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Abstract
Qualitative research provides an in-depth understanding of lived experiences. However, these experiences can be hard to apprehend by using just one method of data analysis. A good example is the experience of resilience. In this paper, the authors describe the chain of the decision-making process in the research of the construct of "resilience". s The authors justify the implications of a multi-method, pluralistic approach, and show how the triangulation of two or more qualitative methods and integration of several qualitative data analysis methods can improve a deeper understanding of the resilience among people with chronic pain. By combining the thematic analysis, narrative analysis, and critical incident technique, lived experiences can be seen from different perspectives.Therefore, the thematic analysis describes the content and answers to "what" regarding resilience, the narrative analysis describes the dynamics of resilience, and answers to "how", while the critical incident technique clarifies the most significant experience and the answers to "why" changes happen. This integrative approach could be used in the analysis of other psychological constructs and can serve as an example of how the rigour of qualitative research could be provided.
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Affiliation(s)
- Elīna Zelčāne
- Department of Health Psychology and Paedagogy, Riga Stradiņš University, Riga, Latvia,CONTACT Elīna Zelčāne Department of Health Psychology and Paedagogy, Riga Stradiņš University, Jāņa Asara street 5, RigaLV-1009, Latvia
| | - Anita Pipere
- Department of Health Psychology and Paedagogy, Riga Stradiņš University, Riga, Latvia
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2
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Spang F. Compromise in Political Theory. Polit Stud Rev 2023; 21:594-607. [PMID: 37435545 PMCID: PMC10331511 DOI: 10.1177/14789299221131268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 07/13/2023]
Abstract
This review article provides a topic-centered overview of the state of compromise in political theory, where compromise is increasingly discussed as a promising approach to dealing with disagreement in politics and society. Given the growing literature on compromise, a systematic approach to the topic is due. The first sections are focused on clarifying the concept of compromise, while the remainder of the article offers different perspectives on those aspects of compromise that are subject to debate.
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Affiliation(s)
- Friderike Spang
- Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Quartier UNIL-Chamberonne, Lausanne, Switzerland
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3
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Bharwani A, Van Dyke J, Santamaria-Plaza C, Palmiano Federer J, Jones P. Transforming Intractable Policy Conflicts: A Qualitative Study Examining the Novel Application of Facilitated Discourse (Track Two Diplomacy) to Community Water Fluoridation in Calgary, Canada. Int J Environ Res Public Health 2023; 20:6402. [PMID: 37510634 PMCID: PMC10379997 DOI: 10.3390/ijerph20146402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Governments face challenges in resolving complex health and social policy conflicts, such as the community water fluoridation (CWF) impasse in Calgary. Track Two diplomacy, informal dialogues facilitated by an impartial third party, is proposed to address these issues amid epistemic conflict and declining public trust in fellow citizens, science, and government. This study examined Track Two diplomacy's application in Calgary's CWF policy conflict. Collaborating with policymakers and community partners, the research team explored a Track Two-CWF process and conducted 21 semi-structured interviews with policymakers, scholars, practitioners, observers, and civil society representatives. Data interpretation explored contextual factors, conflict transformation potential, and design features for a Track Two process. A conflict map revealed factors contributing to impasse: the polarizing nature of a binary policy question on fluoridation; disciplinary silos; failed public engagement; societal populism; societal lack of disposition to dialogue; individual factors (adverse impact of conflict on stakeholders, adherence to extreme positions, issue fatigue, apathy, and lack of humility); together with policy-making factors (perceived lack of leadership, lack of forum to dialogue, polarization and silos). Participants suggested reframing the issue as nonbinary, involving a skilled facilitator, convening academics, and considering multiple dialogue tracks for a Track Two process. The first theory of change would focus on personal attitudes, relationships, and culture. Participants expressed cautious optimism about Track Two diplomacy's potential. Track Two diplomacy offers a promising approach to reframe intractable public health policy conflicts by moving stakeholders from adversarial positions to jointly assessing and solving problems. Further empirical evidence is needed to test the suggested process.
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Affiliation(s)
- Aleem Bharwani
- UCalgary Pluralism Initiative and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 4N1, Canada
- Ward of the 21st Century, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
- Ottawa Dialogue, University of Ottawa, Ottawa, ON K1N 5Y3, Canada
| | - Jessica Van Dyke
- Ward of the 21st Century, University of Calgary, Calgary, AB T2N 4N1, Canada
| | | | | | - Peter Jones
- Ottawa Dialogue, University of Ottawa, Ottawa, ON K1N 5Y3, Canada
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4
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Herlitz A. Toward a Hybrid Theory of How to Allocate Health-related Resources. J Med Philos 2023:7190767. [PMID: 37279934 DOI: 10.1093/jmp/jhad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need are suggested as two values that should be part of a general theory of how to allocate health-related resources. The "small improvement argument" is used to argue that it is implausible that one alternative is always better, worse, or equal to another alternative with respect to these values. Approaches that rely on these values are thus incomplete. To deal with this, it is suggested that we ought to use incomplete theories in a two-step process. Such a process first discards ineligible alternatives, and, second, uses reasons grounded in collective commitments to identify a unique, best alternative in the remaining set.
