Thursday, 23 June 2016

Dysphagia: getting it right for the patient #ADP_2016

I have spent the day (at the generous invitation of Hazel Roddam) at Advancing Dysphagia Practice conference at UCLan, this year focusing on the theme of getting it right for the patient and hence on the application of person centred care. Three papers this morning addressed overlapping aspects of this general theme.

Heulwen Sheldrick asked “how, why, how?” for staying person centred. Using the difficult example of a relative of hers who had recently died and had refused to accept the agreed pessimistic clinical view of her prognosis, she asked how person centred care should address such apparent denial. Should one collude or deny such patient views? Her suggestions were, by her own view, familiar. We should practice empathy (whilst avoiding maudlin sympathy) and sitting alongside. Services should be co-designed, co-produced and co-commissioned wherever possible. And clinicians needed to reconcile their personal with their professional values in order to be authentic.

Hannah Crawford described her own small scale qualitative study of the lived experience of mealtimes and food for people with PIMD and dysphagia from the perspective of the family and carers, looking in depth at three families. Her research had examined meanings, roles, relationships and challenges. For me the key conclusion was that food played a very important role in mother (the primary carer in these cases) child relationships. (The mothers responded to the food-related wishes communicated by their non-verbal children.) Hence ‘messing about’ – as she put it – with food via clinical recommendations came at the potential cost of messing with crucial relationships. These should thus be weighed and understood alongside more narrowly clinical factors.

David Hamilton addressed the challenges of involving patients in complex team decisions using head and neck cancer as an example. Three aspects of his talk stood out. First there is evidence that patients and clinicians place different values on states of health and ill-health (eg living with a full laryngectomy or the consequences of chemo therapy) but further that there is widespread variation within both groups. Second, that typically patients are involved in a clinical decision only after a view / recommendation has been decided without them in a MDT. Often the suggestions / options are then presented to the patient framed in particular ways to elicit the clinically preferred outcome. There is even dispute among honourable clinicians about whether all options should be presented (because it reveals a lack of medical certainty). Third, he presented an example of a patient who had made a decision based on only partially relevant and partially understood prior experience of his patients’ deaths.

That third talk suggested to me a general worry: what is informed decision making? What is the difference between an ‘unwise decision’ based on good though divergent from clinical reasons and, on the other hand, making an ill-informed decision because based on bad reasons? Can reasons and outcomes be sufficiently independent to allow this distinction? This question seems to me particularly pregnant on a day in which the UK is voting in a referendum on whether to exit the EU.

Wednesday, 15 June 2016

Crowdfunding for maternity research

One of my PhD student tutees is attempting to crowdfund an aspect of her research.

Her page is here

"Who am I? ¿QuiĆ©n soy yo? 
My name is Lucia and my ambition is to help women achieve healthier and happier births. I am a midwife and full time self-funding PhD student at the University of Central Lancashire under the supervision of Professor Soo Downe. I am raising funds to be able to carry out this research project, which is a pilot clinical trial looking at the management of pregnant women whose waters have broken when labour haven't started yet"

Friday, 20 May 2016

Philosophy and Psychiatry: Mind, Value and Mental Health

Two linked events for philosophers, scientists, psychiatrists and other mental health professionals, and service users.

3rd Oxford Summer School in Philosophy and Psychiatry: 13-14 July 2017

A two-day summer school delivered by renowned experts in the field through guest lectures and seminars, providing opportunities for substantial dialogue between philosophers, clinicians, scientists and others.

Provisional themes for 2017 include:

Philosophical psychopathology today
Positive aspects of abnormal cognition
Depression/Bipolar disorder
Epistemic injustice and psychiatry

Further details will be announced soon - details of 2015 Summer School.

2nd International Conference in Philosophy and Psychiatry: 15 July 2017

A one-day conference featuring international keynote speakers and short presentations from graduate students and recent post-doctoral researchers. Programme in development - details of 2015 conference.

These events follow on from the highly successful events in 2013 and 2015 and will be led by members of Oxford’s Faculty of Philosophy.

Course directors:

Dr Anita Avramides (Reader in Philosophy of Mind, University of Oxford, and Southover Manor Trust Fellow in Philosophy, St. Hilda’s College)
Professor Martin Davies (Wilde Professor of Mental Philosophy, Corpus Christi College)
Professor Bill Fulford (Fellow of St Catherine’s College and Member of the Philosophy Faculty, University of Oxford, and Emeritus Professor of Philosophy and Mental Health, University of Warwick)
Dr Edward Harcourt (University Lecturer (CUF) in Philosophy, Fellow and Tutor in Philosophy, Keble College)

Please register your interest to receive updates about these events.

