AN ISLAMIC APPRAISAL OF MINDING THE GAP

The neglect of psycho‐spiritual needs of patients as they traverse the modern healthcare system has been a featured theme in medical literature over the past decade. This literature, which often highlights in‐patient palliative care, as well as acute and critical care settings, influences practice guidelines and protocols of doctors and nurses. In this essay, I review some of the pertinent issues raised in the literature and examine the validity of placing an ethical perspective on this issue. I also compare Islamic theocentric perspectives with secular, non‐theistic perspectives on restoring psycho‐spiritual care for patients. I then develop a framework for pastoral intervention based on aspects of the Islamic tradition and elaborate this framework by addressing clinical contexts and cases. The essay is an exposition based upon a review of the modern medical literature, an analysis of some of the traditional Islamic written sources, and the observations of the investigator, a practicing physician and an American Muslim.     

临床检验科人文精神缺失及对策的思考

当今随着经济和社会的发展,在现有的医学教学模式、医疗体制和分配制度下,医院临床检验科越来越推崇医学技术主义和追求高额的经济利益,致使临床检验医生人文精神日益缺失,医生与患者之间最具人性的本质已被淹没,医患矛盾日益增加和凸显。如何以患者需求为导向,让患者满意,这迫切地需要在临床检验科加强人文素质教育,培育检验医生的“医者仁心”大医情怀,以减少和预防医患矛盾的发生,这是检验科管理者应该急需思考的问题。     

Our Literature as the Problem Child of Psychoanalysis Commentary on Paper by Drew Westen

This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its “trials” are all the analytic sessions that have been conducted. Our “literature” has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.     

临床医学教育中的医学哲学

医学哲学是现代医学教育中的重要组成部分,医学科学必须与医学哲学相结合才是未来医学教育的发展方向。在以岗位胜任能力为导向的医学教育转型中,培养医学生的哲学思维无疑是其重要环节之一。为适应全球卫生事业的迅猛发展,医学教育务必在临床思维上进行整合。本文从培养合格医学毕业生的角度出发,阐述了医学与哲学的关系、医学教育中的哲学地位及哲学在临床医学教育中的具体应用。旨在提高医学生的哲学理念,促进现代医学教育的转型发展。     

Thinking through thinking: Deleuze and “the dogmatic image of thought”

In my philosophical thinking, I have followed many of those influenced by Heidegger and Nietzsche (particularly Derrida, Lacan and Deleuze) who argue that philosophy has been colonised from its inception by a specific understanding of what thinking entails. Deleuze articulates this form of colonisation in terms of the eight postulates of “the dogmatic image of thought”. This article responds to the disconcerting realisation, elicited by three encounters, that despite my “philosophising about” a disruptive thinking in the name of complexity, my practice of thinking remains deeply habituated by “the dogmatic image of thought” and I have yet to begin thinking as “habitual disturbance” and an “adventure of learning”. To show why an effort to think through thinking remains important for philosophy in South Africa, I tie this reflection to specific provocations (a conference theme entitled “Philosophy in/as Translation”; a pointed remark that “there is no African word for ‘identity’”). However, the topic of the provocations should not mislead readers to expect scholarship about general relationships between philosophy, translation and decolonisation, although these terms are entangled. Instead, I focus on “thinking”. I discuss a personal response to the remark regarding the untranslatability of “identity” through the lens of Deleuze’s critique of “the dogmatic image of thought”, and reminded by the conference theme that this response is situated in the South African academic context where issues of decolonisation form the underlying fabric of intellectual work. From out of this entanglement I consider what philosophy’s internal decolonisation might entail.

“Thus, to ‘philosophize’ about being shattered is separated by a chasm from a thinking that is shattered” (Heidegger, “Letter on Humanism”).     

