Friday, 30 May 2014

Philosophers' Rally 2014 short video

There is short pop video of a few moments from this year's Rally here. Sorry it seems to have gone. I'll re-link if it returns.

Consultation on Proposals for New Mental Capacity Legislation for Northern Ireland

I learn from Colin Harper that the NI Mental Capacity Bill is now out for consultation. You’ll find the documents here.

Tuesday, 27 May 2014

Grief and attention

Mij Thornton
My mother died on Sunday night. She had been rushed into hospital two months earlier with a subsequent, and for me shocking, diagnosis of leukaemia and given, initially, a day or so to live. Under treatment she rallied, although medical opinion remained pessimistic. Ten days ago we were told that her prognosis had again fallen to a week or two and we watched her decline over the final days. She was 81 and had had what I think one might call a good life with a (morally) good job and loving family. Her death, in the end, in the circumstances, was timely, a release. But such rationalistic and objective thoughts don't immunise me against the pain and sickness of grief. It is like arriving in a horrible parallel world in which the same national events - eg., the EU elections - are taking place but now lack all significance.

Among the many things that have surprised me here is the connection between grief and attention. During the last few weeks, when trying to explain why meetings I was arranging might have later to be cancelled, I found that the act of attending to the point in logical space occupied by the thought I wanted to express (and first, to think it) would bring the weight of emotion which went with the thought crashing down and robbing me of speech. There were things I simply couldn't utter. I could navigate all round them, refer indirectly to some thought, but to essay it, to articulate it for expression, was impossible. The grief reaction, the mood, the affect, was secondary to attending to a possibility but then came with a kind of hideous inevitability.

Now, in the initial aftermath, there's a related but passive version. The productive way that one thought rationalises and leads to another has become an enemy of a peaceful mind. A thought utterly innocent of grave significance might connect by stages to another and dreadful idea - the loss of this, the never seeing or sharing that - which will plunge me, sickeningly, perhaps also embarrassingly, back into grief. I find myself trying to second-guess, without full-on thought (since that would make second-guessing pointless), the destination of a train of ideas.

I am also told (by a colleague who arrived in this territory earlier) of another possibility which may, I suppose, come when I have recovered a little. The temptation to poke a thought with a stick, to see whether the resonances are lessening or still as potent.

If I simply looked elsewhere, could I make all this feel less bad? Or does one simply have to go through a kind of sentence, attending to what will almost immediately bring pain through a kind of necessary compulsion?

(Later I posted my inadequate eulogy here.)

Sunday, 25 May 2014

PanVascular Medicine

Here are the details of a book in which I have a chapter on the nature of tacit and explicit knowledge. Not where I would have expected to publish but very happy to.

P. Lanzer (Ed.) PanVascular Medicine 
  • Sound interdisciplinary platform for vascular care, with emphasis on the need for a team approach 
  • Comprehensive coverage of basic science, diagnostics, and therapy 
  • Discussion of current international guidelines relevant to a wide range of specialists 
Vascular management and care has become a truly multidisciplinary enterprise. As a result of scientific progress, the number of specialists involved in the treatment of patients with vascular diseases is steadily increasing. While in the past, treatments were delivered by individual specialists, in the twenty-first century a team approach is without doubt the most effective strategy. Depending on the clinical manifestations, cardiologists, cardiac surgeons, vascular specialists, angiologists, radiologists, vascular surgeons, neurologists, neurointerventionalists, lipidologists, blood coagulation specialists, and diabetologists, to name but a few, may be involved.

In order to promote professional excellence in this dynamic and rapidly evolving field, a shared knowledge base and interdisciplinary standards need to be established. PanVascular Medicine, 2nd edition has been designed to offer such an interdisciplinary platform, providing vascular specialists with state-of-the-art descriptive and procedural knowledge. Basic science, diagnostics, and therapy are all comprehensively covered. In a series of succinct, clearly written chapters, renowned specialists introduce and comment on the current international guidelines and present up-to-date reviews of all aspects of vascular care.

Friday, 9 May 2014

Beginning Marie McGinn’s book Elucidating the Tractatus, in hope

As a break from answering emails and other administrative tasks, I’d like very briefly to flag a kind of textual anticipation. I’ve started to read Marie McGinn’s book Elucidating the Tractatus [McGinn 2007]. Reading it on my iPad I ignored an early comment by the author that she’d written a long book. It’s more than 300 pages, however, a fact obscured when one doesn’t support its weight (when, for example, reading in the bath). So it will take some time for me to put together enough snatched moments to get through it.

But I’m optimistic – the mood I’d like to record here in advance – because of the possibility of there being an account of the early Wittgenstein which reconciles two things. First, the attraction of taking the later Wittgenstein’s simple mindedness about nonsense to be operating in the TLP and hence ruling out the idea of sly pointing towards metaphysical insights into or even explanations of the hook up between language and the world. But second, the sheer eccentricity of its author offering such a detailed account of language and world if virtually all of it, bar some framing sentences, is merely a kind of reductio. Is there nothing to be said for thinking, for example, that what we might mean by a ‘world’ is a totality of facts, of things (where it is impolite to ask which things) which are the case? And what of the account of logic developed?

