Why should medicine consider a theory of practice? Introduction to the issue

In reference to historical developments, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the relationship(s) between theory and practice. The authors emphasize the need for scientific research in this neglected area for the sake of both clinical practice and medical education.     

Do we need a concept of disease?

The terms “health”, “disease” and “illness” are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the ‘disease’ concept is illusory. The health/disease distinction is irrelevant for most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease.     

Psychoanalysis and homosexuality: do we need a new theory?

No need exists, it is argued, for a new psychoanalytic theory of homosexuality. Certainly psychoanalysis should not be expected to generate such a theory using its own methodology alone. The preoccupation with producing such a theory avoids more important questions about psychoanalytic theory building raised by an examination of the long relationship between psychoanalysis and homosexuality. These questions concern the problems related to using psychoanalytic methodology (1) to construct categories (including the categories normal and abnormal), (2) to construct causal theory (the problems include the limitations of psychoanalytic developmental theory and a long-standing confusion between psychoanalytic developmental theory, psychoanalytic genetic reconstruction, and psychodynamics), and (3) to identify "bedrock." Finally, the question is addressed of what might be needed that is new in the psychoanalytic approach to homosexuality.     

Why do we need perceptual content?

Most representationalists argue that perceptual experience has to be representational because phenomenal looks are, by themselves, representational. Charles Travis (2004 Travis, C. (2004). The silence of the senses. Mind, 113, 57–94.[Crossref], [Web of Science ®] , [Google Scholar]) argues that looks cannot represent. I argue that perceptual experience has to be representational due to the way the visual system works.     

Can we have a distinctive theory of memory?

The current status of the concept of distinctiveness an applied to memory research is discussed. In spite of the fact that distinctiveness is difficult to define, an increasing number of memory phenomena have been explained in terms of distinctiveness. These phenomena are grouped into four classes, which vary in how distinctiveness is operationalized. Distinctiveness has different effects on memory performance, depending on how it is defined, suggesting that the concept of distinctiveness has been overapplied. In addition, current theoretical explanations of the effects of distinctiveness on memory fail to specify what the different definitions of distinctiveness have in common, and fail to encompass adequately the broad range of phenomena to be explained. A limited theory of distinctiveness is proposed, in order to explain why conceptually incongruent material is remembered well.     

Did she mean to do it? Acquiring a folk theory of intentionality

The ability to both identify and explain others’ intentional acts is fundamental for successful social interaction. In two cross-sectional studies, we investigated 3- to 9-year-olds’ (n = 148) understanding of the folk concept of intentionality, using three types of intentionality measures. The relationship between this type of reasoning and false belief and interpretive mind understanding was also examined. Judgment of the appropriateness of an explanation was based on adult responses (n = 20). Overall, the results indicated that the ability to both identify and appropriately explain a range of intentional acts does not fully emerge until 7 years of age or later. The pattern of explanations revealed the gradual development of a folk concept of intentionality. Preschool- and early school-age children focused on the protagonists’ desires and actions, whereas 8- and 9-year-olds and adults were more likely to reference the protagonists’ awareness and skills.     

Why do we want to be healthy? Medicine, autonomous individualism, and the community of faith

Understanding health as empowerment to meet particular goals, we can distinguish a goal of Enlightenment individualism from a goal of creaturely dependent, as affirmed by the Christian community of faith. So argues Dennis Sansom, who traces many of the ethical problems in medical treatment to Enlightenment assumptions about health, and who therefore calls us back to distinctively Christian principles as the foundations for our conception of health and for ethical medical practice.     

Why do we SLIP to the basic level? Computational constraints and their implementation.

The authors introduce a new measure of basic-level performance (strategy length and internal practicability; SLIP). SLIP implements 2 computational constraints on the organization of categories in a taxonomy: the minimum number of feature tests required to place the input in a category (strategy length) and the ease with which these tests are performed (internal practicability). The predictive power of SLIP is compared with that of 4 other basic-level measures: context model, category feature possession, category utility, and compression measure, drawing data from other empirical work, and 3 new experiments testing the validity of the computational constraints of SLIP using computer-synthesized 3-dimensional artificial objects.     

What if we abandon the concept of career proactivity to move research forward?

The idea that individuals need to be proactive to successfully manage their career is predominant in current career research. Despite the great importance attached to career proactivity, the literature on the topic remains fragmented. I thus highly welcome the comprehensive literature review Career proactivity: A bibliometric literature review and future research agenda. The authors conduct a thorough and rigorous bibliometric analysis to uncover the width, evolution, and gaps in the literature on career proactivity. I also welcome their roadmap for future research. I very much agree with the issues they point out: Cleaning up concepts, integrating context, and developing new theories. But I do wonder if their specific suggestions on these issues will not tend toward status quo and further fragmentation. Questioning the agentic assumption and individualistic stance of research on career proactivity, I plea for a different and more unconventional route. Below, I reflect on the author's and my ideas on these three issues: Concept clarification, including context, and new theory.     

