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James Dolbow, MetroHealth Medical Center, Ohio,Eric Curfman, University Hospitals Cleveland Medical Center, Ohio,Neel Fotedar, University Hospitals Cleveland Medical Center, Ohio
A 57-year-old man with history of bariatric surgery (10 years prior) and chronic alcoholism presents to the emergency room after being found by his family, confused and imbalanced. They state his confusion has been slowly getting worse over the past few years after drinking increased (approx. 10 beers/day), however, over the past week he has become much more confused, has fallen many times, is talking less than usual, and has started making up stories. He has also lost weight, eats very little, and seem apathetic to his surroundings. Family denies prior psychiatric history or seizures.
It is a pleasure to be commenting on James Woodward’s characteristically magisterial chapter. I’ll remark on three topics: (1) where things stand now with what Woodward calls “the interventionist framework” for discussing causation; (2) whether the idea of stability has any role in establishing causal relations, particularly in psychiatry; and (3) whether the strategies Woodward outlines in his chapter have any place for one kind of causal thinking that seems essential to psychiatric practice, that of the therapist achieving an understanding of the origin of the content of the patient’s delusions.
Why was Britain the first country in Europe to experience economic growth, with sustained technical change and the invention of machines that cut costs by taking over tasks previously done by hand? Cotton spinning is a striking example. In the 1700s, the world’s best spinners in India put in 50,000 hours to spin 100 pounds of cotton. By 1835, workers with machines took only 135. Technical change also generated new products and affected far more than the textile industry. Examples from 1700s would include the steam engine and new ways of making iron. One explanation for why Britain took the lead here was that its high wages boosted the demand for inventions of machines that could substitute for expensive labor. But closer inspection fails to support this argument. Rather, Britain had a more abundant supply of the skills and ideas that made technical change possible. We can see how they favored Britain by comparing two likely candidates for early industrialization: Lancashire in Britain and Normandy in France. The comparison highlights other advantages that benefited Britain as well, from agglomeration effects to the greater toll that land war took in Continental Europe.
One of the key questions at the heart of Heckers’s reflections on the uses of neuroimaging in psychiatry is whether the actual uses to which neuroimaging are being put in experimental research on the neural markers and mechanisms of psychiatric disorders have application in clinical psychiatry. He points to a mismatch in goals and methods that, it seems to me, demands further scrutiny, and scrutiny of a sort that philosophers might usefully supply. In addition to the questions of causal inference, to which I direct my attention immediately in what follows, are important questions about the difference between general truths about the brains of people with schizophrenia and truths about specific, single cases. Even if the tools of psychiatric research succeed in gleaning causal information about psychiatric disorders in general terms, there will always be an inductive leap in relating the general to the particular, in seeing the individual as properly both an example of the generalizations discovered in research on populations (and controls) and, consequently, as a fitting recipient of the predictions and explanations those generalizations deliver. This gap between the general and the particular lurks in the background of Heckers’s important discussion, but perhaps could be given more of a central place, and would help us distinguish which problems attend the causal uses of neuroimaging and which attend the uniquely messy business of drawing conclusions about single-case causes on the basis of causal knowledge that holds, only for the most part, in certain conditions that we cannot fully adumbrate.
Chapter 3 focuses on the essential element of research articles, the Claim, a declarative response to a research question signifying new knowledge. Claims are plain language, concise statements supported by evidence and reasoning, which makes them distinct from assumptions or opinions. The Claim is often located in the title, the abstract, and the conclusion section. Depending on the nature of the study, there are different types of Claims and differences between primary Claim(s), sub-claims, and findings that can evolve with the research field. This chapter provides several examples to illustrate how to establish the Claim in research papers across disciplines.
There has been a lot of interest lately in the possibility of downward causation, the idea that higher-level processes or events can cause lower-level ones. Downward causation, if it could be made sense of, is seen by some as a way to approach the philosophical problem of free will naturalistically, while others have heralded it as a promising way to explain aspects of the pathogenesis or treatment of psychiatric conditions. But the possibility of downward causation has been called into question because it is claimed to require causation across levels, and interlevel causation has been viewed as problematic. Reductionist accounts, for example, hold that entities or processes at higher levels can be reduced to entities or processes at lower levels, and that causal relations only “really” occur at the most fundamental level. On this basis, Kim’s (1998) causal exclusion argument holds that mental states do not enter causal relations and are merely epiphenomenal. Alternatively, the New Mechanist account holds that neuroscientific explanation is mechanistic explanation, and that the relationship between mechanisms at different levels is one of constitution (part/whole). Because constitution relations are not causal relations, interlevel causation does not exist: causation can only occur within a level (see, e.g., Bechtel & Craver, 2007; Craver, 2007). Several thinkers have suggested that if we can rid ourselves of levels, these problems and others would disappear (Eronen, 2013).
In dialogue with Nietzsche, Heidegger, and Shakespeare, this chapter articulates the difference between an “idol” of experience, which necessarily disappoints desire, and an “icon” of experience, which necessarily surprises; it sketches the parallels between two iconic modes of experience, Heidegger’s wonder for being and St. Francis’s thanksgiving for existence, and it argues that the latter constitutes a unique phenomenological reduction, which distinguishes aletheism from other forms of phenomenology as well as separates it from other sciences. “That desired and hidden other, which thankfully causes the world and me to be, is ‘God’.”
Human rights violations often form part of a pattern or practice of violations, rather than being purely isolated incidents. This context is not consistently taken into account by UNTBs during individual case consideration, however. This chapter explores several ways in which awareness of human rights violations’ embeddedness in wider contexts of violations should inform UNTB practice. In particular, the chapter considers the impact, or potential impact, of patterns and practices of violations on the manner in which UNTBs receive information, and the sorts of sources they recognize in their decisions; on UNTBs approaches to the exhaustion of domestic remedies and the burden of proof; on case structuring; and on findings, recommendations and follow-up procedures. The chapter ends by observing that UNTBs are not only receivers but also key disseminators of information, and suggests ways in which their findings as to the patterns and practices of violations may be more effectively disseminated.
In this chapter, I develop and walk through a theory of the interaction between a legislator and an outsider proposing legislation to be introduced. This theory highlights the tradeoff that legislators face between introducing and securing the passage of a high-quality bill and obtaining a bill that is close to their ideal policy. I lay out the motivations and goals of legislators, bureaucrats, and interest groups and use these to develop a theoretical framework that sets up expectations about the conditions under which interest groups and bureaucrats will be most successful at influencing legislative outcomes. This theory reveals testable implications about which types of legislators and legislatures should use more outsider input in crafting their legislative agenda.