Thursday, 12 May 2016

MMU Workshop: Radical Ethnomethodology

Workshop: Radical Ethnomethodology
23 June 2016
Location: Manchester Metropolitan University, New Business School, Floor 3, room # 3.14 (M16 6BH)
10:00 AM until 6:00 PM

On 23 June 2016, there will be a meeting at MMU on the topic of “Radical Ethnomethodology.” This meeting will include presentations and discussions on the topic of radical ethnomethodology. Just what is (and/or was) radical about ethnomethodology and conversation analysis (CA) will be open to discussion and debate at the meeting, but our initial aim will be to explicate what was radical about the commitments expressed in the writings and lectures of Harold Garfinkel and Harvey Sacks. The purpose of the meeting is to consider the current state of ethnomethodology and CA in light of those commitments.

More than a half-century ago, Garfinkel and Sacks in different ways set out to investigate the production of social actions without privileging the theories, models, and methods of the contemporary social sciences. Along with their contemporaries and successors, Garfinkel, Sacks, and many others produced several interesting lines of work, but recent trends have obscured and diminished their radical initiatives. These trends include treatments of ethnomethodology/CA as: (1) a precursor of more recent programs and “turns” toward culture, discourse, linguistics, and cognitive science; (2) a continuation of one or another line of classical theory; and (3) a method to be integrated with other qualitative and quantitative social science approaches. This meeting will be devoted to critical discussion of these trends, and suggestions of how to sustain ethnomethodology and CA as radical approaches social phenomena.

The meeting will consist of four panel presentations and discussions. Presenters and discussion leaders will include Dusan Bjelic, Graham Button, Jeff Coulter, Michael Lynch, Doug Macbeth, and Wes Sharrock. Among the questions they shall address are:

Just what is radical about ethnomethodology’s programme?
How does ethnomethodology relate to “classic” social theory?
How does ethnomethodology relate to methods of “constructive analysis” in the social sciences?
In light of the way conversation analysis has developed in recent decades, what might a radical ethnomethodological CA look like?

Meeting Organizers: Michael Lynch (Cornell University), Wes Sharrock (University of Manchester), Phil Hutchinson & Marie Chollier (MMU)

Free of charge - Mandatory registration before 15th June
Information & registration:

Thursday, 28 April 2016

The balance of description and criticism in philosophy essays

Another case of putting something on my blog because I often rehash the same broad idea and so should keep a copy.

Teaching on a Philosophy and Mental Health distance learning programme, Gloria and I are often asked by our mainly non-philosopher students about the nature and balance of criticism and description in philosophy writing. For some students, this may be the result of being familiar with the more descriptive style of literature review in the social sciences (though even here, such reviews must have an argumentative purpose). But it is hard to answer directly at the level of a given paragraph because all depends what that paragraph is for.

So here is a top down answer based on an analogy. Sadly this is an analogy that does nothing to explain how fascinating and mind blowing philosophy can be. Sorry.

A philosophy essay is like a report written by a civil servant making a recommendation to a minister or to a committee. The essay as a whole has a purpose: to persuade the reader of the case for something (thinking that something is true or something is right). And hence a critical style of writing is there for that purpose.

(So the analogy gives a ‘top down’ account of why philosophical writing is both critical and descriptive because this follows from the point or purpose of the essay as a whole which shapes the need for individual bits of critical writing.)

Here is an example. Near where I live, there is a proposal to build new, higher capacity connection using very tall electricity pylons to link Sellafield nuclear power station (actually a new power station nearby called Moorside) to centres of population more efficiently. The proposal is contested because the pylons will be visually intrusive and they will be very close to and thus visible from with the Lake District National Park.

In the main, the protesters don’t, however, say that there is no need for the new power connection. They generally accept the force of the arguments for one. (Some, of course, disagree to this whole way of getting power but that opens up a whole new argument so I will stick to those who accept the need but not the means.) So the protesters argue that
a) all or some of it could be underground;
b) it could take a longer route further from the Park
c) it could be submerged under Morecambe Bay
d) the pylons could be smaller.