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Affiliation(s)
- Anders Herlitz
- University of Gothenburg, Gothenburg, Sweden
- Institute for Futures Studies, Stockholm, Sweden, Lund University, Lund, Sweden
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5
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Gaillard JC. The Tout-Monde of disaster studies. Jamba 2023; 15:1385. [PMID: 36873604 PMCID: PMC9982500 DOI: 10.4102/jamba.v15i1.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/16/2022] [Indexed: 06/18/2023]
Abstract
UNLABELLED This essay expands the postcolonial agenda for future disaster studies that we suggested in the conclusion of the book The Invention of Disaster. It provides some refined perspectives on how to capture the diversity and complexity of the world that we draw from the philosophy of Martinican poet and novelist Edouard Glissant. Glissant's philosophy of creolisation and relation offers critical pathways towards pluralistic approaches to understanding what we call disaster in a world that is marked by hybridity and relationships rather than essentialism and nativism. A Tout-Monde, in Glissant's terms, that is the combined additions of different and hybrid interpretations of disaster. CONTRIBUTION Exploring the Tout-Monde of disaster studies will constitute a radical and forward-looking postcolonial agenda; radical in the sense that it will challenge many of our scholarly assumptions, popular discourses as well as common-sense policies and practices.
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Affiliation(s)
- JC Gaillard
- Te Kura Mātai Taiao, Waipapa Taumata Rau, Aotearoa
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6
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Allison E. Debating well: Why don't we, and how can we? Int J Psychoanal 2023; 104:147-152. [PMID: 36799639 DOI: 10.1080/00207578.2023.2162217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This paper introduces the contributions of Alan Sugarman (US), Rachel Blass (Israel), Paul Denis (France), Luisa Perez (Uruguay), Bernard Reith (Switzerland) and David Tuckett (UK) to a debate on the question of how we can enable productive discussion about our scientific differences and why historically it has been so difficult for the discipline of psychoanalysis to initiate and sustain such discussions. By way of introduction the historical example of the Controversial Discussions in the British Psychoanalytic Society is briefly reviewed and several possible factors contributing to the difficulties are provisionally identified, including over-reliance on authority and tradition, eagerness to supervise on the basis of our own theoretical models rather than trying to understand those of others, the lack of clarity and consensus in our definitions of terms, a lack of mutual curiosity resulting in theoretical silos, an experienced threat to identity when adjustments to our positions are called for, and the lack of a methodology for undesrstanding and / or resolving differences.
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Affiliation(s)
- Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, Psychoanalysis Unit, University College London, London, UK
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Fleck LM. The Dobbs Decision: Can It Be Justified by Public Reason? Camb Q Healthc Ethics 2023;:1-13. [PMID: 36683585 DOI: 10.1017/S0963180122000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito's emphasis on "ordered liberty" seems completely at odds with the "disordered liberty" regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until birth as an "unborn human being" begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women.
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Harambam J, Grusauskaite K, de Wildt L. Poly-truth, or the limits of pluralism: Popular debates on conspiracy theories in a post-truth era. Public Underst Sci 2022; 31:784-798. [PMID: 35481767 PMCID: PMC9344487 DOI: 10.1177/09636625221092145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Conspiracy theories are central to "post-truth" discussions. Official knowledge, backed by science, politics, and media, is distrusted by various people resorting to alternative (conspiratorial) explanations. While elite commentators lament the rise of such "untruths," we know little of people's everyday opinions on this topic, despite their societal ramifications. We therefore performed a qualitative content analysis of 522 comments under a Dutch newspaper article on conspiracy theories to study how ordinary people discuss post-truth matters. We found four main points of controversy: "habitus of distrust"; "who to involve in public debates"; "which ways of knowing to allow"; and "what is at stake?" The diverging opinions outline the limits of pluralism in a post-truth era, revealing tensions between technocratic and democratic ideals in society. We show that popular opinions on conspiracy theories embody more complexity and nuance than elite conceptions of post-truth allow for: they lay bare the multiple sociological dimensions of poly-truth.
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Affiliation(s)
- Jaron Harambam
- Jaron Harambam, Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
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9
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Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, Galindo-Suarez RM, Guerino J, Mejía A, Mujoomdar M, Ollendorf D, Ronquest N, Torbica A, Tsiao E, Watkins J, Yeung K. Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report. Value Health 2022; 25:1257-1267. [PMID: 35931428 DOI: 10.1016/j.jval.2022.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.
