Women's experiences of workplace bullying: changes in social relationships

This article reports a qualitative study, which investigated social processes in workplace bullying, based on in‐depth interviews with ten British women professionals who were targets of workplace bullying. Data were analysed using grounded theory methods. The resulting analysis showed links between disclosures of bullying, reactions of others, and some impacts on targets' psychological health. Key themes which emerged from the data included ‘being heard’ which describes how others reacted to disclosures of bullying behaviours, and the ‘ripple effect’ which describes how bullying impacted upon targets' significant others; these predominantly describe relationships with others outside the workplace. The theme of ‘withdrawal’ describes how targets and others managed relationships within the workplace, and ‘denial’ and ‘personalizing problems’ describe how others within the workplace responded to knowledge of bullying behaviours. The theme ‘maintaining self’ describes how participants responded to changed relationships and struggled to maintain a coherent sense of self during and subsequent to bullying. This research emphasizes the role of social processes and social environments, rather than individual or personality characteristics, in explaining the development of workplace bullying and its impacts on targets. Copyright © 2004 John Wiley & Sons, Ltd.     

THE DEFENCE OF THE MYSTERIES OF THE TRINITY AND THE INCARNATION: AN EXAMPLE OF LEIBNIZ'S 'OTHER' REASON

In this paper I will discuss certain aspects of Leibniz's theory and practice of ‘soft reasoning’ as exemplified by his defence of two central mysteries of the Christian revelation: the Trinity and the Incarnation. By theory and practice of ‘soft’ or ‘broad’ reasoning, I mean the development of rational strategies which can successefully be applied to the many areas of human understanding which escape strict demonstration, that is, the ‘hard’ or ‘narrow’ reasoning typical of mathematical argumentation.¹ These strategies disclose an ‘other’ reason, i.e. a complementary set of arguments and methods developed by Leibniz in order to deal with crucial issues such as the ‘weighting’ of probabilities and truths of fact. I will argue that one of the most compelling examples of the importance and fertility of Leibniz's ‘other’ reason is provided by his solution to the problems posed by the unique epistemological status of theological mysteries.     

Subject benchmarking,Orders in Council and European Directives

This paper describes a range of professional self-regulation and of higher education (HE) developments which form a backdrop to decisions the profession/s of psychotherapy (and counselling) may wish to take on issues around professional self-regulation. The developments described are: - the codification of ‘subjects’ and their qualifications in HE by the Quality Assurance Agency, especially ‘Subject Benchmarking’ led by ‘Subject Associations’, and the opportunities this offers, - European Directives of various sorts relating to regulated professions and the impact the relevant Directive would have if the profession was regulated, - the legislative history of professional self-regulation up to the present day and ‘Orders in Council’ made under the Health Act, 1999, and - criteria and safeguards for professions to enjoy statutory self-regulation and their implications. The paper concludes with how these developments interact and options for how the profession could respond to them including a separate Order or joining the Health Professions Council     

The ‘Magic Light’: A Discussion on Laser Ethics

Innovations in technology and science form novel fields that, although beneficial, introduce new bio-ethical issues. In their short history, lasers have greatly influenced our everyday lives, especially in medicine. This paper focuses particularly on medical and para-medical laser ethics and their origins, and presents the complex relationships within laser ethics through a three-dimensional matrix model. The term ‘laser’ and the myth of the ‘magic light’ can be identified as landmarks for laser related ethical issues. These ethical issues are divided into five major groups: (1) media, marketing, and advertising; (2) economic outcomes; (3) user training; (4) the user-patient/client relationship; and (5) other issues. In addition, issues arising from two of the most common applications of lasers, laser eye surgery and laser tattoo removal, are discussed. The aim of this paper is to demonstrate that the use of medical and para-medical lasers has so greatly influenced our lives that the scientific community must initiate an earnest discussion of medical laser ethics.     

A slow unfolding – at double speed: reflections on ways of working with parents and their young children within the Tavistock clinic's under fives service

This paper describes clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work. It elaborates psychoanalyst Annette Watillon's idea that it is the dramatic way in which children enact their (and their family's) predicament in the consulting room which speeds up the process of change. The author clusters clinical cases into three categories, each cluster representing a different kind of ‘dramatic’ enactment and leading to a different kind of intervention relating to the therapist's role, the structure of the interventions and the ‘ports of entry’ for the work. The categories are defined as: ‘child-led drama’ with the therapist in the role of ‘therapeutic observer’; ‘internal parental drama’ with the therapist in the role of ‘therapeutic consultant’; and ‘external parental drama’ with the therapist in the role of ‘therapeutic modulator’. The author defines these categories, illustrating each category with clinical examples.     

Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

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.’     

Irony,Embodiment, and the ‘critical Attitude’: Engaging Saba Mahmood's Critique of Secular Morality

At the intersection of feminism, postcolonial studies, and religious studies, this essay engages Saba Mahmood's critique of universalistic ethics and post-structural feminism. It contrasts Mahmood's ‘ethical embodiment’ with a concept of ‘ethical irony’, offering examples of the latter from literature (Brecht, Baudelaire) and cultural theory (Carolyn Steedman, Judith Butler, Michel Foucault). Its thesis is that ethical irony signifies modes of critical engagement that are not premised on notions of metaphysical subjectivity or abstract rules, but may nonetheless be cross-culturally translatable. One specific formulation of ethical irony considered concerns the figure of injurable bodies. At once material (bodily) and transcendental (unknown injuries from unknown sources, or the possibility of injury), injurable bodies the irreducibility of ethics to the purely abstract and the purely empirical. Finally, the defence of ethical irony speaks to the viability of upholding what Foucault called the ‘critical attitude’ as a cross-cultural norm.     

Religious,Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making

Religion and spirituality have always played a major and intervening role in a person’s life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient’s religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient’s values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients’ varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.     

Reply to Reynolds

Abstract

How should we read Foucault's claims, in his late work, for the relevance of ‘aesthetic criteria’ to politics? What is Foucault's implicit understanding of the nature of aesthetics and the autonomy of the aesthetic sphere? Would an ethics which gave a place to the aesthetic legitimize a politics of manipulation, brutality and aggression ‐ in short, a ‘fascist’ politics ‐ as some of Foucault's critics argue? In this paper, I examine key accounts of the fascist ‘aestheticization of politics’ ‐ from Walter Benjamin's classic essay, ‘The Work of Art in the Age of Mechanical Reproduction’ (1936), to Philippe Lacoue‐Labarthe's work on the relation between Heidegger's philosophy and the fascist theme of politics as the plastic art of the state. Through a discussion of Foucault's late work, the paper demonstrates the connection between Foucault's turn to ancient Greek ethical practices and his call for a contemporary renewal of the idea of ethics as an art of living. The aim of the paper is to show in what ways the ethico‐political position which is presented in Foucault's late work, far from contributing to a fascist politics, in fact provides ways of thinking about the relationship between the aesthetic and the political which avoid both mindless radicalism and totalitarian narcissism. In doing so, the key question is, ‘What's aesthetic about Foucault's “aesthetics of existence"?’     

Nuancing the Healer's art — The epistemology of patient competence

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the ‘living human body’ alone, but on the patientqua person.     

On the Moral Value of Physical Activity: Body and Soul in Plato's Account of Virtue

It is arguable that some of the most profound and perennial issues and problems of philosophy concerning the nature of human agency, the role of reason and knowledge in such agency and the moral status and place of responsibility in human action and conduct receive their sharpest definition in Plato's specific discussion in the Republic of the human value of physical activities. From this viewpoint alone, Plato's exploration of this issue might be considered a locus classicus in the philosophy of sport. Indeed, it is in this place that Plato offers a highly distinctive account of the value of physical education in terms of its vital contribution to the development of a part of the soul that he characterises in terms of ‘spirit’, ‘energy’ and/or ‘initiative’. Drawing on more recent work in ethics and philosophy of action, this paper sets out to revisit and evaluate Plato's argument. While concluding that Plato's case ultimately flounders on fundamental uncertainty regarding the logical role of spirit in the explanation of agency, the paper concludes that there is much to be learned – in the philosophy of sport and elsewhere – from the instructive failures of Plato's argument.     

