WHY BIOETHICS NEEDS THE PHILOSOPHY OF MEDICINE: SOME IMPLICATIONS OF REFLECTION ON CONCEPTS OF HEALTH AND DISEASE

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the “science” of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice.     

行为与脑的关系及其与机体其它属性间的相互作用的研究──心理学研究展望

“二十一世纪的心理学”的论题是当今许多科学家感兴趣的．这种预测是一种想象与现实相结合的尝试。审视过去和现在．心理学未来的雏形的基础可能是行为与脑的关系及其与生命其它属性之间的相互作用。     

Three Problems for “strong” Modal Fictionalism

Philosophical Studies -     

Cognitive rehabilitation of chronic alcohol abusers

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.     

Lateralized Changes in Regional Cerebral Blood Flow during Performance of Verbal and Facial Recognition Tasks: Correlations with Performance and “Effort”

Functional neuroimaging has been used to investigate neural substrates of mnemonic processes, and cerebral blood flow (CBF) measures have been sensitive to activation with memory tasks. Studies of memory with two-dimensional¹³³Xenon clearance techniques found that word and face recognition tasks produced contralateral CBF changes in mid-temporal cortical regions. This study replicated the activation paradigm, expanding to the three-dimensional resolution of positron emission tomography (PET). Word and face recognition, and a control baseline task were administered to 19 healthy right-handed volunteers (11 men, 8 women) during successive 10 min PET¹⁵O-water measures of CBF. Quantitative CBF rates were calculated with the arterial input function and the equilibrium model. Redistributions of blood flow were compared across tasks using both absolute and relative (region/whole brain) CBF.Replicating the¹³³Xenon clearance findings, CBF was “appropriately” lateralized during task performance (left–right for words > left–right for faces) in the mid-temporal region. Contrary to predictions, the recognition tasks did not activate expected mesolimbic or prefrontal areas. The task-induced CBF changes also correlated with performance. Bilateral CBF in mid-temporal and parahippocampal gyrus regions of interest correlated with the ability to correctly identify word targets (sensitivity). Left-lateralized CBF in the amygdala and hippocampus correlated with better word sensitivity as well as specificity (ability to correctly reject foils). Complementally, right-lateralized CBF in the parahippocampal gyrus correlated with better face specificity performance. In addition, left-lateralized CBF in the amygdala and right-lateralized CBF in the parahippocampal gyrus and hippocampus correlated with “mental effort” indices (task performance relative to basal ability) for word and face memory tasks, respectively. Thus, whereas this recognition task showed the expected lateralized increase in the mid-temporal region and not in frontal and limbic areas, lateralized activation in some of these areas was associated with better performance. Exploratory analyses on other regions showed lateralized changes in one additional temporal region, the occipital-temporal, and several limbic regions.     

Ethnic differences in psychiatric disorders among adolescent substance abusers in treatment

The present study describes the diagnostic profile of over 800 adolescents admitted to residential therapeutic community programs for treatment of drug abuse and related problems. The relationship between race/ethnicity and psychiatric disturbance is examined, and the association among these factors to outcome is investigated. Over 90% of the sample had a DSM-III-R nonsubstance diagnosis. There were significant differences among the race/ethnic groups on attention deficit-hyperactivity and the disruptive behavior and affective disorders. In general, African-American adolescents yielded the lowest rates of disturbance across all categories of disorders. There was no relationship among race/ethnicity, psychiatric disturbance, and 1-year posttreatment outcomes.     

Freud, Oedipus and the Hebrew Bible

The current paper examines the question of why Freud employed Greek rather than Hebrew foundation legends, specifically the story of Oedipus, as a basis for psychoanalysis, Freud's choice of Oedipus emanates from his deterministic view of the universe, paralleling the Greek rather that the Biblical story of creation. In the Biblical account God precedes and creates nature with no sign of an Oedipal conflict. In the Greek account, nature precedes the gods and the Oedipal conflict is inherent. Freud's choice has implications for his view of human psychology.     

THE SIMILARITY OF BRAIN ACTIVITY ASSOCIATED WITH TRUE AND FALSE RECOGNITION MEMORY DEPENDS ON TEST FORMAT

Abstract— Event-related potentials (ERPs) were compared for correct recognitions of previously presented words and false recognitions of associatively related, nonpresented words (lures). When the test items were presented blocked by test type (old, new, lure), waveforms for old and lure items were different, especially at frontal and left parietal electrode sites, consistent with previous positron emission tomography (PET) data (Schacter, Reiman, et. al., 1996). When the test format randomly intermixed the types of items, waveforms for old and lure items were more similar. We suggest that test format affects the type of processing subjects engage in, consistent with expectations from the source-monitoring framework (Johnson, Hashtroudi, & Lindsay, 1993). These results also indicate that brain activity as assessed by neuroimaging designs requiring blocked presentation of trials (e g, PET) do not necessarily reflect the brain activity that occurs in cognitive-behavioral paradigms, in which types of test trials are typically intermixed.