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Affiliation(s)
| | | | | | | | - Nathorn Chaiyakanapruk
- University of Utah, Salt Lake City, UT, USA; Monash University, Selangor, Malaysia; IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | | | | | | | | | - Michelle Mujoomdar
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | | | | | | | - Emily Tsiao
- Premera Blue Cross, Mountlake Terrace, WA, USA
| | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Centre, Seattle, WA, USA
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10
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Karbelnig AM. Chasing infinity: Why clinical psychoanalysis' future lies in pluralism. Int J Psychoanal 2022; 103:5-25. [PMID: 35168483 DOI: 10.1080/00207578.2021.1975288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Part of an ongoing political and scholarly effort to move the psychoanalytic project towards greater cohesiveness, the author proposes a standard method, borrowing the phrase from physics, for a structured, eclectic clinical pluralism. She [or he] uses psychoanalytic and philosophical arguments, as well as considerations of patients' personal idiosyncrasies, to conclude that achieving one, over-arching metapsychology will prove impossible. In other words, and despite their ardent efforts, psychoanalytic theorists, including Freud (1895/1991), Rangell (1975, 2006), Greenberg and Mitchell (1983), Wallerstein (1988, 1990, 2002, 2005, 2013), and others, failed to create models accounting for the dynamically interacting variables creating human subjectivity. Their struggles to bridge psychoanalytic theories of mind and method also fell short. As a result, the author suggests, clinical psychoanalysis' ultimate fate lies in organizing what Wallerstein (2005) called the "common ground" (p. 626) into methodology which invites psychoanalytic practitioners to mine the psychoanalytic opus for its "plethora of theoretical metaphors" (Wallerstein, 2013, p. 36), "controlling fictions" (Greenberg, 2015, p. 17), "useful untruths" (Lament,020, p. 196), or "regional dialects" (Fulgencio, 2020, p. 15). Cohesively applying a pluralistically based metapsychology to guide clinical processes, rather than provide maps of the mind, offers much-needed unity to psychoanalysis' applied wing.
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Affiliation(s)
- Alan Michael Karbelnig
- In Private Practice at, Pasadena, CA, USA.,The New Center for Psychoanalysis, Los Angeles, CA, USA
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11
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Gauld C, Nielsen K, Job M, Bottemanne H, Dumas G. From analytic to synthetic-organizational pluralisms: A pluralistic enactive psychiatry. Front Psychiatry 2022; 13:981787. [PMID: 36238942 PMCID: PMC9551055 DOI: 10.3389/fpsyt.2022.981787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Reliance on sole reductionism, whether explanatory, methodological or ontological, is difficult to support in clinical psychiatry. Rather, psychiatry is challenged by a plurality of approaches. There exist multiple legitimate ways of understanding human functionality and disorder, i.e., different systems of representation, different tools, different methodologies and objectives. Pluralistic frameworks have been presented through which the multiplicity of approaches in psychiatry can be understood. In parallel of these frameworks, an enactive approach for psychiatry has been proposed. In this paper, we consider the relationships between the different kinds of pluralistic frameworks and this enactive approach for psychiatry. METHODS We compare the enactive approach in psychiatry with wider analytical forms of pluralism. RESULTS On one side, the enactive framework anchored both in cognitive sciences, theory of dynamic systems, systems biology, and phenomenology, has recently been proposed as an answer to the challenge of an integrative psychiatry. On the other side, two forms of explanatory pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first is tolerant, it examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second is integrative and proposes to bring together the different levels of understanding and systems of representations. We propose that enactivism is inherently a form of integrative pluralism, but it is at the same time a component of the general framework of explanatory pluralism, composed of a set of so-called analytical approaches. CONCLUSIONS A significant number of mental health professionals are already accepting the variety of clinical and scientific approaches. In this way, a rigorous understanding of the theoretical positioning of psychiatric actors seems necessary to promote quality clinical practice. The study of entanglements between an analytical pluralism and a synthetic-organizational enactivist pluralism could prove fruitful.
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Affiliation(s)
- Christophe Gauld
- Department of Child Psychiatry, Hospices Civils de Lyon, Grenoble, France.,Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS and Université Claude Bernard Lyon 1, Paris, France
| | - Kristopher Nielsen
- School of Psychology, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Manon Job
- Institut Jean Nicod, École Normale Supérieure-EHESS, Paris, France
| | - Hugo Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM), Center for the National Scientific Research (CNRS), APHP, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, Paris, France.,Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Department of Philosophy, Sorbonne University, SND Research Unit, Center for the National Scientific Research (CNRS), UMR 8011, Paris, France
| | - Guillaume Dumas
- CHU Sainte-Justine Research Center, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada.,Mila - Québec Artificial Intelligence Institute, Université de Montréal, Montréal, QC, Canada
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Smith K, McLeod J, Blunden N, Cooper M, Gabriel L, Kupfer C, McLeod J, Murphie MC, Oddli HW, Thurston M, Winter LA. A Pluralistic Perspective on Research in Psychotherapy: Harnessing Passion, Difference and Dialogue to Promote Justice and Relevance. Front Psychol 2021; 12:742676. [PMID: 34552542 PMCID: PMC8450328 DOI: 10.3389/fpsyg.2021.742676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good.