McGinn promises to steer a middle course which accepts the first point but which offers a view of the TLP as offering some sort of insight into language and logic and the articulation of a world which goes hand in hand with that. A quick skim of the first half suggests two concrete ideas from the first ten pages help with this.

First, there is the idea held dear by the resolute reading that ‘the early and the later philosophy are united in their rejection of the very possibility of taking what John McDowell calls ‘a sideways on’ perspective on language’ [ibid: 5-6]. With this idea in play, the baldy metaphysical tone of the first few sentences of TLP is thought of not as grounding a view of language as from outside it, nor as the result of a kind of inference to the best explanation of what the world in itself must really be like if language is possible, but rather a pithy expression of the most general way the world is articulated as seen, obviously, from within language. (I want to add: which is to say, from within the limits of sense, which is no qualification at all.)

Second there’s an idea to defuse the traditional view that simple names stand in relates to enduring metaphysical atoms which is stated like this at the start:

The concept of a simple object that is correlated with a name emerges, I want to argue, in the context of this conception of the meaning of a word as something that we grasp and which explains our ability to understand the sense of propositions in which the word occurs, without having their sense explained to us. As both Ishiguro and McGuinness remark, the idea of the object that is the meaning of a name that emerges in this context does not correspond in any way to our ordinary notion of particular, concrete objects that constitute parts of empirical reality. [ibid: 7]

and then rather later thus:

Objects are not necessary existents that endure through all change, but the meanings of primitive signs in a system for representing the world in propositions. [ibid: 144]

Thus, Wittgenstein wants us to recognize that our investigation into how a proposition expresses its sense is directed, not towards what symbols mean (the object they signify), but towards how they symbolize: how they are used with a sense. The conception of meaning that dominates Wittgenstein’s argument for simples now slips into the background and his logical investigation focuses exclusively on the use of expressions in propositions with sense. [ibid: 163]

The second move is the sort of thing that might make the first possible. But whether it is enough to head off what had seemed an account of how representation is possible, an account itself self-undermined with desperate acts of pointing, and replace it with mere description, I’m not sure. Nor whether what results is a kind of philosophical insight.

I have always liked the sketch of a sense of method in resolute readings – not that one discovers that particular possibilities are ruled out, since in the preference for talk of limits of sense over limitations, nothing is exogenously ruled out – but that each reader is invited to reflect on whether she or he has put in the work to invest meaning in particular combinations of symbols. I worry that this seems a solipsistic activity. I also worry that we can no longer say what it was that was achieved: not for example showing that a private language was impossible since that now becomes showing that *** *** is impossible. But at least there seems to be a premiss discharging philosophical method.

McGinn,M. (2007) Elucidating the Tractatus: Wittgenstein's Early Philosophy of Logic and Language, Oxford: Oxford University Press

Thursday, 8 May 2014

Advancing Dysphagia Practice conference at UCLan

I was lucky enough to be invited to help out at a day-long conference on dysphagia, today, at UCLan by chairing two question periods.

Clearly there is a substantial body of bio-medical knowledge which underpins dysphagia care and had today’s conference focussed on that I would have been at sea. But instead it looked at other aspects including the symbolic nature of eating (nourishment rather than mere nutrition), values-based decision making, capacity and best interests, different patient reactions to severe illness, the balance of risk and wellbeing, rational reasons for rejecting gastrostomy and experience-based co-design of services.

Conferences are not neutral selections of clinicians. They tend to be self selecting depending on the nature of the content to be presented. But I was struck by the audience’s acceptance of the importance of values based practice, the central role of capacity decisions, the value of an acceptance of risk rather than the clinically safer idea of liquidising all food (to over simplify grossly) and all sorts of other non-narrowly-medical-scientific judgements. Why would that be?

In mental health care, one reason for an interest in such aspects is as a reaction to the ever present possibility of the uber-paternalism reflected in coercive treatment under the Mental Health Act. But that doesn’t apply to dysphagia care. But it was suggested to me over lunch that the reason might be this: no other area of medicine presents to non-medical-doctors the frequent interplay of both a lack of capacity in its patients with the need for invasive medical procedures. So speech and language therapists are forced to think of the broader aims of healthcare and the key issue of a balance of quality of life versus its mere preservation. If so, we should expect them to be at the forefront of the philosophy of healthcare. I must keep an eye open.

Tuesday, 6 May 2014

Live streaming Lear

Last week, I caught the well reviewed Simon Russell Beale / Sam Mendes King Lear live-streamed from the National Theatre. I have popped down to London in the past for matinees of Antigone and Timon of Athens (also with SRB) but with trains and tickets the cost is about £130. By contrast, a trip up the M6 to a cinema in Penrith cost about a tenth of that. So the slightly negative thoughts I have should be balanced against that thought.

