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Carol A. Bowman 《Theoretical medicine and bioethics》1992,13(3):265-283
This essay argues that making a diagnosis in medicine is essentially a hermeneutic enterprise, one in which interpretation skills play a major part in understanding a disease. The clinical encounter is an event comprised of two voices; one is the voice of science which is grounded in empiricism, the other is that of human experience, which is grounded in story-telling and the interpretation of those stories.Using two voices, one from the Diagnostic and Statistical Manual of Mental Disorders-III-Revised, which describes alcohol abuse and alcohol dependence, and the other, that of Claire, a character in Edward Albee's play, A Delicate Balance, who is conversing with her brother-in-law, Tobias, I apply principles from Hans-Georg Gadamer's hermeneutics to the clinical diagnostic process. The essay will demonstrate that we overlook an enormous amount of information about alcoholism by an overreliance on objective data and that our hope for understanding alcoholics is in listening to their voices, and sharing the interpretation of their experiences with them. 相似文献
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Alven Neiman 《Studies in Philosophy and Education》1996,15(1-2):121-129
In Habits of the Heart and The Good Society, Bellah et al. diagnose our loss of public life in areas such as education and relate this loss both to flaws in moral ecology and to our institutions. Their opposition to the Lockean metaphysic of self and community and to objectivist epistemology as a way of understanding schools is helpful in that it naturally suggests the kind of piecemeal, contextualized change that we locate within Dewey's viewpoint. But, I argue, Bellah et al.'s penchant for first philosophy ultimately taints their work. While I applaud their turn to Dewey, I find their choice of a metaphysical, rather than a Rortyan reading of Dewey misguided. The proper alternative to a Lockean metaphysics is not a communitarian/Aristotelian one; the proper corrective to objectivist epistemology is not Deweyan epistemology or critical theory. We need to see, as in Rorty (1991b), that democracy exists prior to normative philosophy just as it has priority over substantive religion. To think otherwise would lead to a loss of contact with the ordinary, specific, ever-changing realms where our lives, and our democratic institutions — including the university — must either thrive or flounder. Finally, there is no epistemology or metaphysics that will adequately ground the university's workings. Instead, there is only, as Dewey put it, growth or failure to grow, guided by hints and resonances that arise in evolving circumstances. 相似文献
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Ruth E. Kastner 《国际科学哲学研究》2004,18(1):89-94
The “N‐box experiment” is a much‐discussed thought experiment in quantum mechanics. It is claimed by some authors that a single particle prepared in a superposition of N+1 box locations and which is subject to a final “post‐selection” measurement corresponding to a different superposition can be said to have occupied “with certainty” N boxes during the intervening time. However, others have argued that under closer inspection, this surprising claim fails to hold. Aharonov and Vaidman have continued their advocacy of the claim in question by proposing a variation on the N‐box experiment, in which the boxes are replaced by shutters and the pre‐ and post‐selected particle is entangled with a photon. These authors argue that the resulting “N‐shutter experiment” strengthens their original claim regarding the N‐box experiment. It is argued in this article that the apparently surprising features of this variation are no more robust than those of the N‐box experiment and that it is not accurate to say that the particle is “with certainty” in all N shutters at any given time.
Shutters, Boxes, but No Paradoxes: Time Symmetry Puzzles in Quantum Theory
Published online:
14 October 2010 Figure 1 Hilbert Space of the Shutter Particle. 相似文献
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Annette Jeneson C. Brock Kirwan Larry R. Squire 《Learning & memory (Cold Spring Harbor, N.Y.)》2010,17(9):454-459
Two recent studies described conditions under which recognition memory performance appeared to be driven by nondeclarative memory. Specifically, participants successfully discriminated old images from highly similar new images even when no conscious memory for the images could be retrieved. Paradoxically, recognition performance was better when images were studied with divided attention than when images were studied with full attention. Furthermore, recognition performance was better when decisions were rated as guesses than when decisions were associated with low or high confidence. In three experiments, we adopted the paradigm used in the earlier studies in an attempt to repeat this intriguing work. Our attempts were unsuccessful. In all experiments, recognition was better when images were studied with full attention than when images were studied with divided attention. Recognition was also better when participants indicated high or low confidence in their decision than when they indicated that their decision was a guess. Thus, our results conformed to what typically has been reported in studies of recognition memory, and we were unable to demonstrate recognition without awareness. We encourage others to explore this paradigm, and to try to identify conditions under which the phenomenon might be demonstrated.Declarative memory refers to the capacity to recollect facts and events, and can be contrasted with a collection of nondeclarative memory abilities, including skills, habits, and the phenomenon of priming, which are expressed through performance rather than recollection (Squire et al. 2004). Declarative memory depends on