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Affiliation(s)
- Kate Smith
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - John McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Mick Cooper
- Department of Psychology, Roehampton University, London, United Kingdom
| | - Lynne Gabriel
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Christine Kupfer
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Julia McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Hanne Weie Oddli
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Mhairi Thurston
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Laura Anne Winter
- Manchester Institute of Education, Schools of Environment, Education, and Development, University of Manchester, Manchester, United Kingdom
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13
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Aftab A. Explanatory methods in psychiatry: interview with Paul McHugh, MD. Int Rev Psychiatry 2021; 33:446-451. [PMID: 32787593 DOI: 10.1080/09540261.2020.1800599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This interview with Paul McHugh, MD, delves into his Perspectives approach to psychiatry. Building on the philosophical work of forerunners such as Adolf Meyer and Karl Jaspers, the Perspectives approach identifies four explanatory methods underlying the practice of the profession: the perspectives of brain diseases, personality dimensions, motivated behaviours, and life encounters. The disease perspective describes how neurobiological injuries can disrupt the functioning of the brain, as with delirium or dementia. The dimensional perspective describes the vulnerabilities of some individuals to emotional unrest tied to aspects of the self-defining features characterising them, as with intellectual disability or personality disorders. The behaviour perspective describes problematic, habit-sustained activities that arise from the teleological features, as with anorexia nervosa or alcohol dependence. The life story perspective describes how emotional distresses is generated by the interaction of life events and the extrinsic/experiential features of mind, as with grief, post-traumatic stress disorder, or demoralisation. The Perspectives approach structures and operationalises the several elements of a psychiatric formulation, with the understanding that the approach to an individual patient requires us to take into account several different aspects of their life and state of mind in making sense of their presentation.
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Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.,Northcoast Behavioral Healthcare (Ohio Department of Mental Health and Addiction Services), Northfield, OH, USA
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14
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Kowalski CJ, Redman RW, Mrdjenovich AJ. The transition from inquiry to evidence to actionable clinical knowledge: A proposed roadmap. J Eval Clin Pract 2021; 27:667-676. [PMID: 33755289 DOI: 10.1111/jep.13562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way". The result will be an increased appreciation for the meaning and structure of "actionable clinical knowledge". METHODS We review the literature to identify pertinent works dealing with evidence production and translation into actionable clinical knowledge. We draw from insights in this literature about various aspects of reasoning relevant to clinical questions and integrate these into a unified approach to the processes that lead to actionable clinical knowledge. RESULTS We collect, collate, and integrate some of the work by Bauer, Carper, Goldman, Haack, McHugh and Walker, and Upshur and colleagues and obtain guidelines to aid in the evidence-to-actionable-clinical- knowledge transition. CONCLUSIONS Clinical decision-making is not infallible, and the steps we can take to minimize error are context dependent. Medical evidence, produced as it is by human effort, can never be perfect. We will be doing well by assuring that the evidence we use has been produced by a reliable process and is relevant to the question posed.
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Affiliation(s)
- Charles J Kowalski
- Health and Behavioral Sciences IRB, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard W Redman
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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15
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González-Díaz RR, Bustamante-Cabrera GI. Predictive Sequential Research Design to Study Complex Social Phenomena. Entropy (Basel) 2021; 23:e23050627. [PMID: 34069864 PMCID: PMC8157385 DOI: 10.3390/e23050627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 01/29/2023]
Abstract
Social phenomena in their simplest form share infinite complexities and relationships, and by interacting with other entities, their levels of complexity become exponentially inexplicable and incomprehensible. Using a single form of study in complex phenomena could be insufficient, and new forms of analysis should be opened that allow for observing the multidimensionality of study problems from integrative perspectives. The emergence of research using mixed methods attempts to reconcile these methodologies through integration, configuring a stage of interconnection between research paradigms that cause cuts and leaks that may or may not be consistent with the study’s object. At the time of integration, vices can be created by specific value and subjectivity judgments, with investigative diffraction being an alternative to extend integration through data fracture and redirecting the object of study. This work proposes a Predictive Sequential Research Design (DISPRE) for complex social phenomena, which uses fuzzy logic as a tool to solve the information biases caused by the investigative diffraction of each methodological approach as a strategy to capture, explain, understand and predict the intrinsic complexity of the social entity under study.
