Empowerment,agency, and power

As ‘empowerment’ and ‘agency’ have received wider usage within development research and policy, ambiguities and variant meanings have proliferated. Amidst this conceptual drift, there has also been a tendency to assimilate the two concepts. This tendency is problematic in a number of ways. First, ‘agency’ has various meanings, and the weakest of these captures little of the concept of empowerment. Second, empowerment has a conceptual link with well-being that agency cannot have. Third, when empowerment is assimilated with expanded agency, that agency is not considered in a relational way: the focus is on how the agency of a group or individual becomes greater than it was, not on the degree to which their agency is dependent on or dominated by the agency of others. If ‘empowerment’ no longer refers to social relations, it loses its direct relevance to the transformation of those relations and, as some critics have claimed, it ceases to be a ‘transformative’ concept. After showing that there are cases of empowerment that cannot be captured by conceptions of empowerment that ‘take power out’, I draw upon the capability approach to propose relational conceptions of agency and empowerment that ‘bring power back in’.     

专家医生的知识结构及诊断推理方式

医学专长研究中“中间者效应”的发现,引发了研究者对专家医生知识结构的探讨。在“知识打包”的基础上,医生的临床知识以“疾病脚本”的方式组织起来。随着临床经验的增加,专家医生积累了丰富的疾病脚本。在临床诊断中,他们无需对病人所有的体征和症状进行仔细地和系统地分析,而是通过非分析性的推理方式——“模式识别”或“样例识别”便可自动激活与之匹配的疾病脚本,据此对病人做出迅速而准确的诊断。医学专长的本质就在于专家医生以“疾病脚本”的方式组织起来的知识结构。“适应性专长”代表了未来医学专长研究的新方向     

Being ‘Spiritual’ and Being ‘Religious’ in Europe: Diverging Life Orientations

The present study shows that being ‘spiritual’ and being ‘religious’ are becoming different life orientations for a large part of the population. As far as we know, for the first time, a sample from an European country shows that these orientations are reflected in two coherent clusters of beliefs, experiences, and practices of what we call ‘new spirituality’ on the one hand and ‘traditional, church-related religion’ on the other hand. In addition, it appears that ‘only spiritual’ (and not ‘religious’) people and ‘only religious’ (and not ‘spiritual’) people have less ‘intensive’ spiritual/religious lives than people who describe themselves as ‘both spiritual and religious’. The ‘both’ category is not homogenous, probably as a result of the different associations which its members have of the conceptions of ‘spiritual’ and ‘religious’. The people in this category can be sub-divided in two sub-groups which show different profiles.     

The Gift of the Non aliud: Creation from Nothing as a Metaphysics of Abundance

Although the doctrine of creation from nothing may seem to instantiate a metaphysics of privation, in which the creature’s existence is ultimately one of humiliation, further reflection shows that this conclusion is not justified. For God to be over against the creature as an other who might threaten its autonomy in this way would imply a gap between God’s will and creaturely substance that is inconsistent with creation ex nihilo, according to which creatures are other than God, but God, as the exclusive ground of creaturely existence, is ‘Not other’ than they. This point disrupts the relationships of privation or dependence that mark inner‐worldly acts of creating. To be (always only partly) dependent on a created other is indeed to be revealed as less than sufficient unto oneself; but to be (wholly) dependent on the ‘Not other’ is to be fully sufficient to fulfil the promise of one’s existence.     

Being marked as different: The emotional politics of experiences of depression and migrant belongings

This article asks the question: “What does it mean to think about ‘home’ and ‘belonging’ when migratory experience is enmeshed with the story of depression?”. The article focuses on the personal story of a woman who migrated from the United States (US) to Australia, and whose sense of disconnection and displacement in relation to everyday life is embedded within a narrative of depression. Our discussion of her twin narratives of emotional distress and migration is located within theoretical debates about depression, migration and the constitution of subjectivity. In particular, we draw on psychoanalytical approaches to subjectivity to argue that her emotional distress and the medical diagnosis of depression together represent a form of ‘experienc[ing] oneself as a subject’ (Butler, 2005), and function as a precondition to her narrative of migration. Ultimately, we conclude, the woman's intertwined narratives of depression and migration operate simultaneously to provide retroactive order to her subjectivity.     