The production itself had points of interest. For example, modern but fascistic dress in the initial court scene suggesting a kind of rally and nice positioning of the actors (Lear facing his daughters plus husbands in two cases and an empty chair in the third) helped to emphasise Cordelia's difference from the others and explained her sisters' temptation to exaggeration. But later scenes seemed to verge on the hysterical with an homage to Tarantino in a 'wine cellar with corkscrew' blinding of Gloucester. Of the recent Lears I have seen, this one placed the greatest emphasis on the king's initially possible, and then later more obvious, madness. (Additionally, SRB seemed to have borrowed Bruno Ganz Parkinson's mannerisms from Downfall.) Much, in other words, to watch and think about even if it were not all equally successful.

What was more striking, though, was the experience of the live-streaming itself. Initially sitting three rows back from the screen, it seemed to me that a static camera from a fairly central position in the National Theatre would be fine. What I thought I wanted from the experience was a way to access the view I might have had (in fact, a better view than I would be likely to have had for a modest ticket price) had I tripped down to London. But that isn't what we were given (and I understand that this is the norm). Rather, like a film or tv production, the camera panned in to give us close ups of the actors: mainly whoever was speaking. But this had various problems which I will simply list.
  • It obviously takes great skill to direct film cameras. But there is no reason why a theatre should possess it. Given that there were a few cuts to a view of nothing or to a rushed camera move, the National obviously doesn't have it yet. 
  • One often wants to watch the reception of an actor's speaking and doing, so the focus on the speaker often seemed wrong. But further, in the theatre, we are used to having a choice as to where to look. To rule this freedom out without loss would require thinking through more the relation of the actors and their relation to the camera so that we would only want to look where the camera looks.
  • The camera tracked the action in such a way that it was sometimes hard to locate where on a mental map of the stage it took place. This was particularly odd when the camera tracked action on the National's rotating stage.
My assumption is that once one has cameras in place it is too tempting to think of the action as the the raw material for a film rather than as something different. Then again, I did see (only) the film version of the David Tennant Hamlet. With its theme of a surveillance state with CCTV and concomitant paranoia, it was all about the perspective of the camera. But much thought had obviously gone into how that was possible.

Thursday, 1 May 2014

Judgement, normativity and the philosophy of mental healthcare

Here is the first section of a draft summary of my research. The rest is here.

Judgement, normativity and the philosophy of mental healthcare
A synoptic review of my research

My research concerns the nature of judgement. Implicit in the idea of forming an individual judgement, or in the faculty of judgement in general, is a distinction between correctness and incorrectness. Judgement can be correct or incorrect and, further, aims at correctness. It is an essentially normative notion. But this raises the question of what underpins such normativity, what disciplines judgement, and hence the objectivity of judgement in different areas.

My work straddles mainstream philosophy and the newly developing field of philosophy and psychiatry. It critically engages with some important contemporary and twentieth century philosophers such as Wittgenstein, Davidson, McDowell, Ryle and Polanyi. But it applies the results in the analysis of issues that arise at the heart of mental healthcare. Reflecting the influence of Wittgenstein, my approach is therapeutic as opposed to systematic. Rather than attempting to construct philosophical theories, I aim instead to trace back philosophical confusions to the underlying but questionable assumptions that lead to them. Nevertheless there are some common themes concerning judgement, normativity and anti-reductionism. A central concern is to combat the idea that only judgements whose standards of correctness can be reduced to natural scientific terms or codified in general terms can be objective. Starting with work on rules and meaning, this concern runs through to moral judgement, tacit knowledge and understanding.

This document outlines the main themes of my research and their connections.
1.       Judgement and the objectivity of meaning
2.       The objectivity of other normative judgements
3.       Tacit knowledge and clinical judgement
4.       Anti-reductionism
5.       Normativity, anti-reductionism and the concept of disorder
6.       Understanding in mental healthcare

In the final section I outline my contribution to setting an agenda for the future development of philosophy and psychiatry.

Philosophy and Psychiatry Summer School and Conference, Oxford 2015

"Oxford Summer Schools and Conferences

Mind, Value and Mental Health: Philosophy and Psychiatry Summer School and Conference

Two linked events exploring areas in which the philosophy of mind and ethics or the philosophy of value make contact with issues about mental health.
  • Summer School 23–24 July 2015
  • Conference 25 July 2015
Featuring guest keynote speakers, the events will be led by members of Oxford's Faculty of Philosophy:
  • 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 (Emeritus Professor of Philosophy and Mental Health, University of Warwick and Fellow of St Catherine’s College)
  • Dr Edward Harcourt (University Lecturer (CUF) in Philosophy, Fellow and Tutor in Philosophy, Keble College)
We will be taking bookings soon, please hold the date and look out for further updates. +44 (0)1865 286945"