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Affiliation(s)
- Romel Ramón González-Díaz
- Centro Internacional de Investigación y Desarrollo—CIID, Monteria 230001, Colombia
- Correspondence: ; Tel.: +57-3104057503
| | - Gladys Inés Bustamante-Cabrera
- Latin American Bioethics Committee of the Centro Internacional de Investigación y Desarrollo—CIID, Monteria 230001, Colombia;
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16
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Abstract
Psychiatric disorders are studied at multiple levels, but there is no agreement on how these levels are related to each other, or how they should be understood in the first place. In this paper, I provide an account of levels and their relationships that is suited for psychopathology, drawing from recent debates in philosophy of science. Instead of metaphysical issues, the focus is on delivering an understanding of levels that is relevant and useful for scientific practice. I also defend a pragmatic approach to the question of reduction, arguing that even in-principle reductionists should embrace pluralism in practice. Finally, I discuss the benefits and challenges in integrating explanations and models of different levels.
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Affiliation(s)
- Markus I. Eronen
- Department of Theory and History of Psychology, University of Groningen, Grote Kruisstraat 2/1 9712 TS Groningen, Netherlands
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17
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Jennings B, Gusmano MK, Kaebnick GE, Neuhaus CP, Solomon MZ. Civic Learning for a Democracy in Crisis. Hastings Cent Rep 2021; 51 Suppl 1:S2-S4. [PMID: 33630334 DOI: 10.1002/hast.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This essay introduces a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This multiauthored report offers wide-ranging assessments of increasing polarization and partisanship in American government and politics, and it proposes constructive responses to this in the provision of objective information, institutional reforms in government and the electoral system, and a reexamination of cultural and political values needed if democracy is to function well in a pluralistic and diverse society. The essays in the special report explore the norms of civic learning and institutions, social movements, and communal innovations that can revitalize civic learning in practice. This introductory essay defines and explains the notion of civic learning, which is a lynchpin connecting many of the essays in the report. Civic learning pertains to the ways in which citizens learn about collective social problems and make decisions about them that reflect the duties and responsibilities of citizenship. Such learning can occur in many social settings in everyday life, and it can also be facilitated through participation in the processes of democratic governance on many levels. Civic learning is not doctrinaire and is compatible with a range of public goals and policies. It is an activity that increases what might be called the democratic capability of a people.
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18
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McCaffrey G. Kasulis' intimacy/integrity heuristic and epistemological pluralism in nursing. Nurs Philos 2020; 22:e12333. [PMID: 33058476 DOI: 10.1111/nup.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
Epistemological pluralism is a recognized feature of nursing knowledge, which embraces both objective, scientific knowledge and situated knowledge that include subjective experience, values and affect, and is encountered in relationship. While there is a lively literature about describing and validating the need for pluralism in nursing's knowledge base, there has been less discussion of how to work with and across different kinds of knowing that are used in practice. In this paper, I describe Kasulis' heuristic framework for understanding more clearly what is entailed in different kinds of knowledge, and what some of their advantages and disadvantages might be. The framework was created by Thomas Kasulis, an American scholar of Japanese philosophy who identified broad orientations in Asian and Western philosophies that he characterized as 'intimacy' and 'integrity', respectively. Kasulis emphasized that his framework is a heuristic, a tool for making distinctions more clearly between different styles of thinking, that can manifest not only between cultural traditions from different parts of the world, but also between subcultures within one of the dominant orientations. He breaks his two orientations down by five distinguishing categories of objectivity, relating, affect, embodiment and transparency. In this paper, each category is described and discussed in relation to aspects of nursing knowledge. Looking at different epistemological viewpoints in this way helps to clarify their differences, and to explain the difficulty of reading across them, when they entail basic assumptions that are not commensurable with each other. Kasulis' framework offers a new way of reading across viewpoints commonly seen in the epistemological pluralism of nursing. It is a tool that can sharpen critical discernment about what is at stake, what can be gained, and what might get missed while operating in either the intimacy or integrity orientation.
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19
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Corbella V. Enactment: A necessary conceptual review. Int J Psychoanal 2020; 102:51-67. [PMID: 33952014 DOI: 10.1080/00207578.2020.1796490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Enactment as a psychoanalytic concept was coined by Jacobs in 1986. Since then, it has developed within the psychoanalytic community as a concept. Originally, enactment described an aspect of countertransference expressed through subtle actions within the analytic process, as distinct from noisier performances that fall within the spectrum of "acting out". Nowadays, the concept of enactment poses some difficulties that should not be ignored. As a theoretical concept, enactment has a complex epistemological position, and as a clinical concept it sheds light on contemporary psychoanalytic practices. This paper explores the results from an empirical and conceptual research work, focusing on the history, translations and usages of the term "enactment", and its comparison with related terms. It will also consider the epistemological perspective regarding the current status of enactment as a scientific concept and its relationship with the psychoanalytic theoretical field.