the integrity of medial temporal lobe structures, while the various forms of nondeclarative memory depend on other brain systems (Schacter and Tulving 1994; Eichenbaum and Cohen 2001; Squire 2004). The best-studied example of declarative memory is recognition memory—the ability to judge items as having been encountered previously. Successful recognition is ordinarily accompanied by a conscious experience of familiarity, and sometimes by conscious memory of the prior encounter itself (Gabrieli 1998).One interesting idea that has been explored in some detail is that recognition memory decisions based on familiarity might also benefit from priming. Priming refers to an improved ability to produce or identify an item on the basis of a recent encounter with the same item or a related item, but without a requirement that there be conscious knowledge of the prior encounter (Tulving and Schacter 1990; Schacter and Buckner 1998). In early studies, it was suggested that previously encountered items might be processed more fluently (e.g., with greater speed and with more ease), and that improved fluency might influence familiarity judgments. Specifically, items perceived with greater fluency might tend to be identified as familiar (Mandler 1980; Jacoby and Dallas 1981; Johnston et al. 1991).This idea encountered difficulty when it was found that severely amnesic patients can perform at chance on conventional recognition tests despite exhibiting intact perceptual priming (Hamann and Squire 1997; Stark and Squire 2000). If fluency facilitates recognition, severely amnesic patients who exhibit intact perceptual priming should perform better than chance on recognition memory tests. Thus, it has seemed that the perceptual fluency that mediates priming does not also support familiarity-based recognition judgments, at least not to a measurable degree. Indeed, the contribution of perceptual fluency appears to be too weak to drive recognition performance noticeably above chance (Conroy et al. 2005).Nonetheless, it remains possible that conditions might be found under which recognition decisions can benefit from perceptual fluency, and in this way be linked to nondeclarative memory. Two recent studies (Voss et al. 2008; Voss and Paller 2009) described conditions under which recognition memory appeared to be significantly driven by nondeclarative memory. Participants studied difficult-to-verbalize images (Fig. 1) with either full attention or divided attention. At test, each image was paired with a highly similar new image, and participants made a speeded forced-choice decision. The striking finding was that, under these conditions, accurate recognition memory performance occurred, but without the awareness that ordinarily accompanies successful recognition. Specifically (and paradoxically), performance was better under divided-attention conditions (which ordinarily degrade memory performance) than under full-attention conditions (Fig. 2A). Furthermore, in one study (Voss et al. 2008), recognition was better when participants reported that they were guessing than when they reported conscious memory of the images (combined high- and low-confidence trials) (Fig. 2B). Notably, this phenomenon occurred only when the test was given in a forced-choice format, and not in a yes/no format. The other study (Voss and Paller 2009) reported a similar advantage for guessing in the divided-attention condition. These two reports appear to demonstrate recognition without awareness and a significant contribution of nondeclarative memory to recognition performance.Open in a separate windowFigure 1.In the full-attention condition, participants studied 14 images for 2 sec each (1.5-sec intertrial interval). Alternatively, in the divided-attention condition, participants studied the images while deciding whether a digit heard during the previous trial was odd or even. The forced-choice recognition test probed memory for the middle 10 images presented in the study sequence. Each studied item was presented together with a highly similar new item, and participants selected the old item by responding “left” or “right.” After each response, participants indicated how confident they were in their recognition decision (G, guess; L, low confidence; H, high confidence).Open in a separate windowFigure 2.Data from Experiment 2 in Voss et al. (2008), estimated from their Figure 2. (A) When recognition was probed using a forced-choice format, performance was more accurate in the divided-attention condition than in the full-attention condition. (B) In both conditions, forced-choice recognition was more accurate in trials where participants indicated that their recognition decision was a guess (G) than in trials where participants indicated low or high confidence (L/H) in their decision. Asterisks indicate performance significantly above chance (P < 0.05). Error bars indicate SEM.These findings challenge the conventional view that recognition memory is more effective when full attention is given to a task than when attention is divided (Anderson 1980), that recognition memory is associated with a conscious experience of familiarity (Gabrieli 1998), and that recognition memory accuracy is positively correlated with ratings of confidence (Reed et al. 1997; Mickes et al. 2007). Because the reported findings are exceptional, we explored the phenomenon further in three separate experiments in an attempt to replicate it and identify its boundary conditions. We adopted the same paradigm as was used in the original study (Voss et al. 2008). 相似文献
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Erin J. Wamsley Matthew A. Tucker Jessica D. Payne Robert Stickgold 《Learning & memory (Cold Spring Harbor, N.Y.)》2010,17(7):332-336