Each of these counter-proposals (to the original idea) is opposed by counter-counter arguments. Burying is expensive. Longer routes cost more. In some countries the bigger pylons are regarded as works of sculptural art and hence are not visually intrusive anyway. Etc etc.

So imagine that you were writing a report for the minister or a planning committee, what would you do?

First, I suggest, you need to understand all the arguments, counter-arguments, counter-counter-arguments etc. as their proposers understand them. To describe the lie of the land, you have to have a descriptive understanding of the arguments put forward.

Next, you will need to think about how the various ‘battles’ between opposing views stack up. For example, defenders of using pylons argue that burying the cable instead would cost too much money: 20 miles of buried lines would cost about £450m more than using pylons. ( But assessing this point will also involve seeing what one side makes of the argument. Eg., with respect to the cost of burying the cable, opponents of pylons have argued that this would add only about 40p a year to the average electricity bill in England and Wales. As you do this, you yourself will begin to assess what you think of these arguments. That is an exercise of critical assessment. Some reasons will turn out to be stronger than other reasons when you think them through in context. Some will probably be irrelevant, rhetorical red herrings.

Once you have this global view of – descriptively – what everyone says for and against the main position and supporting arguments and – critically – your own assessment of which arguments work out which way, which reasons are stronger, you will have taken some view of the overall issue.

In a committee paper, there are then various possible outcomes:
  • One view may be obviously the best. Still, to show why it is the best, you will need to show why the arguments in favour of the other view fail. And that requires saying – descriptively – what those arguments or reasons or factors are and – critically – how strong they are.
  • That one view is better than another may depend on a tricky issue to resolve. For example, one reason for not building the pylons is economic: it will undermine tourism. But another is aesthetic: it will spoil the beauty of the country. Weighing the financial cost of burying the cable against the aesthetic loss of beauty isn’t straightforward and a civil servant might try to describe both cases and then leave this up to the minister / planning committee to judge.
  • The opposing views may both be flawed because of other factors (the sudden discovery that one cannot, after all, build the power-station that needs all the pylons). So both sides may have made assumptions that frame their case but both turn out to be wrong.
Once one has taken a view about what can be rationally concluded, there is need to be imaginative in working out a rational way to present the arguments to the minister/committee. One good way to do this might be to start by saying what the recommendation is (“This report will argue for limited burying of cables across some of the distance of the power line”) and then saying how that conclusion will be arrived at (“The report will describe the facts for and against including the relative costs. The argument that tall pylons are actually beautiful will be considered and rejected.” Etc etc)

The analogy may be plodding but a philosophy essay works in the same argumentative way. It needs a balance of descriptive and critical writing because it needs to present and to assess competing arguments to arrive at some sort of conclusion (even if that is that there is no clear answer). That isn’t a feature of the style of philosophy in the way that poetry may have a particular metre or rhyming structure. Rather it stems from what philosophy is for. And that is deciding what is true and what is good.

Philosophers are God’s civil servants!

Tuesday, 26 April 2016

Values-Based Practice Theory Network Spring Conference, Oxford 3-4 May 2016

The second meeting of the Values-Based Practice Theory Network will be a two-day conference held at St Catherine’s College Oxford on 3rd and 4th May 2016. The conference is run in partnership with the Collaborating Centre for Values-Practice in Health and Social Care ( and Anna Bergqvist’s established Particularism in Bioethics, Professional Ethics and Medicine Network at Manchester Metropolitan University.

Venue: The Collaborating Centre for Values-based Practice, St Catherine’s College Oxford.

Theme: Value, Context and Narrative in Medical Epistemology and Health Care Practice.

The theme of this interdisciplinary conference is focused on the theoretical underpinnings of values-based practice, and explores the implications of illness narrative and contextualism for debates about objectivity and value in philosophy of medicine and medical epistemology more generally. It builds on our first conference on Values-Based Practice and Moral Particularism in October 2015, with special attention to philosophy of psychiatry, clinical practice and scientific methodology. By bringing together theorists and practitioners from the disciplines of Philosophy and Psychology our aim is to explore the ways in which normative critical perspectives challenge the implicit or assumed reductive theoretical paradigm of many current models and measures of ‘value’ in health care contexts in developing new integrative and holistic approaches. We hope that the event will open up a dialogue about the ways we might think and argue differently about the benefit of conceptual and evaluative thought in these contexts.