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Affiliation(s)
- Valeria Corbella
- Pontificia Universidad Católica Argentina, Departamento de Psicología, Buenos Aires, Argentina.,Asociación Psicoanalítica Argentina, Buenos Aires, Argentina
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20
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Yous ML, Strachan PH, Ploeg J. Is feyerabendian philosophy relevant for scientific knowledge development in nursing? Nurs Philos 2020; 21:e12309. [PMID: 32537914 DOI: 10.1111/nup.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/20/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
To revitalize nursing science, there is a need for a new approach to guide nurse scientists in addressing complex problems in health care. By applying theoretical concepts from a revolutionary philosopher of science, Paul K. Feyerabend, new nursing knowledge can be produced using creativity and pluralistic approaches. Feyerabend proposed that methods within and outside of science can produce knowledge. Despite the recognition of Feyerabendian philosophy within science, there is currently a lack of literature regarding the relevance of Feyerabendian philosophy for nursing science. We aim to (a) describe and critique Feyerabendian concepts, (b) discuss the potential application of Feyerabendian philosophy for knowledge production within gerontological nursing and (c) describe theoretical possibilities for nurse scientists in using Feyerabendian philosophy to guide nursing knowledge development. We begin by introducing Feyerabend's life and his inspirations for his theoretical concepts, epistemological anarchism, theoretical pluralism and humanitarianism, and conclude by offering suggestions of how to apply Feyerabendian philosophy in nursing research.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, Department of Health, Aging and Society, Faculty of Health Sciences and Associate Member, School of Nursing, McMaster University, Hamilton, ON, Canada
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21
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Abstract
Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants' understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects' motives for participation, and to creating space for studies of empirical ethics.
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Affiliation(s)
- Arsenii Alenichev
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.,The Barcelona Institute for Global Health, Barcelona, Spain
| | | | - René Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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22
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Abstract
The availability of big data has the potential to transform many areas of the life sciences and usher in new ways of doing research. Here, I argue that big data biology also raises fundamental questions in the philosophy of science: for example, what is a good dataset, and how can reliable knowledge be extracted from big data? Collaborations between biologists, data scientists and philosophers of science will help us to answer these and other questions.
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Affiliation(s)
- Sabina Leonelli
- Department of Sociology, Philosophy and AnthropologyUniversity of ExeterExeterUnited Kingdom
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23
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Abstract
The principle of the Protection of Civilians (PoC) in armed conflict has ethical repercussions in various actions undertaken by states and international organisations, from humanitarian relief, development aid, and peacekeeping, to warfare and military intervention. While the ethics of humanitarian intervention are instructive in this regard, most PoC practices should be conceived rather as modes of humanitarian governance across borders-from interventionist to resilience-oriented kinds. The consequences of this for the ethics of PoC are explored in this paper, highlighting questions of power, culture, and complicity. By relating these questions to the ethical strands of solidarist and pluralist internationalism, it positions the ethics of PoC within the broader field of the ethics of world politics. Examples are drawn from recent scholarly debate on PoC efforts in war-torn countries such as South Sudan. This analysis of the ethics of PoC reconfigures central positions in the debate on humanitarian intervention to an era of global humanitarian governance.
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Anderson BJ, Jurawanichkul S, Kligler BE, Marantz PR, Evans R. Interdisciplinary Relationship Models for Complementary and Integrative Health: Perspectives of Chinese Medicine Practitioners in the United States. J Altern Complement Med 2019; 25:288-295. [PMID: 30523704 PMCID: PMC6437621 DOI: 10.1089/acm.2018.0268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The combination of biomedicine and traditional and complementary medicine (T&CM) is often referred to as integrative medicine. However, the degree to which the medical disciplines are integrated varies between medical settings, and it is believed by some to be impossible due to epistemological and paradigmatic differences. Clinicians' perspectives are important determinants of how different medical disciplines are used together. This study explores the perspectives of experienced Chinese medicine practitioners when asked about the most ethical model (opposition, integration, or pluralism) for the relationship between biomedicine and T&CM. DESIGN Thirty-one Chinese medicine practitioners, undertaking a doctoral upgrade program at the Pacific College of Oriental Medicine, participated in this study. Participants were asked to read a publication discussing three models (opposition, integration, and pluralism) for the relationship between biomedicine and T&CM and then discuss, via an online forum within Moodle learning management system, the most ethical model. An inductive content analysis of the forum posts was undertaken to identify common themes, followed by member checking. RESULTS The data were found to contain six major and six minor themes. There was a clear preference for pluralism. The Chinese medicine practitioners expressed reservations about the integrative model, and, above all, cared about the quality of patient care. Much dialogue occurred around issues related to a power imbalance within health care, and possible cooptation issues. Paradigmatic differences and a lack of compatibility between biomedical research models and the practice of Chinese medicine were seen as problematic to the validity of research findings. Interprofessional education was viewed as critical for the development of respect, shared patient care, and referrals between clinicians from different disciplines. CONCLUSIONS This study provides insight into the issues associated with combining biomedicine and T&CM that are perceived by Chinese medicine practitioners. Such insights are important for the development and management of clinical settings that provide complementary and integrative health care, especially as the provision of insurance coverage for T&CM increases.
