Prognosis in medicine: An analysis of its meaning and rôles

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as “prognosis of a disease”, “the prognosis of this patient”, “the prognosis is unknown”, is examined.     

WITTGENSTEIN AND DEFINING CRITERIA

Let us introduce two antithetical terms in order to avoid certain elementary confusions: To the question “How do you know that so-and-so is the case?”, we sometimes answer by giving ‘criteria’ and sometimes by giving ‘symptoms. If medical science calls angina an inflammation caused by a particular bacillus, and we ask in a particular case “Why do you say this man has got angina?” then the answer “I have found the bacillus so-and-so in his blood” gives us the criterion, or what we may call the defining criterion of angina. If on the other hand the answer was, “His throat is inflamed”, this might give us a symptom of angina, I call “sympton” a phenomenon of which experience has taught us that it coincided, in some way or other, with the phenomenon which is our defining criterion, Then to say “A man has angina if this bacillus is found in him” is a tautology or it is a loose way of stating the definition of “angina”. But to say, “A man has angina whenever he has an inflamed throat” is to make a hypothesis. (BB, pp. 24–25)¹     

Discrete dynamic choice: An extension of the choice models of thurstone and luce

The present paper deals with the extension of two well-known static discrete choice theories to the dynamic situation in which individuals make choices at several points in (continuous) time. A dynamic version of Luce's Axiom, “independence from irrelevant alternatives”, is proposed and some of its implications are derived. In the static case Yellott (J. Math. Psych. 1977, 15, 109–146) and others have demonstrated that an independent random utility model generated from the extreme value distribution exp(?e^?ax?b) becomes equivalent to Luce's Axiom. Yellott also introduced an axiom called “invariance under uniform expansions of the choice set”, and he proved that within the class of random utility models with independent identically distributed utilities (apart from a location shift) this axiom is equivalent to Luce's Axiom. These results are extended to the dynamic situation and it is shown that if the utility processes are expressed by so-called extremal processes the corresponding choice model is Markovian. A nonstationary generalization is proposed which is a substantial interest in applications where the parameters of the choice process are influenced by previous choice experience or by time-varying exogenous variables. In particular, it is demonstrated that the nonstationary model is Markovian if and only if the joint choice probabilities at two points in time have a particular form. Thus, the paper provides a rationale for applying a specific class of Markov models as the point of departure when modelling mobility processes that involve individual discrete decisions over time.     

Against the odds: human values arising in unfavourable circumstances elicit the feeling of being moved

People sometimes say they are “moved” or “touched” by something. Although the experience is familiar to most, systematic research on being moved has just begun. The current research aims to advance our understanding of the prototypical elicitors of being moved. We tested the hypothesis that being moved is elicited by core values (i.e. values that are particularly central to being human) that manifest themselves in circumstances that are unfavourable to their emergence. In three experiments, two with text stimuli and one with pictorial stimuli, we found compelling evidence that the same core value (e.g. love, willpower, beauty) is perceived as more moving when it emerges in unfavourable than in favourable circumstances. The effect was found in both males and females, although stronger in the latter group, and across all investigated core values, although love was generally more moving than other core values. The theoretical and practical significance of these findings is discussed.     

建立儒家人文主义的学术传统:由文化“复建”到文化“复兴”

本文回顾了作者跟随杨国枢教授推动本土心理学的学术历程,并依据自己的切身体会,提出本土心理学运动必须以科学哲学作为基础。作者身体力行,在最近二三十年间,深入学习科学哲学的理论,逐步建立本土心理学的相关理论。其最终目标,是打算以儒家文化作为基底,吸纳西方近代文明的菁华,“中学为体,西学为用”,摆脱西方学术的宰制,建立“儒家人文主义”的自主学术传统。作者认为,唯有大力发展本土社会科学,建立华人“自主的社会科学传统”,华人学术社群才有可能走出“学术自我殖民”的心态。     

“Hall of Broken Mirrors”—Enactment in an Analytic Group of “Difficult Patients”

This article focuses on the transformation of dissociated self-states as a curative factor in an analytic group of “difficult patients.” Foulkes (1964) referred to the analytic group as a “curative hall of mirrors.” I would like to integrate group analytic theory with relational psychoanalytic concepts. I propose that when dissociated self-states are expressed in a group, this creates a “broken mirrors” experience that is sometimes expressed through enactment. I develop this idea, and argue that the group mirrors to the patient his image—distorted and defective—and forces him to cope with his “not me” states. I demonstrate, through three clinical vignettes, how dissociated states hinder the reflective space and create a “hall of broken mirrors” experience. I would argue that in a safe space, the patients’ “not me” states can be transformed, and the hall of broken mirrors can turn into a curative hall of mirrors.     

