Qualitative Cancer Genetic Counseling Research, Part I: Ethnography in a Cancer Clinic

This is a report of the experience of several months' ethnographic research by a genetic counselor researcher in a cancer treatment clinic. One goal of the exercise was to directly experience a method of qualitative research known as ethnography, which relies heavily on participant-observation, in an applied clinical setting. Another goal was to explore a previously undescribed research area in the genetic counseling literature, namely, the meaning of cancer and cancer treatment for affected individuals and their support companions. Here we report on a personal account of the experiences of conducting and publishing the research. The preliminary analysis and results of this field experience are published elsewhere (Peters et al. (2001) J Genet Counsel 10(2):151–168.). These initial findings support the feasibility of genetic counselors, who are trained in specific social science methodologies, to conduct qualitative research pertinent to genetic counseling practice.This work was completed at the University of Pittsburgh before employment at the National Cancer Institute (NCI) and does not represent the views of the NCI, the National Institutes of Health, the Department of Health and Human Services, or the Federal Government     

Trust,Reliance, and Democracy

Abstract

From the perspective of philosophy and political science it is often pointed out that trust is of central value for democracy. The paper critically examines this claim and argues that we should not overestimate the role of trust in democracy. In order to do that, I argue for a specific understanding of the notion of trust that appropriately accounts for the distinction between trust and mere reliance. In a second step, I argue that we have no reason to put this kind of trust in our elected officials and representatives, but should instead focus on legislative and institutional ways to make sure that they are reliable in particular respects. After contrasting my suggestion with the position of Hardin, I point to two advantages of my account: (1) The avoidance of political analysis through the lens of trust allows us to react more flexibly to unforeseen circumstances and resist populist attempts to emotionalize public debates; (2) at the same time, diffusing the tension between trust and civic vigilance solves a systematic problem in political philosophy. In a concluding section, I briefly discuss the question whether there is an alternative role for trust to play in the field of politics.     

Transformative Choice,Practical Reasons and Trust

Abstract

In this article I reflect on the question of whether we can have reason to make transformative choices. In attempting to answer it, I do three things. First, I bring forward an internalist account of practical reasons which entails the idea that agents should deliberate to the best of their ability. Second, I discuss L.A. Paul’s views on transformative choice, arguing that, although they present a real problem, the problem is not as profound as she believes it is. Third, I argue that, given the situation in which we face transformative choices (a situation of principled uncertainty though not cluelessness), trust is an appropriate response to transformative choices, and that when one’s trust that one’s current desires will be fulfilled in making a transformative choice is reasonable, one has a reason to make it. Thus, trust turns out to be a crucial response to a profound problem each of us will face during our lives.     

Other voices,other minds

I argue to a conclusion I find at once surprising and intuitive: although many considerations show trust useful, valuable, important, or required, these are not the reasons for which one trusts a particular person to do a particular thing. The reasons for which one trusts a particular person on a particular occasion concern, not the value, importance, or necessity of trust itself, but rather the trustworthiness of the person in question in the matter at hand. In fact, I will suggest that the degree to which you trust a particular person to do a particular thing will vary inversely with the degree to which you must rely, for the motivation or justification of your trusting response, on reasons that concern the importance, or value, or necessity of having such a response.     

Health-Risking Social Behaviors: Moving Forward

The National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) have a long history of supporting investigator-initiated research and research training to enhance the scientific understanding of and effective interventions for a range of problems associated with youth violence. New technologies are emerging and basic research has promise for increasing our understanding of how biological factors operate in conjunction with other factors to contribute to violent behavior, psychopathology, and drug abuse. This article describes emerging areas and directions for research in this important area of public health.The views expressed are those of the authors and do not necessarily represent those of the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government.     

Close Calls and the Confident Agent: Free Will, Deliberation, and Alternative Possibilities

Two intuitions lie at the heart of our conception of free will. One intuition locates free will in our ability to deliberate effectively and control our actions accordingly: the ‘Deliberation and Control’ (DC) condition. The other intuition is that free will requires the existence of alternative possibilities for choice: the AP condition. These intuitions seem to conflict when, for instance, we deliberate well to decide what to do, and we do not want it to be possible to act in some other way. I suggest that intuitions about the AP condition arise when we face ‘close calls,’ situations in which, after deliberating, we still do not know what we really want to do. Indeed, several incompatibilists suggest such close calls are necessary for free will. I challenge this suggestion by describing a ‘confident agent’ who, after deliberating, always feels confident about what to do (and can then control her actions accordingly). Because she maximally satisfies the DC condition, she does not face close calls, and the intuition that the AP condition is essential for free will does not seem to apply to her. I conclude that intuitions about the importance of the AP condition rest on our experiences of close calls and arise precisely to the extent that our deliberations fail to arrive at a clear decision. I then raise and respond to several objections to this thought experiment and its relevance to the free will debate.     