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Affiliation(s)
- Belinda J. Anderson
- Pacific College of Oriental Medicine, New York, NY
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Roni Evans
- University of Minnesota, Minneapolis, MN
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25
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Jones A, Steel D. Evaluating the quality of medical evidence in real-world contexts. J Eval Clin Pract 2018; 24:950-956. [PMID: 29952125 DOI: 10.1111/jep.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/17/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
How should the quality of medical evidence be evaluated? Proponents of evidence-based medicine advocate the use evidence hierarchies to rank the quality of evidence on the basis that certain methods produce more reliable evidence. Some criticisms of this approach focus on whether certain methods deserve their place in the hierarchy, while others claim that evidence hierarchies should be abandoned in favour of other evidence assessment techniques. We claim that this debate pays insufficient attention to the real-world contexts in which medical decisions are made. To address this limitation, we explore the value of using evidence hierarchies and other evidence assessment techniques in differing contexts of medical decision making and argue that the way in which the quality of medical evidence should be evaluated depends on context. Focusing the discussion of the evaluation of medical evidence on real-world contexts has implications for the viability of the principle of total evidence.
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Affiliation(s)
- Andrew Jones
- Department of Philosophy and Science and Technology Studies, University of British Columbia, Vancouver, Canada
| | - Daniel Steel
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
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26
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Simon B, Eschert S, Schaefer CD, Reininger KM, Zitzmann S, Smith HJ. Disapproved, but Tolerated: The Role of Respect in Outgroup Tolerance. Pers Soc Psychol Bull 2018; 45:406-415. [PMID: 30079828 DOI: 10.1177/0146167218787810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted two studies to test the hypothesis that respect for disapproved outgroups increases tolerance toward them. In Study 1, we employed a panel sample of supporters of the Tea Party movement in the United States and found that Tea Party supporters' respect for homosexuals and Muslims as equal fellow citizens positively predicted Tea Party supporters' tolerance toward these groups. There was no indication that alternative recognition processes (i.e., achievement recognition or need recognition) played a similar role in the development of tolerance. Study 2 replicated the respect-tolerance link with the experimental method and a more comprehensive measure of tolerance. In particular, it demonstrated that the link also holds with regard to tolerance in the public or political sphere. The wider implications of our research for societal pluralism are discussed.
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27
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Abstract
Faith-based organisations, especially those related to specific ethnic or migrant groups, are increasingly viewed by secular Western government agencies as potential collaborators in community health and welfare programmes. Although clergy are often called upon to provide mental health pastoral care, their response to such problems remains relatively unexamined. This paper examines how clergy working in multiethnic settings do not always have the answers that people want, or perhaps need, to problems of misfortune and suffering. In the UK these barriers can be attributed, generally, to a lack of training on mental health problems and minimal collaboration with health services. The current paper attempts to highlight the dilemmas of the established churches' involvement in mental health care in the context of diversity. We explore the inability of established churches to accommodate African and other spiritual beliefs and practices related to the etiology and treatment of mental health problems.
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28
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Rey AL. [Agonism and antagonism]. Rev Synth 2016; 137:227-246. [PMID: 28205086 DOI: 10.1007/s11873-016-0301-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This essay considers dissensus as the starting point for the construction of a common epistemic space rather than as the acknowledgement of an irreducible disagreement. In the argumentative confrontation and disagreements, we do not want to identify a process which might lead to agreement through rational debate. The aim of this essay is rather to understand how dissensus leads to the constitution of plural communities. It discusses a certain number of texts of political philosophy (Habermas, Mouffe, etc.), where the notion of agreement is crucial to an analysis of argumentative confrontations. This essay uses the hypothesis to analyse the circulation of Leibniz's dynamics in his correspondence with De Volder. This perspective shows eventually that dissensus is not an obstacle but the basis on which multiple circulations of theories are possible.
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Affiliation(s)
- Anne-Lise Rey
- Université de Lille I, UMR Savoirs, Textes, Langage. UFR Physique, (bât. P5). Cité scientifique, 59655, Villeneuve d'Ascq, France.
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29
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Abstract
The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.
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30
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Willemsen J, Cornelis S, Geerardyn FM, Desmet M, Meganck R, Inslegers R, Cauwe JMBD. Theoretical pluralism in psychoanalytic case studies. Front Psychol 2015; 6:1466. [PMID: 26483725 PMCID: PMC4586353 DOI: 10.3389/fpsyg.2015.01466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/14/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or "Classical psychoanalysis" dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals.