Mathematics and the definitions of religion

In 2014, I published a proposal for a definition of “religion”. My goal was to offer a definition of this contentious term that would include Buddhism, Daoism, and other non-theistic forms of life widely considered religions in the contemporary world. That proposal suggested necessary and sufficient conditions for treating a form of life as a religious one. It was critiqued as too broad, however, on the grounds that it would include the study of math as a religion. How can one include forms of life based on non-theistic realities without including math? In this paper, I show the flaw in the previous definition and the weaknesses of two attempts to evade that flaw, before recommending a shift, first, to a Wittgenstein-inspired polythetic definition of “religion” and, second, to a certain kind of polythetic definition that I call “anchored”.     

In Defense of Ambivalence and Alienation

In this paper, I argue against certain dogmas about ambivalence and alienation. Authors such as Harry Frankfurt and Christine Korsgaard demand a unity of persons that excludes ambivalence. Other philosophers such as David Velleman have criticized this demand as overblown, yet these critics, too, demand a personal unity that excludes an extreme form of ambivalence (“radical ambivalence”). I defend radical ambivalence by arguing that, to be true to oneself, one sometimes needs to be radically ambivalent. Certain dogmas about alienation are even more entrenched. Allen Wood’s entry on “alienation” in the Oxford Companion to Philosophy begins as follows: “A psychological or social evil, characterized by one or another type of harmful separation, disruption or fragmentation, which sunders things that belong together.” I think that it is not true that self-alienation is necessarily “harmful.” I argue that radical ambivalence is a form of self-alienation. Thus, because faithfulness to oneself sometimes requires radical ambivalence, to be true to oneself, one sometimes needs to be alienated from oneself.     

Fishing: Finding One’s Way to the Unconscious

By imagining ourselves to be fishing in the deep waters of the unconscious, we consider here many questions about the meeting of the personal ego and the powerful unknown energies that lie below—questions ranging from “Why should we even want to connect with such forces?” to “What’s the best way of doing it?” There are many more questions to ask, such as how does the unconscious express itself and when should we avoid a direct meeting with it and why?

As individuals and as cultures, we have long histories with the unconscious, sometimes welcoming it, sometimes trying to wall it off, sometimes being overwhelmed by it. In this article the author emphasizes the necessity of becoming aware of the unconscious, knowing it as something that is always active in us, recognizing that it is not under our control, and realizing that it is not of our own making.     

THE CONCEPT OF PHILOSOPHICAL EXPERIENCE

Abstract: We often speak about religious experience, and sometimes we speak about metaphysical experience. Yet we seldom hear about philosophical experience. Is philosophy purely a matter of theories and theses, or does it have an experiential aspect? In this article, I argue for the following three claims. First, there is something we might call philosophical experience, and there is nothing mystical about it. Second, philosophical experiences are expressed in something quite similar to what Kant called “aesthetic judgements.” Third, philosophical experiences are expressed by using words in what Wittgenstein called “secondary sense.” Finally, I try to show the educational significance of pursing philosophical experiences. Through articulating them one might find one's ground, and through articulating them in a less private and more universal form one might raise oneself to universality. Thus, in expressing philosophical experiences one aspires to speak in a universal voice.     

On the Autonomy and Justification of Nanoethics

In this paper, I take a critical stance on the emerging field of nanoethics. After an introductory section, “Conceptual Foundations of Nanotechnology” considers the conceptual foundations of nanotechnology, arguing that nanoethics can only be as coherent as nanotechnology itself and then discussing concerns with this latter concept; the conceptual foundations of nanoethics are then explicitly addressed in “Conceptual Foundations of Nanoethics”. “Issues in Nanoethics” considers ethical issues that will be raised through nanotechnology and, in “What’s New?”, it is argued that none of these issues is unique to nanotechnology. In “It’s a Revolution!”, I express skepticism about arguments which hold that, while the issues themselves might not be unique, they nevertheless are instantiated to such a degree that extant moral frameworks will be ill-equipped to handle them. In “What’s Different?”, I draw plausible distinctions between nanoethics and other applied ethics, arguing that these latter might well identify unique moral issues and, as such, distinguish themselves from nanoethics. Finally, in “What Now?”, I explore the conclusions of this result, ultimately arguing that, while nanoethics may fail to identify novel ethical concerns, it is at least the case that nanotechnology is deserving of ethical attention, if not a new associative applied ethic.     