Tuesday 3rd May
09:00 – 09:15. Registration and Welcome
09:15 – 09:45. Benedict Smith (Durham University), ‘Values Based Practice and Context’.
09:45 – 10:30. Ulrik Kihlbom (Uppsala University), ‘Narrative Understanding in Clinical Decision Making and Serious Games Interventions’.
10:30 – 11:00. Tea & Coffee.
11:30 – 12:15. Lubomira Radoilska (University of Kent), ‘Ignorance of What One is Doing’.
12:15 – 13:00. Ian J. Kidd (University of Nottingham), ‘Illness, Ethics and Exemplarism’.
13:00 – 14:00. Lunch
14:00 – 14:45. Richard Gipps (University of Oxford), ‘Psychotherapy as Moral Practice’.
14:45 – 15:30. Anna Bergqvist (MMU), ‘Value, Perspective and Integration: Reassessing Narrative Selfhood in Borderline Personality Disorder’.
15:30 – 16:00. Tea & Coffee
16:00 – 16:45. Mark Haydon-Laurelut (University of Portsmouth/NHS). ‘Systemic Psychotherapy, Narrative and Autistic Spectrum Conditions’.
16:45 – 17:00. Concluding Remarks.
18:00 – Dinner (at own expense).

Wednesday 4th May
09:00 – 09:45. Anna Zielinska (Sorbonne), ‘The Normativity of Empirical Enquires: The Case of Genetics’.
09:45 – 09:45. Dieneke Hubbeling (Royal College of Psychiatrists, Philosophy Special Interest Group), ‘Outcome Bias, Values, and Moral Luck’.
10:30 – 11:00. Tea & Coffee
11:30 – 12:15. Alan Thomas (Tilburg University), ‘Particularism and Group Agency’.
12:15 – 13:00. Tim Thornton (University of Central Lancashire), ‘Who Are We? Subjectivity in Objective Values-Based Practice’.
13:00 – 14:00. Lunch
14:00 – 14:45. Caroline Vass (University of Manchester/Uppsala University), ‘What is Health Economics? Problematising Value in Stratified Medicine’.
14:45 – 15:30 Jens Erik Paulsen (Norwegian Police College University), ‘Policing as a Values-Based Practice: Challenges and Prospects’.
15:30 – 16:00 Tea & Coffee
16:00 – 17:00 Roundtable Discussion
17:00 Close

The event is free and open to all but places are limited, for which reason registration is necessary. To register, please send an email to the conference organiser and director of the VBP Theory Network Anna Bergqvist at no later than Thursday 28 April 2016.
Please state any dietary or disability restrictions as appropriate, all of which will be fully catered for.


Monday, 25 April 2016

The subjectivity that is supposed to be a correlative of moral objectivism

I’ve been mulling over a train of thought in Travis’ paper ‘Frege’s target’ which I’ve summarised before on this blog. The line starts with crediting McDowell a frequent appeal to the idea that judgement in a particular area may call for a subject to have a ‘special design’ in some way. The obvious area is in making value judgements, where McDowell stresses the importance of education in acquiring a second nature.

McDowell himself makes frequent appeal to ways in which we, or relevant thinkers, are thinkers of a special sort. Our special design opens our eyes, as he puts it, to particular tracts of reality. That our eyes may be thus opened shows where, and how, there may be facts that it takes special capacities, not enjoyed by just any thinker, to see. [Travis 2002: 305]

But this prompts the question.

Can mind-design select which tract of reality we deal with... without also deciding, of the selected tract, how things there are—without shaping the world along with our responsiveness to it? [ibid: 333]

The worry is that McDowell’s reliance on the idea that education and induction into the space of reasons opens a subject’s eyes to aspects of the world commits him (McDowell) to a form of idealism. This problem is brought into focus because McDowell rejects what he calls a ‘deductive paradigm that leads us to suppose that the operations of any specific conception of rationality in a particular area - any specific conception of what counts as doing the same thing - must be deductively explicable; that is, that there must be a formulable universal principle suited to serve as major premiss in syllogistic explanations’ [McDowell 1979: 339-40]. Special capacities are needed precisely because the demands of reason are not in general accessible to just any rational subject because, in turn, they are not codifiable in principles graspable by just any subject. But now the worry is that the role the special capacities have is to constitute the aspect of reality supposedly revealed.

Travis offers McDowell a way out of this potential worry based on his own philosophical signature dish which he draws from an interpretation of Wittgenstein: occasionalism. The key idea is that this allows Travis (and hence potentially McDowell) to distinguish between two different contributions that the mindedness of a subject – our nature – might make.