"On my bed at night I sought him whom my heart loves"" reflections on trust, horror, G*d, and the queer body in vowed religious life

What can the multifaceted bouquet of queer love reveal about G*d? In this paper I wish to answer this question by reflecting on the queer body of the male vowed religious. I will argue that, since gendering is a key feature in our attempts to create epistemic order, the performance of gender instability in turn destabilizes our attempts to create epistemic order. In short: gender trouble leads to epistemic trouble. Far from being only a passive sign for these troubles, the male religious body, which is stylized by renouncing penetration, is also a field for the active experience of the horror and the need for trust implied in our fragile epistemic situation. Both trust and horror can be interpreted as an experience of the Dark Night, as the experiential side of Negative Theology. I will argue that the grace that we as queer men and women in general contribute to the Church is that we are pointing to and living out the fundamental reality of epistemic uncertainty and the troubling necessity of trust.     

Discussion of “On Deconstructive Interventions” by R. M. Billow

This discussion challenges the importation of ideas from other disciplines such as philosophy to group psychotherapy. I do not suggest that there should be no engagement with these other domains; inevitably, it does occur. Rather, I am suggesting that such theoretical support may not necessarily add to our practical as well as our theoretical knowledge and should therefore be used only when ideas from within our own field do not suffice.     

Moral Learning,Rationality, and the Unreliability of Affect

James Woodward and John Allman [2007, 2008] and Peter Railton [2014, 2016] argue that our moral intuitions are products of sophisticated rational learning systems. I investigate the implications that this discovery has for intuition-based philosophical methodologies. Instead of vindicating the conservative use of intuitions in philosophy, I argue that what I call the rational learning strategy fails to show philosophers are justified in appealing to their moral intuitions in philosophical arguments without giving reasons why those intuitions are trustworthy. Despite the fact that our intuitions are outputs of surprisingly sophisticated learning mechanisms, we do not have reason to unreflectively trust them when offering arguments in moral philosophy.     

Free Will,Determinism, and the Possibility of Doing Otherwise

I argue that free will and determinism are compatible, even when we take free will to require the ability to do otherwise and even when we interpret that ability modally, as the possibility of doing otherwise, and not just conditionally or dispositionally. My argument draws on a distinction between physical and agential possibility. Although in a deterministic world only one future sequence of events is physically possible for each state of the world, the more coarsely defined state of an agent and his or her environment can be consistent with more than one such sequence, and thus different actions can be “agentially possible”. The agential perspective is supported by our best theories of human behaviour, and so we should take it at face value when we refer to what an agent can and cannot do. On the picture I defend, free will is not a physical phenomenon, but a higher‐level one on a par with other higher‐level phenomena such as agency and intentionality.     

Partiality and prejudice in trusting

You can trust your friends. You should trust your friends. Not all of your friends all of the time: you can reasonably trust different friends to different degrees, and in different domains. Still, we often trust our friends, and it is often reasonable to do so. Why is this? In this paper I explore how and whether friendship gives us reasons to trust our friends, reasons which may outstrip or conflict with our epistemic reasons. In the final section, I will sketch some related questions concerning trust based on the trustee’s race, gender, or other social identity.     

A framework for assessing program institutionalization

This article presents a framework for assessing the institutionalization of programmatic innovations in nonprofit community agencies and in schools. Institutionalization is the attainment of long-term viability and integration of innovations in organizations. Institutionalization is often characterized as the final stage in an innovation diffusion process. The framework was derived from a qualitative study of ten health promotion programs that were innovations in their host organizations. The framework is a two dimensional matrix: one dimension consists of organizational subsystems; the other consists of levels of institutionalization termed passages, routines, and niche saturation. The cells of the matrix are the basis for assessing program institutionalization. Robert M. Goodman is a research assistant professor in the Department of Health Behavior and Health Education at the University of North Carolina's School of Public Health. Currently, Dr. Goodman directs a four-year intervention study on the dissemination of tobacco prevention curricular funded by the National Cancer Institute. Allan Steckler is an associate professor in the Department of Health Behavior and Health Education at the University of North Carolina's School of Public Health. Dr. Steckler is also the principal investigator of the National Cancer Institute tobacco prevention study.     