The humanities and gross anatomy: Forgotten alternatives

Researchers in medical education have extensively studied negative reactions to gross anatomy, sometimes grouped under the term “the cadaver experience.” Although there has been disagreement about the extent and importance of such phenomena, several attempts at curricular reform have been designed to “humanize” the student-cadaver encounter. However, some obvious sources linking gross anatomy and the humanities have been consistently overlooked. Such sources—from the history of art, the history of anatomy, and autobiographical and imaginative literature—not only bear witness to the “cadaver experience” for anatomists of the past, but also offer forgotten alternatives for placing present-day reactions in perspective. Former methods of teaching which used such material might serve as models for reintegrating the humanities into the study of gross anatomy as a possible humanizing force.     

Healthy Death

The concept of healthy death is introduced and explored. A review of literature on the subject of death and dying reveals efforts that have sought to make death a “good” and “meaningful” experience. The article concludes with a summary definition of healthy death.     

对塔斯基“真”理论的辩护——与陈晓平教授商榷

陈晓平教授对塔斯基的"真"理论提出四点批评,并给出了使用"T′模式"作为真之定义的建议。但"T′模式"并不具有"内容恰当性"和"形式正确性",其引入的对"p"的摹状词解释比塔斯基的方案更复杂,对"真"进行递归定义在现有逻辑学内是不可能的。陈晓平教授对塔斯基"真"理论的批评和建议的失误之处在于误解塔斯基的原意、引入形而上学词项、需要新建形式逻辑。总之,其作为真之定义的"T′模式"是"不能允许地冗长"。     

感知运动经验在心理时间线形成中的作用—来自盲生的证据

本研究考察视觉和读写习惯有关的感知运动经验是如何影响心理时间形成的。实验1和实验2分别采用一天内和一生中的词语或短句,以小学三年级的普生和盲生为被试,结果发现不论是短的还是长的时间,普生对早的刺激按左键,晚的刺激按右键反应更快,而盲生未出现早左晚右的心理时间线。实验3和实验4分别以短时间和长时间范围的时间词为材料,以初一盲生和普生为被试,结果发现普生和盲生都是对过去的时间按左键,未来的时间按右键反应快;而且在长的时间范围内,盲生的反应时长于普生。结果表明视觉是心理时间线的基础,阅读经验在盲生心理时间线的形成中起着关键作用。     

The elusive tradeoff: Speed vs accuracy in visual discrimination tasks

Theoretical models for choice reaction time and discrimination under time pressure must account for Ss’ ability to trade accuracy for increased speed. The fast guess model views these tradeoffs as different mixtures of “all-or-none” strategies, while incremental models assume they reflect different degrees of thoroughness in processing the stimulus. Three experiments sought tradeoffs for difficult visual discriminations, using explicit payoffs to control and manipulate pressures for speed and accuracy. Although guessing was pervasive, the simple fast guess model could be rejected; Experiments II and III obtained tradeoffs even when fast guesses were purged from Ss’ data. Tradeoff functions fit by several formulations revealed: (1) slower rates of increase in accuracy for more similar stimuli, and (2) substantial “dead times” (80–100 msec slower than detection times) before discrimination responses could exceed chance accuracy. Errors were sometimes faster and sometimes slower than correct responses (depending on S’s speed-accuracy trade); the latter effect may reflect a ceiling on S’s achievable accuracy. A final discussion examines implications of the results for models of discrimination under time pressure; it suggests modifications in present models, focusing on the random walk model, and describes an alternative “deadline” model.     

Blurring two conceptions of subjective experience: Folk versus philosophical phenomenality

Philosophers and psychologists have experimentally explored various aspects of people's understandings of subjective experience based on their responses to questions about whether robots “see red” or “feel frustrated,” but the intelligibility of such questions may well presuppose that people understand robots as experiencers in the first place. Departing from the standard approach, I develop an experimental framework that distinguishes between “phenomenal consciousness” as it is applied to a subject (an experiencer) and to an (experiential) mental state and experimentally test folk understandings of both subjective experience and experiencers. My findings (1) reveal limitations in experimental approaches using “artificial experiencers” like robots, (2) indicate that the standard philosophical conception of subjective experience in terms of qualia is distinct from that of the folk, and (3) show that folk intuitions do support a conception of qualia that departs from the philosophical conception in that it is physical rather than metaphysical. These findings have implications for the “hard problem” of consciousness.     

Concepts as Tools Not Rules: a Commentary on (Re-) Defining Racism

In (Re-) Defining Racism, Alberto Urquidez argues that conflicting philosophical accounts over the definition of racism are at bottom linguistic confusions that would benefit from a Wittgensteinian-inspired approach. In this essay, I argue that such an approach would be helpful in disputes over the definition of metaphysically contested concepts, such as “race,” or semantically contested concepts, such as “racialization.” I disagree, however, that such insights would prove helpful or do very little for disputes concerning normatively contested concepts, such as “racism.”