant behaviors and unpleasant feelings which psychiatrists diagnose and treat. Future study encompassing top-down and bottom-up research should include genome-neural-behavioral analyses.

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered.

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

The reflections put forward in this text concern the clinical and practical difficulties posed by the existence of patients in PVS, and the essential ethical issues raised, combining these ethical questions with practical and theoretical experience. Section 1 presents the methodology of the ethical reflection as we see it. Section 2 describes the clinical condition of patients in PVS. Section 3 develops the ethical difficulties relative to PVS from the French point of view. Section 4 illustrates the relevance of debating the ethical significance of such problematic situations, whilst defending a practical position based on a philosophical conviction. Section 5 points out the limits of ethical reflection in a biomedical context, and calls for reflection closer to the source of the problems described. For a comprehensive appraisal of biomedical rationality, the final section suggests combining the bioethical debates with traditional philosophical ethical reflection so as to get a clearer understanding of the real, if limited, relevance of these debates.