Reflexivity in quantitative research: A rationale and beginner's guide

Reflexivity is the act of examining one's own assumption, belief, and judgement systems, and thinking carefully and critically about how these influence the research process. The practice of reflexivity confronts and questions who we are as researchers and how this guides our work. It is central in debates on objectivity, subjectivity, and the very foundations of social science research and generated knowledge. Incorporating reflexivity in the research process is traditionally recognized as one of the most notable differences between qualitative and quantitative methodologies. Qualitative research centres and celebrates the participants' personal and unique lived experience. Therefore, qualitative researchers are readily encouraged to consider how their own unique positionalities inform the research process and this forms an important part of training within this paradigm. Quantitative methodologies in social and personality psychology, and more generally, on the other hand, have remained seemingly detached from this level of reflexivity and general reflective practice. In this commentary, we, three quantitative researchers who have grappled with the compatibility of reflexivity within our own research, argue that reflexivity has much to offer quantitative methodologists. The act of reflexivity prompts researchers to acknowledge and centre their own positionalities, encourages a more thoughtful engagement with every step of the research process, and thus, as we argue, contributes to the ongoing reappraisal of openness and transparency in psychology. In this paper, we make the case for integrating reflexivity across all research approaches, before providing a ‘beginner's guide’ for quantitative researchers wishing to engage reflexively with their own work, providing concrete recommendations, worked examples, and reflexive prompts.     

Bodily Thought and the Corpse Problem

Abstract: A key consideration in favour of animalism—the thesis that persons like you and me are identical to the animals we walk around with—is that it avoids a too many thinkers problem that arises for non‐animalist positions. The problem is that it seems that any person‐constituting animal would itself be able to think, but if wherever there is a thinking person there is a thinking animal distinct from it then there are at least two thinkers wherever there is a thinking person. Most find this result unacceptable, and some think it provides an excellent reason for accepting animalism. It has been argued, however, that animalists face an analogous problem of too many thinkers, the so‐called corpse problem, as they must accept both 1) that we are distinct from our bodies, as our bodies can and we cannot persist through death as corpses and 2) that our bodies can think. I argue that the best reasons animalists have for accepting the two claims that generate the distinctness part of the problem double up as reasons to reject the claim that our bodies can think, and vice versa. I argue further that Lockeans cannot similarly get around their problem of too many thinkers.     

整形美容外科的实践认识和选择性治疗的哲学应用

随着我国经济、生活条件的改善,现代整形美容技术飞速发展给广大有身体缺欠者提供了机会,同时也给临床工作者带来了很多问题。因此对整形美容外科实践进行哲学思考,进行选择性治疗,遵守客观规律,既有利于满足医患双方的利益,缓解医患关系,减少医疗纠纷的发生,又有利于提高整形美容外科的整体医疗服务质量。     

Index to Volume 49

Abstract

I introduce an approach to group that has remained undeveloped in the literature, but represents an essence of relationally oriented group psychotherapy. Evolving from the verbalizations and enactments through which the group symbolizes and becomes known–a nuclear idea takes shape. It emerges from the nucleus of the group process: co-created from intersubjective forces and locations that cannot be fully specified, yet may be possible to observe, name, and utilize clinically. Groups organize themselves by developing nuclear ideas, with the therapist’s active participation. They are vehicles through which a group comes to think about its thinking: not only what it thinks, but also how it thinks, or chooses not to think, and when and why. Developing the nuclear idea provides a framework for how the therapist–and the group itself–goes about the task of containing. With its emphasis on meaning and the development of meaning as transformational, the concept of the nuclear idea supplements the whole group, interpersonal, and intrapsychic lenses through which the therapist comes to understand group experience and base interventions. Clinical vignettes illustrate how the therapist may develop nuclear ideas thematically, conceptualize further, and negotiate meaning with the co-participation of other group members.     

Bearing Witness Through Medicine: An Exploratory Study of Attitudes to Service Among Australian Evangelical Christian Doctors

This study explores the attitudes of Australian evangelical Christian doctors to healing, suffering and good practice, using in-depth interviews. Doctors described an intellectualised faith, in which medical care was conceived in itself as a way of bearing witness. The alleviation of suffering, for these doctors, included supporting patients to rediscover purpose and meaning in their lives. There was diversity of opinion about evangelising, with many feeling that this was a contingent activity best conducted outside the consultation. This cohort of doctors, mostly non-denominational, had consciously engaged in work with the poor and marginalised as an expression of their faith.     

Hegel: Death of God and Recognition of the Self

Abstract

This paper covers the theme of the death of God considered from a Hegelian standpoint. For Aristotle, the image of God as ‘thought thinking itself’ was an image of the knowledge aspired to in philosophy. With the notion of God becoming man and his insistence on the icon of the Cross, Hegel challenged the Aristotelian goal of philosophy as immutable knowledge of an ‘ultimate’ reality. Hegel viewed the crisis of normativity (the death of the Cartesian divine guarantor) as strictly linked to the conception of the self. It is Nietzsche who is best known for alluding to the full significance of this image for modern life, but Hegel’s thought on the complex relations of philosophy and religion in the modern world can be regarded as an attempt to think through this same historical phenomenon. In this paper, I focus on the philosophical relevance of Hegel’s notion of the death of God. I argue that unpacking the significance of the ‘truths’ presented symbolically in modern Christianity is crucial in understanding the requirements that an idealistic philosophy must meet.     