Rawls,Sartre, and the Question of Camaraderie

In his classic text, A Theory of Justice, John Rawls argues that the structural principles of a society are just when they issue from a procedure that is fair. One crucial feature that makes the procedure fair is that the persons who will be subjected to these principles choose them after they have deliberated together in a condition marked by a certain balance of knowledge and ignorance. In particular, these people know enough to consider principles that are workable, yet converse behind a “veil of ignorance,” unable to predict what their place in society will be and hence discouraged from slanting the principles toward any preferential interests. My paper questions whether this attempt to ensure the disinterestedness of the conversation of justice is feasible. I worry that when we approach this question practically, we discover that the education that furnishes us with the knowledge necessary to choose viable principles must at the same time preclude genuine ignorance about our social position and interests. As an alternative, I suggest that we convene the conversation of justice behind a “veil of existence.” In this condition, people possess knowledge about how their society works and even about their places in it; however, this knowledge does not foster preferential interests because all interests are subjected to the question of their existential meaning. As Jean-Paul Sartre explains in his essay, “Existentialism is a Humanism,” for our interests to be truly meaningful, they must be affirmed as free responses to our thrownness into existence. Yet how do we find the wherewithal to make such responsible choices rather than lapse into paralysis before their essentially arbitrary differences? My positive thesis is that we may do so by acknowledging how all of us in this existential predicament critically and mutually provoke each to commit oneself to depart from the others in specific ways. This process of provocation is thus educational. It broaches a conception of non-instrumental, non-mimetic, liberal study, one which I try to enact in a writing that employs direct address, regular returns to questions that put discourse at a loss, and expanding webs of association. In this manner, I hope to demonstrate that liberal study may deepen our appreciation of our communal nature, our camaraderie, and thus motivate us to participate unselfishly in the conversation of justice.     

A Critique of Dependence Concepts. Review of Multivariate Models and Dependence Concepts, by Harry Joe

Harry Joe in the Department of Statistics, University of British Columbia, is an expert on the topic of multivariate dependence concepts. He received his Ph.D. in statistics from Florida State University. Professor Joe has taught a graduate course entitled Multivariate Models for Non-normal Response, with Covariates at both the University of Pittsburgh and the University of British Columbia. The current book is based in part on the materials developed for that course.  Ram Shanmugam was an associate professor in the Department of Mathematics at the University of Colorado when this review was completed. He has been actively engaged in both teaching and research work in multivariate statistics. He is an elected fellow of the International Statistical Institute.     

关系持续预期与规范目标激活：合适性逻辑下的信任决策

人际互动过程中,信任作为决策过程受到诸多因素的影响,信任的决策逻辑在不同的研究背景中存在冲突。本研究以合适性为信任决策框架,互动关系为激活规范目标的变量,分析了存在互动关系持续预期和不存在互动关系持续预期对信任行为的影响及其影响机制。结果表明：（1）被试间存在关系持续时,信任水平较高;关系持续预期消失时,信任水平显著下降。（2）被试对关系持续的重要性感知与其信任决策显著相关。（3）情境中的目标未被激活时,个体的信任倾向与信任决策显著相关;而当情境目标被激活时,信任倾向与信任决策相关不显著。     

You Can Get Here From There

This paper is a review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychoanalytic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psycho-analyst—my first ambition and great love.     