Why do narcissists take more risks? Testing the roles of perceived risks and benefits of risky behaviors

Much prior research demonstrates that narcissists take more risks than others, but almost no research has examined what motivates this behavior. The present study tested two potential driving mechanisms of risk-taking by narcissists (i.e., heightened perceptions of benefits and diminished perceptions of risks stemming from risky behaviors) by administering survey measures of narcissism and risk-taking to a sample of 605 undergraduate college students. Contrary to what might be expected, the results suggest that narcissists appreciate the risks associated with risky behaviors just as much as do less narcissistic individuals. Their risk-taking appears to instead be fueled by heightened perceptions of benefits stemming from risky behaviors. These results are consistent with a growing body of evidence suggesting that narcissists engage in some forms of potentially problematic behaviors, such as risk-taking, because of a surplus of eagerness rather than a deficit of inhibition.     

Why do we think? Consequences of regarding thinking as behavior

Cognitive psychologists have made significant progress in explaining how people think. However, relatively little time and energy have been invested in understanding why we think--the factors that make us start or stop thinking, choose and change strategies and solutions. Such questions are linked to motivation and to discriminative and reinforcing stimuli. In this article, the idea that studying thinking as a form of behavior closely connected to antecedent stimuli and consequences leads to potentially important questions that are not presently being studied in the field of cognitive psychology. This is not an argument for reverting to behaviorism--rather, the argument is made that integrating a behavioral perspective on thinking would enrich cognitive psychology.     

Why do we listen to music? A uses and gratifications analysis

Four 'uses and gratifications' studies investigated peoples' reasons for listening to music (Study 1); and whether these reasons differ significantly from those associated with other leisure activities (Study 2). In Study 3, an open-ended, qualitative research design was used to investigate why people listen to music. In Study 4, a cross-sectional design was used to investigate the possibility that people of different ages might listen to music for different reasons. Findings showed that there are a number of reasons why participants listen to music, comparison of which indicated that participants listen to music primarily to manage/regulate their moods. Comparison with other leisure activities indicated that for the most part, listening to music was rated better than other leisure activities at serving an individual's different needs. This versatility may explain why music is so important to people. Evidence was also found to suggest that the reasons for listening to music may change as people grow older.     

Why do children lack the flexibility to innovate tools?

Despite being proficient tool users, young children have surprising difficulty in innovating tools (making novel tools to solve problems). Two experiments found that 4- to 7-year-olds had difficulty on two tool innovation problems and explored reasons for this inflexibility. Experiment 1 (N = 51) showed that children’s performance was unaffected by the need to switch away from previously correct strategies. Experiment 2 (N = 92) suggested that children’s difficulty could not easily be explained by task pragmatics or permission issues. Both experiments found evidence that some children perseverated on a single incorrect strategy, but such perseveration was insufficient to explain children’s tendency not to innovate tools. We suggest that children’s difficulty lies not with switching, task pragmatics, or behavioral perseveration but rather with solving the fundamentally “ill-structured” nature of tool innovation problems.     

Must the bearer of a right have the concept of that to which he has a right?

Stevens critiques what he calls the "conceptual possession requirement" as defined by Michael Tooley in his article, "Abortion and infanticide," Philosophy and Public Affairs 1972 Fall; 2(1): 37-65. Tooley argued that a being has a right to something only if it has the concept of that thing. He claimed that fetuses and infants do not have a serious right to life because they have no concept of a continuing self, and that therefore abortion and infanticide are morally permissible. Stevens contends that the conceptual possession requirement is not valid, offers a counterexample to Tooley's argument, and defends his reasoning against what he presumes might be Tooley's counterarguments.     

From cover to cover? A critique of Wolterstorff's theory of the Bible as divine discourse

International Journal for Philosophy of Religion -     

Why do people sacrifice to approach rewards versus to avoid costs? Insights from attachment theory

This research provides the first empirical investigation of how attachment orientations contribute to approach and avoidance goals for engaging in sacrifice. Study 1 is a cross‐sectional study of individuals in dating relationships, and Study 2 is a 14‐day daily experience study of dating couples. Results showed that attachment anxiety was associated with a greater frequency of sacrifice and more willingness to sacrifice for approach goals (particularly self‐focused goals) and avoidance goals. Attachment avoidance was associated with a lower frequency of sacrifice, less willingness to sacrifice for approach goals (particularly partner‐focused goals), and more willingness to sacrifice for avoidance goals (both self‐ and partner‐focused). Daily sacrifice goals were also associated with the partner's attachment orientation. Theoretical and practical implications are discussed.