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Affiliation(s)
- Jochem Willemsen
- Centre for Psychoanalytic Studies, University of Essex Colchester, UK
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Filip M Geerardyn
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Joachim M B D Cauwe
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
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31
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Abstract
AIM To argue for the use of mixed methods when researching communities. BACKGROUND Although research involving minority communities is now advanced, not enough effort has been made to formulate methodological linkages between qualitative and quantitative methods in most studies. For instance, the quantitative approaches used by epidemiologists and others in examining the wellbeing of communities are usually empirical. While the rationale for this is sound, quantitative findings can be expanded with data from in-depth qualitative approaches, such as interviews or observations, which are likely to provide insights into the experiences of people in those communities and their relationships with their wellbeing. DATA SOURCES Academic databases including The Cochrane Library, MEDLINE, CINAHL, AMED, INTERNURSE, Science Direct, Web of Knowledge and PubMed. REVIEW METHODS An iterative process of identifying eligible literature was carried out by comprehensively searching electronic databases. DISCUSSION Using mixed-methods approaches is likely to address any potential drawbacks of individual methods by exploiting the strengths of each at the various stages of research. Combining methods can provide additional ways of looking at a complex problem and improve the understanding of a community's experiences. However, it is important for researchers to use the different methods interactively during their research. CONCLUSION The use of qualitative and quantitative methods is likely to enrich our understanding of the interrelationship between wellbeing and the experiences of communities. This should help researchers to explore socio-cultural factors and experiences of health and healthcare practice more effectively.
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Affiliation(s)
- Bertha M N Ochieng
- Department of Clinical Education and Leadership, University of Bedfordshire, Luton, UK
| | - Danny Meetoo
- School of Nursing, Midwifery and Social Work, University of Salford, Greater Manchester, UK
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32
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Abstract
This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required.
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Abstract
We review limitations of the traditional paradigm for cultural research and propose an alternative framework, polyculturalism. Polyculturalism assumes that individuals' relationships to cultures are not categorical but rather are partial and plural; it also assumes that cultural traditions are not independent, sui generis lineages but rather are interacting systems. Individuals take influences from multiple cultures and thereby become conduits through which cultures can affect each other. Past literatures on the influence of multiple cultural identities and cultural knowledge legacies can be better understood within a polyculturalist rubric. Likewise, the concept elucidates how cultures are changed by contact with other cultures, enabling richer psychological theories of intercultural influence. Different scientific paradigms about culture imply different ideologies and policies; polyculturalism's implied policy of interculturalism provides a valuable complement to the traditional policy frames of multiculturalism and colorblindness.
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Affiliation(s)
- Michael W Morris
- Columbia Business School, Columbia University, New York, New York 10027; ,
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34
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Abstract
This article describes a pluralistic regime of oral health provision in a rural part of northern Lebanon, where dental care came from two main sources: professionally trained dentists and "informal" Dom dentists with Syrian nationality. Relying on a combination of interviews and ethnography, I offer a multivocal view of oral health services that incorporates data from patients and formal and informal providers. I argue that informal dentistry constituted an interstitial and translocal mode of dental care. In the northern Lebanese Biqa Valley, close to the Syrian border, the local articulation of neoliberal health governance created opportunities for heterodox practices in oral health. The organization of informality was predicated on the presence of the open border between Syria and Lebanon, which favored patterns of flexible cross-border mobility. In this context, informal dentistry was not alternative, but supplementary and lateral in relation to official forms of oral health provision.
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35
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Abstract
This article details the relationship between history and bioethics. I argue that historians' reluctance to engage with bioethics rests on a misreading of the field as solely reducible to applied ethics, and overlooks previous enthusiasm for historical perspectives. I claim that seeing bioethics as its practitioners see it - as an interdisciplinary meeting ground - should encourage historians to collaborate in greater numbers. I conclude by outlining how bioethics might benefit from new histories of the field, and how historians can lend a fresh perspective to bioethical debates.
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Affiliation(s)
- Duncan Wilson
- University of Manchester's Centre for the History of Science, Technology and Medicine, Manchester, UK.
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36
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Abstract
The ubiquity of top-down causal explanations within and across the sciences is prima facie evidence for the existence of top-down causation. Much debate has been focused on whether top-down causation is coherent or in conflict with reductionism. Less attention has been given to the question of whether these representations of hierarchical relations pick out a single, common hierarchy. A negative answer to this question undermines a commonplace view that the world is divided into stratified 'levels' of organization and suggests that attributions of causal responsibility in different hierarchical representations may not have a meaningful basis for comparison. Representations used in top-down and bottom-up explanations are primarily 'local' and tied to distinct domains of science, illustrated here by protein structure and folding. This locality suggests that no single metaphysical account of hierarchy for causal relations to obtain within emerges from the epistemology of scientific explanation. Instead, a pluralist perspective is recommended-many different kinds of top-down causation (explanation) can exist alongside many different kinds of bottom-up causation (explanation). Pluralism makes plausible why different senses of top-down causation can be coherent and not in conflict with reductionism, thereby illustrating a productive interface between philosophical analysis and scientific inquiry.
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Affiliation(s)
- Alan C. Love
- Department of Philosophy, Minnesota Center for Philosophy of Science, University of Minnesota, 831 Heller Hall, 271 19th Ave. S, Minneapolis, MN 55455-0310, USA
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