Life,the Unhistorical,the Suprahistorical: Nietzsche on History

Abstract

Nietzsche was a philosopher who prided himself, in deliberate contradistinction with previous philosophers, on his ‘historical sense’. But this leaves many questions unanswered about the precise role of the historical in Nietzsche’s philosophy. Perhaps most importantly, can the conception of genealogy in Nietzsche’s later philosophy, as a revised historical method, be taken to represent his mature philosophical methodology in general? I argue, firstly, that there is considerable continuity between Nietzsche’s conceptions of history in the early essay ‘On the uses and disadvantages of history for life’ and those of his later philosophy. The former can therefore be used as a resource for understanding the latter. Through a reading of the early history essay I demonstrate that Nietzsche’s conception of the historical here is intimately bound up with the notion of the ‘unhistorical’ and that it is precisely renewed access to the unhistorical which is required in order for history to be conducive to the flourishing of humanity. I go on to contend that this holds for Nietzsche’s later writings as well, and that genealogy, being purely historical, must therefore be seen as one subsidiary part of a broader philosophy in which the unhistorical will play, literally, a vital role.     

An objection to gareth evans' account of self-identity

In chapter seven ‘Self Identification’ of his challenging book The Varieties of Reference, Gareth Evans attempts to give an account of how it is that one is able to think about oneself self‐consciously. On Evans’ view, when one attempts to think of oneself self‐consciously that person is having what he calls an ‘I’ thought. Since these ‘I’ thoughts are a case of reference, more specifically self‐reference, Evans thinks that these thoughts can be explained by employing the same theoretical framework that he uses to explain other kinds of reference. Evans thinks all thoughts are essentially structured, and this means that they must fall under his ‘generality constraint’. Since ‘I’ thoughts are also ‘thoughts’ they are essentially structured as well, and they too must be subject to the generality constraint. The radical implication of this is that Evans thinks that if ‘I’ thoughts are subject to the generality constraint, then he can show that self‐reference must be reference to a thing which we can locate on a spatio‐temporal map. In this article I hope to accomplish three things. First, I will spell out in detail the argument Evans uses to arrive at his claim that self‐reference must be reference to something located on a spatio‐temporal map. Second, I will raise an objection, which states that Evans’ conclusion that self‐reference must involve spatio‐temporal location is not a consequence of the generality constraint. Finally I will argue that Evans’ conclusion that self‐reference must involve spatio‐temporal location is in fact in tension with the generality constraint, rather than being an implication of it.     

An internalist view on the value of life and some tricky cases relevant to it

If we understand death as the irreversible loss of the good of life, we can give meaning to the idea that for suffering patients in the end stage of their illness, life may become an evil and death no longer a threat. Life may lose its good already in the living person. But what does the good of life consist in, then? I defend an internalist view according to which the goodness of life is intrinsically related to the attitudes, concerns, interests and experiences of the person who is leading the life. This results in the contention that the core of what we understand as the value of a person’s life is to be identified with what makes life go well for the person living the particular life. This internalist view does not presuppose (or imply) hedonism or mentalism, nor does it pose an experience requirement. Something may be good for you, because it is valuable as seen from your authentic viewpoint, even if you do not actually experience this goodness, or think otherwise because you are mistaken about your own well‐being. To test this position, and the authenticity‐requirement it includes, I discuss three cases of patients who are persistent in denying that in their life any value is left and who contend that death is no worse than further living. Internalism acknowledges that in the life of these patients there may be ’functionings’ and ’beings’ that are worthwhile, where the test of value is at least partially independent of subjective assessment. Still, internalism claims that something truly valuable can only contribute to the good of one’s life of it has positive meaning as seen from the attitudinal viewpoint that identifies oneself.     