一个临床医生所遭遇的尴尬

学习自然辩证法的好处之一,就是使得一个多年从事临床医疗实践的医生获得了一个宝贵的机会,可以静下心来从理性和哲学的高度来思考问题,而不是整日沉溺于病人、手术之类的繁琐事物中。然而,通过对医患关系的本质的思考,以及对医学临床当中一些现象的分析,比如,医生和病人对截肢术的不同想法,并上升到哲学高度对医学范式进行了讨论,竟引发出令人困惑的哲学尴尬。最终感到,“以人为本”的思想才是解决困惑的利器。     

Modern Philosophy,the Subject,and the God of the Bible

In my paper, I undertake to show that the God of the Bible is the subject of modern philosophy, i.e., that philosophy is biblical and that the Bible is philosophical. Central to the argument of my paper is an analysis of the fundamental difference between the philosophy of Aristotle (consistent with Socrates and Plato), as based on the law of contradiction and thus on the contradictory opposition between necessity and existence, and the philosophy of, in particular, Spinoza and Kant, as based on the transcendental logic of the necessary relationship of thought and existence. Thus, I argue that the ontological argument (proving the existence of God) demonstrates the necessary existence of the thinking subject and of the subject thought, at once human and divine. In short, metaphysics is practical reason, the practice of doing unto others what you want others to do unto you, and reason is metaphysical practice, the practice of proving that there is one thing that you, a subject, cannot think without it necessarily existing, and that is the other subject (the neighbor/God).     

Soziales Netzwerk Psyche

In six steps I attempt to show how modernized psychoanalysis contributes to a ??social theory of mind?? (Mitchell, pp.?17?f.). First of all, the pluralism of schools is reflecting the lack of a psychoanalytic core theory, a shortcoming which is merely concealed by its conceptional oversupply and can only be overcome by scientific research. Secondly, I suggest to give up the inclination towards deep thinking, typical of our profession always on the lookout for new metaphors of the psyche, and to replace this inclination by the precise observation of interactions. Thirdly, I discuss the suggestion to understand the unconscious as a hidden link between self and the real world, as a relational tendency of the psyche to connect??a legacy of symbiotic experience??the inside with the outside not only in dreams but in reality. This is, fourthly, my understanding of the unconscious drive of human mind to express itself in a social world whose interactive platforms only allow that building of mental structures we call mentalization, according to Fonagy. Fifthly I point out that the monadic theory of mind implicated in classical drive theory is obsolete in a scientific sense in order to plead, sixthly, for a modernization of psychoanalysis replacing its central metaphor of the mental apparatus by that of a mental network: The modernized psyche is nowadays less in charge of managing intrapsychic drive-economy; its main duty in the age of modern reflexivity seems to be the skilful management of self-relation in the broadly stretched network of interpersonal relationships.     

It takes two to tango: Research and practice as an amazing dance

This paper offers an appreciative critique of Kim Etherington's recent book, Narrative Approaches to Working with Adult Male Survivors of Male Child Sexual Abuse. I discuss the issues raised in the book with reference to one of my current clients. Etherington does not produce new substantive theory: the power of this work is in the narrative. Her important contribution lies in the reflexivity with which she encounters her material. The use of critical reflexivity challenges the subject/object dichotomy inherent in much positivistic research, and presents a much‐needed approach to process that is congruent with the lived experience of counselling. I would suggest that research is more likely to succeed in informing practice if the material is open to personal interpretation by the reader/therapist. Further, I would claim that the activity of using research creatively is itself a heuristic process: useful learning is most likely to occur if the dialogic relationship with the client and therapist is mirrored in the relationship between the therapist and the research text.     