Women,men, and aggression in an egalitarian society

Vanatinai, a small island society off New Guinea, is egalitarian, with no indigenous formal systems of rank or authority. Assertiveness and autonomy are highly valued as personal qualities and equivalent for males and females. Overt aggression is condemned and violence is rare. Women were the aggressors in four out of five incidents over ten years. Sexual jealousy was the dominant motif in all five cases. This article considers, in historical contexts, indigenous concepts of the gendered person and their relations to anger, violence, and the supernatural aggression of sorcery and witchcraft. The Vanatinai case is evidence that the rarity of intragroup violence, especially of attacks by men on women, is a characteristic of egalitarian societies.An earlier version of this paper was read at the Session on Female Aggression at the American Anthropological Association Annual Meeting, Chicago, in November 1991. I would like to thank session participants, Douglas Fry, Victoria Burbank, Robert Lepowsky, Florence Lepowsky, and the anonymous reviewers forSex Roles for their helpful comments at various points. The fieldwork in Papua New Guinea on which this paper is based was carried out over a total of eighteen months in 1977–1979, 1981, and 1987. I gratefully acknowledge the financial support of the National Science Foundation, Chancellor's Patent Fund and Department of Anthropology of the University of California, Berkeley, the Papua New Guinea Institute of Applied Social and Economic Research, the National Institute of Child Health and Human Development of the National Institutes of Health, the Wenner-Gren Foundation, and the Graduate School of the University of Wisconsin, Madison.     

信任以稀为贵?下属感知被信任如何以及何时导致反生产行为

感知被信任是信任相关研究中的重要组成部分, 近年来逐渐受到研究者们的重视。以往研究大多认为, 下属感知被上司信任对下属自身以及组织整体都会产生积极影响, 却忽视了其潜在的负面影响。基于自我评价理论, 本文采用实验研究(研究1、2)与多时间点、多源的实地问卷调查(研究3), 探讨了下属感知被信任的潜在黑暗面。研究结果表明：下属感知被信任会引发下属心理权利感, 进而增加其反生产行为, 下属感知到信任的稀缺性在这一过程中起调节作用。具体来说, 当下属感知到信任的稀缺性较高时, 下属感知被信任通过心理权利感影响其反生产行为的正向中介效应显著; 而当下属感知到信任的稀缺性较低时, 上述中介效应不显著。本研究发现了感知被信任的潜在负面影响, 并明确了其对反生产行为的作用机制与边界条件, 为感知被信任相关研究提供了更加全面、辩证的研究视角, 同时也扩展了心理权利感和反生产行为的相关研究。     

Something-We-Know-Not-What,Something-We-Know-Not-Why: Berkeley,Meaning and Minds

It is sometimes suggested that Berkeley adheres to an empirical criterion of meaning, on which a term is meaningful just in case it signifies an idea (i.e., an immediate object of perceptual experience). This criterion is thought to underlie his rejection of the term ‘matter’ as meaningless. As is well known, Berkeley thinks that it is impossible to perceive matter. If one cannot perceive matter, then, per Berkeley, one can have no idea of it; if one can have no idea of it, then one cannot speak meaningfully of it. But if this is Berkeley’s position, then there is a puzzle, because Berkeley also explicitly claims that it is impossible to perceive/have ideas of minds. So if he is relying on a criterion on which terms get their meaning by referring to ideas, then, just as Berkeley rejects talk of material substance, so, too, must he reject talk of mental substance. Famously, however, Berkeley insists that there is no parity between the cases of material and mental substance. It is typically suggested that the disparity between matter and minds rests on the fact that although one cannot strictly speaking perceive minds, nonetheless Berkeley thinks that one can have experiential access to minds via reflection, and that this access allows for meaningful talk of minds. Of course, one can only have reflective experience of one’s own mind. But what of other minds, which one cannot reflectively experience? Here the usual tactic is to suppose that, although one cannot have direct reflective experience of other minds, nonetheless one can indirectly experience such minds via analogy to our own minds, and that this indirect experience grounds the meaningfulness of talk of other minds. In this paper, I argue that the reasoning behind Berkeley’s ‘likeness principle,’ that an idea can only be like another idea, can be generalized to argue against this experience-based account of our access to other minds. I claim instead that Berkeley allows for the meaningfulness of talk of other minds by expanding the criterion of meaning in a different way. I argue that Berkeley holds a criterion of meaning on which a term is meaningful just in case it signifies either an object of experience or an object that one has reason to posit on the basis of experience, i.e., an object that is necessary to explain our experiences. When an object is neither experienced nor explains our experiences, then and only then is Berkeley willing to reject it as meaningless. Thus he writes of “the word matter,” that “it is no matter whether there is such a thing or no, since it no way concerns us: and I do not see the advantage there is in disputing about we know not what, and we know not why” (Principles, §77.) The word is not meaningless merely because we do not know what matter might be; it is meaningless because we also do not know why it should be. Correspondingly, I argue that the term ‘mind’ is meaningful because although we have no experience of minds, nonetheless they play an important role in explaining our experiences.