Life-World,Sub-Worlds,After-Worlds: The Various ‘Realnesses’ of Multiple Realities

This paper will discuss the correlation between the world of everyday life, finite provinces of meaning, and religion. To this end, the paper will start out by explaining Schutz’ considerations on “paramount reality” of the world of everyday life as well as the theory of “multiple realities” and “finite provinces of meaning”. Schutz’ considerations will then be elaborated upon and taken a step further in a discussion of the various ‘realnesses’ of the multiple realities. Special attention will be paid to a finite province of meaning only mentioned in passing by Schutz: religion. The paper will first analyze the special features of religion as a finite province of meaning and highlight the correlation it enters with the world of everyday life. Subsequently, hereafter and paradise conceptions will be described as “ultimate provinces of meaning,” and it will be shown how their realnesses connect to the world of everyday life. Finally, the “fundamental anxiety” will be studied as the motor of the relevance structures of the world of everyday life, the finite provinces of meaning as well as the hereafter conceptions.     

The Pain of Dying

SUMMARY

Dying can be a painful and difficult business. Fears, hopes, losses, questions, and uncertainty result in a form of pain that lies beyond the therapeutic reach of science and pharmacology. Efforts to preserve and prolong life or to make things better can sometimes result in this pain being overlooked or remaining unheard. To search the deepest part of oneself is the journey that beckons us all as we are dying. Within this space resides the source of our own suffering but also the seeds for healing. This exploration has a momentum of its own but requires conditions not often found within the biomedical paradigm. If this model of care remains the only source of hope for those with a life-threatening illness, ‘the pain of dying’ may not be addressed.     

Geographies of Meaningful Living

Because it is significantly unclear what ‘meaningful’ does or should pick out when applied to a life, any account of meaningful living will be constructive and not merely clarificatory. Where in our conceptual geography is ‘meaningful’ best located? What conceptual work do we want the concept to do? What I call agent‐independent and agent‐independent‐plus conceptions of meaningfulness locate ‘meaningful’ within the conceptual geography of agent‐independent evaluative standards and assign ‘meaningful’ the work of commending lives. I argue that the not wholly welcome implications of these more dominant approaches to meaningfulness make it plausible to locate ‘meaningful’ on an alternative conceptual geography — that of agents as end‐setters and of agent‐dependent value assessments — and to assign it the work of picking out lives whose time‐expenditures are intelligible to the agent. I respond to the challenge confronting any subjectivist conception of meaningfulness that it is overly permissive.     

The alchemy of training

Abstract: Training in Zurich has its own special character but also is marked by the very fact that it is in Zurich. Zurich radiates its own distinct energy and carries a specific historical significance in the world of analytical psychology. This, like all things with psychic energy, has a spectrum of meaning. This spectrum, as well as the ‘spirit’ of the place, will be critically examined, taking into account the ‘blessings’ and ‘curses’ of such genius loci. Training in Zurich is experientially based and is first and foremost an initiation: an initiation into symbolic life, or rather life where symbol plays an important role. Training is understood to involve a transformation of one's self, much like the 8^th century alchemist Morienus Romanus understood the opus as a ‘human transformation system’. It is not merely an education. The requirement of ‘immersion’ is core to the experience of becoming an analyst in Zurich and this sets up a valuable discomfort between rational intellectual learning and intuitive experience, between knowing and not‐knowing. How does this dis‐serve the making of an analyst? What is implicit in this immersion and its discomfort? Does it have a role in today's emphasis on clinical and empirical training? Does Zurich still offer something unique and valuable in the world of training, or is it passé? From these questions, the dichotomy of what is ‘urgent’ and ‘essential’ in training will be examined.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

'This is our life': strong evaluation in psychotherapy narrative

This paper examines the relevance of both client and counsellor conceptions of the ‘good life’ in relation to a narrative analysis of the first session of a case of successful client-centred therapy.In this opening session, the client embeds her ‘problem’ story within contrasting cultural narratives of what it means to live a good life. The therapist discourse also consistently draws upon a therapeutic meta-narrative that conveys an implicit story of how to live life well. This material is discussed from the perspective of the concept of ‘strong evaluation’ offered by the philosopher CharlesTaylor.Implications for research and practice are discussed.     