临床医学新趋势：语言作为一种治疗工具的复兴

在履践生物心理社会医学模式中,语言具有不可替代的重要作用。现代医疗设备和仪器的高度发达使医生逐渐脱离了患者;技术主体化倾向使医生的语言功能逐渐地退化,语言能力的欠缺不仅影响医患关系,也直接影响疾病的治疗效果。因此,履践语言的临床复兴,务必掌握语言的艺术、沟通的技巧,以建立和谐稳固的医疗环境和医患关系,良好的语言是缓解患者痛苦的有效良方,在当今诸多医学及复杂社会因素的影响下,语言作为一种治疗工具必将成为临床医疗的新趋势。     

Sense in Competing Narratives of Secularization: Charles Taylor and Jean-Luc Nancy

In this article, using the recent work by Charles Taylor in A Secular Age as my point of departure, I will argue that Jean-Luc Nancy enables us to think past the competing binary of atheistic and religious experience and allows us to surpass the present narratives of secularism. In A Secular Age, Taylor himself seeks a middle ground between atheism and religion, arguing that it is possible to open ourselves to the cross-pressures of modern existence that find us caught between scientific atheism and a need for spiritual and religious guidance. Here, Taylor finds a way of picturing ourselves within a secular age, remaining faithful to scientific rationalism, but still open to religion and a sense of a higher good. However, as I shall demonstrate, in his thesis Taylor misrepresents the Continental philosophical tradition (particularly Nietzsche and post-structuralism) that has itself sought to understand these cross-pressures of existence. Taking this misrepresentation, and specifically his reductive and colloquial analysis of Nietzsche, Camus, and Derrida, as my point of departure, I provide an alternative manner of thinking through the work of these writers, one that leads to a detailed analysis of Jean-Luc Nancy and his project the deconstruction of Christianity. In this analysis I argue that Nancy provides a manner of thinking that remains open and allows an experience of freedom, without seeking to close that sense of openness with explanation, nor maintaining that sense of openness with a conception of the divine.     

The Semantics of Wisdom in the Philosophy of Tang Junyi: Between Transformative Knowledge and Transcendental Reflexivity

In this article, I offer a provisional analysis of the philosophical semantics of “wisdom” in the thought of the New Confucian thinker Tang Junyi. I begin by providing some pointers concerning the concept of wisdom in general and situating the discourse on wisdom in comparative philosophy in the context of the later Foucault’s and Pierre Hadot’s historical investigations into ancient Graeco-Roman philosophy as a mode of spiritual self-cultivation and self-transformation. In the remainder of the paper, I try to describe and think through what Foucault identifies as a “Cartesian moment,” in which self-knowledge becomes the ultimate precondition for the ethico-spiritual project of “caring for the self,” in Tang’s approach of wisdom. In the course of my argument, I outline the complex relation between his vision of a renewed Confucian mode of religious practice on the one hand and his philosophical presuppositions concerning the transcendental status of subjectivity and the reflexivity of consciousness on the other.     

Indiscriminable shades and demonstrative concepts

Virtue ethicists argue that modern ethical theories aim to give direct guidance about particular situations at the cost of offering artificial or narrow accounts of ethics. In contrast, virtue ethical theories guide action indirectly by helping one understand the virtues—but the theory will not provide answers as to what to do in particular instances. Recently, this had led many to think that virtue ethical theories are self-effacing the way some claim consequentialist and deontological theories are. In this paper I defend virtue ethics against the charge of self-effacement. I distinguish between modestly self-effacing theories, immodestly self-effacing theories and theories that recommend indirect guidance. Though all self-effacing theories are indirect, not all indirect theories are self-effacing. I argue that virtue ethics is not self-effacing, but rather indirectly action-guiding. The response I articulate draws on the distinctive virtue ethical mode of action-guidance: namely, that thinking hard about virtue and what kind of person one aims to be offers the kind of guidance we want (or should want) as we face practical moral problems.     

Self‐supervision,surveillance and transgression

Transgression is not only an inevitable part of systemic supervision but is also necessary if we are to work towards innovative and inclusive supervisory and therapeutic practice. Defying culturally generated ‘rules’ of systemic practice can allow for more relevant and productive ways of talking. Systemic practitioners are increasingly finding themselves trying to practice systemic therapy in employing authorities and training courses which are dominated by inflexible professional narratives and manualised procedures. Our profession is committed to ethical inner and outer dialogue, to self‐ and relational reflexivity as distinct from the rule‐bound surveillance culture in which we live and work. Systemic supervisors and therapists may find themselves at odds with monological institutional discourse and attempts from within our own profession to manualise practice. I introduce examples from supervisory conversations to illustrate how supervisors can develop more culturally sensitive practices through supporting practitioners to hear and have heard their own marginalised and oppressed voices and those of their clients.