The Art of Aidagara: Ethics,Aesthetics, and the Quest for an Ontology of Social Existence in Watsuji Tetsurō's Rinrigaku

This paper provides an analysis of the key term aidagara (‘betweenness’) in the philosophical ethics of Watsuji Tetsurō (1889–1960), in response to and in light of the recent movement in Japanese Buddhist studies known as ‘Critical Buddhism’. The Critical Buddhist call for a turn away from ‘topical’ or intuitionist thinking and towards (properly Buddhist) ‘critical’ thinking, while problematic in its bipolarity, raises the important issue of the place of ‘reason’ vs ‘intuition’ in Japanese Buddhist ethics. In this paper, a comparison of Watsuji's ‘ontological quest’ with that of Martin Heidegger (1889–1976), Watsuji's primary Western source and foil, is followed by an evaluation of a corresponding search for an ‘ontology of social existence’ undertaken by Tanabe Hajime (1885–1962). Ultimately, the philosophico-religious writings of Watsuji Tetsurō allow for the ‘return’ of aesthesis as a modality of social being that is truly dimensionalized, and thus falls prey neither to the verticality of topicalism nor the limiting objectivity of criticalism.     

Why is Ethics First Philosophy? Levinas in Phenomenological Context

This paper explores, from a phenomenological perspective, the conditions necessary for the possession of intentional content, i.e., for being intentionally directed toward the world. It argues that Levinas's concept of ethics as first philosophy makes an important contribution to this task. Intentional directedness, as understood here, is normatively structured. Levinas's ‘ethics’ can be understood as a phenomenological account of how our experience of the other subject as another subject takes place in the recognition of the normative force of a command. This supplies a condition that—as the paper shows by examining Husserl and Sartre on how our experience of the Other constitutes an ‘objective’ world—earlier phenomenologists have misunderstood, because they have treated ethical experience as ‘founded’ on a prior theory of representation (‘ontology’ in Levinas's language). Ethics is first philosophy because it is only by acknowledging the command in the ‘face’ of the Other that we can account for the sensitivity to the normative distinctions that structure intentional content. Throughout, the paper shows how Levinas's analyses, in Totality and Infinity, draw upon and develop the analyses of Husserl and Sartre.     

Understanding black issues in postgraduate counsellor training

This paper presents a brief account of a qualitative multicultural study and heuristic exploration of how trainee counsellors understand black issues in their training and in their therapeutic work with clients. This initiative is supported by a previous survey of black clients and therapists who suggest that changes are needed in training. It presents current legislation and need for equalities in Higher Education and counsellor training, by challenging the dominance of Eurocentric approaches. A pluralistic, flexible Action Research methodology will be outlined. The theory and context of previous studies are presented. Phases of the process are described to show how this study was approached. Phase one describes how interviews with a variety of experienced practitioners confirmed the need for the study. Using examples of trainees’ narratives, phase two describes how the phenomenon of black issues was integrated into training and the process of generating data. The paper shows how the explication process reveals elements of fear, history, guilt and racism, present in the dynamic of black issues. The paper highlights how racism features highly in trainees’ concerns and influences their ability to share and understand. A snapshot of emerging concepts such as ‘finding a voice’ and ‘recognition trauma’ which are developed to assist the reflexive process is featured. The role of the researcher and black trainees as ‘black expert’ is discussed. In the context of ethical concerns and working through the researcher's counter transference as a black female tutor researcher, the process of modelling within a participatory role is described. An excerpt from a discussion with colleagues gives an essence of the outcome. The outcome is summarised in the conclusion:'A bridge from fear to transformation’. The study enabled both trainees and staff as collaborators to shift from a position of fear and not knowing to engaging in active dialogue about black issues on a personal and professional basis.     

Journal reviews

Articles reviewed: Bernstein, Jeanne Wolff. ‘Countertransference: our new royal road to the unconscious?’, Psychoanalytic Dialogues Crastnopol, Margaret. ‘The analyst's personality: Winnicott analyzing Guntrip as a case in point’, Contemporary Psychoanalysis Epstein, L. ‘The analyst's “bad-analyst” feelings: a counterpart to the process of resolving implosive defenses’, Contemporary Psychoanalysis Garwood, Alfred. ‘Psychic security: its origins, development and disruption‘, British Journal of Psychotherapy Haynes, Jane. ‘Facing the self: is man no more than this?’, Harvest Papadopoulos, Renos K. ‘Storied community as secure base: Response to the paper by Nancy Caro Hollander “Exile: Paradoxes of Loss and Creativity”’, British Journal of Psychotherapy Sand, Rosemary. ‘The interpretation of dreams: Freud and the Western tradition’ & Greenberg, Ramon & Pearlman, Chester. ‘The interpretation of dreams: a classic revisited’, Psychoanalytic Dialogues Spensley, Sheila. ‘Learning from Bion’, Journal of the British Association of Psychotherapists Wilgowicz, Perel. ‘Listening psychoanalytically to the Shoah half a century on’,International Journal of Psychoanalysis