‘Meaning-dawning’ in Wittgenstein’s Notebooks: a Kierkegaardian reading and critique

In this paper, I am going to propose a new reading of Wittgenstein’s cryptic talk of ‘accession or loss of meaning’ (or the world ‘waxing and waning’ as a whole) in the Notebooks that draws both on Wittgenstein’s later work on aspect-perception, as well as on the thoughts of a thinker whom Wittgenstein greatly admired: Søren Kierkegaard. I will then go on to argue that, its merits apart, there is something existentially problematic about the conception that Wittgenstein is advocating. For the renunciation of the comforts of the world that Wittgenstein proposes as a way of coping with the brute contingencies of life seems only to come as far as what Kierkegaard calls ‘infinite resignation’, and this falls far short of the joyful acceptance of existence that appears necessary for inhabiting what Wittgenstein calls a happy world. That is to say, I will show that what Wittgenstein’s proposal lacks is a way of reconnecting with the finite after one has renounced it – the kind of transformation of existence achieved by the person Kierkegaard calls the ‘knight of faith’.     

Morality,choice and inwardness

The present paper tries to analyse the way in which Judge William, in Sören Kierkegaard's work Either/Or, distinguishes between the aesthetic and the ethical way of life. Basically his distinctions seem to be that the ethicist is a seriously committed person (has inwardness) whereas the aestheticist is indifferent, and that the former accepts universal rules whereas the latter makes an exception for himself. — In order to come from the aesthetic to the ethical stage one must, according to Judge William, make a choice of oneself. We try to show that such a choice is only one among several factors implicit in his reasoning and that he does not at all consider it as a ‘leap’, but as based upon reasons, though his reasons are mostly of an aesthetic nature. Far from seeing the Judge as a champion of choice, we maintain that the book primarily contains a plea for a certain personality ideal. This probably has to do with the fact that he does not seem to be in doubt as to what one ought to do, only as to how to become a person who does what he ought to do. We shall also argue that a choice of oneself, as a matter of fact, is neither necessary nor sufficient in order to bring a person within the ethical stage, as described by the Judge. — A person who lives ethically does not, according to Judge William, necessarily act rightly, but his actions are either right or wrong, as opposed to the actions of the aestheticist which fall outside the domain of the ethical. In order to obtain a tenable distinction within his philosophy between ‘being within the ethical stage’ and ‘acting ethically rightly’ the first concept should be defined in terms of inwardness (serious commitment), the latter as inward conformity with certain universal rules. — This idea of inwardness, probably the most original and fruitful contribution of ‘Equilibrium’, seems to be based, however, like most of his ethical reasoning, on certain controversial assumptions about human nature.     

Sartre and the Doctors

Abstract

This paper considers how the experience of illness fits within Sartre’s account of embodiment in Being and Nothingness. Sartre makes some remarks about illness, but does not develop a full account. I show that the anti‐naturalistic ontological framework in which Sartre’s discussion of the body is placed, which opposes my ‘being‐for‐Others’ to my ‘being‐for‐myself’, imposes a revisionary account of illness, and how Sartre’s model of interpersonal relations affects his view of doctors, and their role in the illness experience. I note and discuss the connection Sartre draws between illness and bad faith. I also point out that recent phenomenologically inspired criticisms of the medical establishment that draw on Sartre’s account of the body are limited by their failure to engage with Sartre’s ontology.