Let P be a way a statement might thus represent things. Then, accepting that idea, we may still innocently allow that the way given thinkers think decides whether some one of their statements stated that P, or, say, that Q, where that is another such way for a statement to represent things. But one cannot, accepting this idea, allow that, where a statement spoke of things as being P, whether it thus stated truth depends on how a particular (sort of) thinker thinks. [Travis 2002: 338]

The latter would be a form of idealism which undermines the autonomy of our rules and normativity. But the former locates the contribution of subjectivity to selecting the way we represent the world to be. This is the role of occasionalism. What is said in using a sentence depends on the occasion of its use. Hence, also, whether what is said is true or false depends on the occasion, which in turn depends, among other things, on the nature of the speaker.

Travis gives an everyday example

Sid buys a DIY chair kit. On bringing it home he discovers that it is much more difficult to assemble than he had imagined. It remains a neatly stacked pile of chair parts in his spare room. One day, someone, pointing at the pile, asks, ‘What’s that?’ ‘It’s a chair’, Sid replies, ‘I just haven’t got around to assembling it yet.’ On a later occasion, Sid and Pia, with guests, find themselves a chair short for dinner. ‘There’s a chair in the spare room’, Sid says helpfully. But there is still only the pile. [ibid: 336]

The idea is that Sid’s first answer is true. On that occasion it is correct to say that the pile is a chair. But on the second occasion, his comment is false. The pile of parts is not a chair in the context of the dinner party. The same word ‘chair’ can be used correctly and falsely of the pile of parts because different things are said to be so with it on both occasions. This suggests a role for our psychological design, not in shaping the aspect of the world judged, but in shaping the nature of what we say with our words.

It seems to me that this doesn’t scratch the right itch, however. For one thing, occasion sensitivity is supposed to be a quite general feature of meaning rather than something tied to a specific aspect of the space of reasons. It doesn’t relate to the specific character of moral judgements, for example. Being sensitive to the demands of meanings is a akin to being sensitive to the demands of values in a McDowellian enriched conception of nature but occasion sensitivity seems to privilege meanings and reach out to values only via meanings.

Travis’ account does however, head off the worry about idealism. It is innocent to think of aspects of special design affecting what subjects mean, in making a judgement, and hence affecting what would make it true or false without letting the mind affect whether a given judgement, understood in a specific way, is true or false given how the world is. So another possibility to head off idealism would be a transcendental rather than empirical reading of the connection between meaning and subject-hood. There’s an often quoted passage in Cavell which may help illustrate this idea:

We learn and teach words in certain contexts, and then we are expected, and expect others, to be able to project them into further contexts. Nothing insures that this projection will take place (in particular, not the grasping of universals nor the grasping of book of rules), just as nothing insures that we will make, and understand, the same projections. That on the whole we do is a matter of our sharing routes of interest and feeling, senses of humour and of significance and of fulfilment, of what is outrageous, of what is similar to what else, what a rebuke, what forgiveness, of when an utterance is an assertion, when an appeal, when an explanation – all the whirl of organism Wittgenstein calls ‘forms of life’. Human speech and activity, sanity and community, rest upon nothing more, but nothing less, than this. It is a vision as simple as it is difficult, and as difficult as it is (and because it is) terrifying. [Cavell 1969: 52]

So one might think that it’s a condition of possibility of projecting words into new contexts in the same way, and hence as counting as using them correctly, that one is a certain sort of subject with shared routes of interest and feeling, senses of humour and of significance and of fulfilment etc etc: all the whirl of organism. But here the problem is that in some cases – for example continuing mathematical series – other ways of going on seem mere misses of the point, failures of understanding rather than promising to illustrate other possibilities. In other cases, different practices do seem possible but not as different versions of say strictly moral evaluation. Perhaps they are practices of face saving or bravado which block the possibility of playing the moral valuing game.

Filling out the nature of the subject that transcendentally underpins our practices of responding to meanings or values looks to collapse into what McDowell calls a ‘locus of pure thought’. One needs to be a subject who can follow moral, or meaningful, or logical demands.

Playing the ‘games’ we play sincerely and wholeheartedly seems to rule out being able to flesh out an interesting link between objectivism in a domain and the necessity of a certain kind of subject-hood. Perhaps thinking that objectivity requires a correlative subjectivity is more trouble than its worth.