Here, we examined the effect of a daytime nap on changes in virtual maze performance across a single day. Participants either took a short nap or remained awake following training on a virtual maze task. Post-training sleep provided a clear performance benefit at later retest, but only for those participants with prior experience navigating in a three-dimensional (3D) environment. Performance improvements in experienced players were correlated with delta-rich stage 2 sleep. Complementing observations that learning-related brain activity is reiterated during post-navigation NREM sleep in rodents, the present data demonstrate that NREM sleep confers a performance advantage for spatial memory in humans.A growing body of animal and human literature suggests that the consolidation of memories occurs optimally during periods of post-learning sleep. Nonrapid eye movement sleep (NREM), in particular, may be beneficial for the offline consolidation of hippocampus-dependent learning. The neurophysiological basis for this hypothesis is derived largely from electrophysiological studies in rodents, demonstrating that patterns of hippocampal place cell activity first seen during waking exploration are later reexpressed during post-learning sleep (Wilson and McNaughton 1994; Kudrimoti et al. 1999; Nadasdy et al. 1999; Ji and Wilson 2007). Behavioral studies in humans meanwhile demonstrate that NREM sleep is beneficial for declarative memory performance, relative to equivalent periods of wakefulness (Plihal and Born 1997; Tucker et al. 2006). However, the memory tasks typically employed in human research are quite different from those used in rodents, with human studies most often focusing on the memorization of verbal or visual stimuli (Plihal and Born 1997; Schabus et al. 2004; Clemens et al. 2005; Ellenbogen et al. 2006; Tucker et al. 2006; Daurat et al. 2008). Thus far, sleep-dependent memory reactivation has not been established to be directly beneficial for memory performance in an animal model, as the protocols employed in this research typically involve well-learned simple tasks which do not easily lend themselves to measurement of learning across time (Wilson and McNaughton 1994; Kudrimoti et al. 1999). Although the hippocampal memory reactivation described in rodents is a possible explanation for the effect of NREM sleep on human declarative memory, widely divergent methodologies employed across species prohibit confidence in this conclusion.Bridging this conceptual gap, a small handful of studies have begun to explore the relationship between spatial navigation and NREM sleep in humans. Notably, a PET study by Peigneux et al. (2004) demonstrated that learning-related hippocampal activity seen while training on a virtual maze task is again expressed during post-learning human sleep. Furthermore, this hippocampal reactivation strongly predicted overnight improvement on the task (Peigneux et al. 2004). Additional studies have suggested a link between sleep and other types of spatial-related learning, including mental rotation performance (Plihal and Born 1999), the ability to reproduce a complex figure (Clemens et al. 2006; Tucker and Fishbein 2008), performance on a computerized version of Milner''s (1965) “bolt head” maze (Tucker and Fishbein 2008), and memory for the location of verbal information on a screen (Daurat et al. 2008).Yet it remains unclear whether sleep, relative to wakefulness, provides a performance benefit for human route-learning in the context of a realistic spatial environment. Navigation through virtual environments is a strongly hippocampus-dependent task (Peigneux et al. 2004; Astur et al. 2005) and provides an experimental model closely paralleling the spatial exploration tasks employed in the rodent literature. However, the few studies reporting effects of sleep on human navigation performance have been contradictory. Using a navigation task similar to that of Peingeux et al. (2004), Orban et al. (2006) failed to detect any effect of post-learning sleep deprivation on maze performance but did find evidence of altered task-related brain activity, concluding that sleep supports “covert” memory reorganization (Orban et al. 2006). In direct contrast, Ferrara et al. found that spatial memory is improved when a retention interval falls across a night of sleep, relative to when route memory must be retained during daytime wakefulness, or across a night of sleep deprivation (Ferrara et al. 2006, 2008).The present study clarifies these issues by examining the effect of a post-learning nap on complex route-learning in a three-dimensional (3D) virtual environment. When controls are tested at a different time of day than sleep participants, circadian confounds may present a substantial problem. Alternatively, overnight protocols employing sleep-deprived subjects necessarily suffer from confounds related to this sleep deprivation during the retention interval. The use of a daytime nap as a sleep intervention avoids these pitfalls by allowing all subjects to be trained and tested at the same circadian time, and in the absence of sleep deprivation. A series of recent studies confirm that a daytime nap is sufficient to induce performance improvements on declarative and procedural memory tasks, relative to wake subjects (Mednick et al. 2003; Backhaus and Junghanns 2006; Nishida and Walker 2006; Tucker et al. 2006; Lahl et al. 2008; Tucker and Fishbein 2008).Participants (n = 53, 34 female) were trained on a virtual maze-learning task at 12:30 pm. Following training, nap participants lay down for a 1.5-h sleep opportunity. These subjects were allowed to obtain as much NREM sleep as possible but were awoken at the first signs of REM (see Table Novice players Experienced players TSTa 39.29 ± 11.40 49.72 ± 11.06 Stage 1 (min) 9.79 ± 2.58 9.28 ± 2.58 Stage 1 (%) 27.27 ± 14.54 19.18 ± 10.75 Stage 2 (min) 26.21 ± 12.06 29.31 ± 8.97 Stage 2 (%) 64.87 ± 14.45 59.17 ± 14.68 SWS (min) 3.29 ± 5.87 9.47 ± 11.49 SWS (%) 8.34 ± 14.35 18.44 ± 21.83 REM (min) 0.00 ± 0.00 1.16 ± 3.03 REM (%) 0.00 ± 0.00 2.24 ± 5.89