Giving evil its due: radical evil and the limits of philosophy

Despite Hannah Arendt's prediction in the wake of World War II that "the problem of evil will be the fundamental question of post-war intellectual life," the majority of postwar philosophers have preferred to stay away from the idea of evil. But at the same time that philosophical reflection on the notion of evil has dissipated, there is no denying the fact that referring to "evil" has remained very common among the public at large, among political leaders, and in popular culture. To better understand what meaning the concept of evil might have for us today, in this paper I will address two main questions. First, recognizing the problems recent philosophers have raised against the idea of "evil," we should ask if we should simply take our leave of the concept of evil, admitting that it has been exhausted by overuse, shifting intellectual paradigms, and a triumphant secular age. In other words, does it make any sense for us today to go beyond calling something wrong or unjust or harmful or unspeakable and to speak in terms of "evil?" Is talk about evil simply a relic of a way of speaking and thinking about the world that we have long left behind? Is "evil" in fact one of those terms that have always drawn people into error and sometimes even into committing horrific acts? Second, if we believe we can begin to address this first set of questions about the notion of evil, it remains to be seen what exactly we might mean by evil. What are we pointing to when we call something "evil?" What makes something evil rather than merely wrong or unjust? What kinds of things do we reserve the judgment of evil for? This set of questions leads us to come up with a substantive account of evil, an account of what evil is and what distinguishes evil from other wrongdoing. To address these questions, our argument will proceed as follows. We will begin with an overview of the recent return to discussing evil after a turn away from evil by the majority working in philosophy. After giving a brief historical overview of these shifts we will then begin to argue for the need for philosophers to think about evil and the concept of evil. In short, as I will argue, because we continue to turn to the notion of evil in response to extreme forms of wrongdoing, philosophical reflection is warranted in trying to clarify what we might reasonably mean when we call an agent or action evil. Moving to a discussion of the idea of radical evil, we will begin with a close reading and interpretation of Kant's account of radical evil, pausing to discuss what he gets right and where he may err. We will then move to recent discussions of evil in contemporary philosophy, much of which can be understood as revolving around Kant's account of radical evil. In these contemporary accounts, evil is no longer used in an inclusive, wide sense, but almost exclusively to refer to the kinds of extreme, unforgivable wrongdoing we might classify under the notion of radical evil. In these recent accounts, there is an attempt to distinguish degrees of evil, between the "normal" or "ordinary" evils of serious wrongdoing that we nevertheless can understand, punish, and cope with, versus the "radical" or extreme evils that we cannot really understand, punish, or fit into our intellectual and moral frameworks. After discussing these recent accounts and appreciating the progress they make, we will nevertheless ask whether they can really help us grasp the kinds of horrendous evil they were developed in response to. In particular, we will argue that these recent accounts still fail to appreciate the notion of radical evil to its full extent, preferring to focus on the harm caused and on notions like the banality of evil and ordinary evildoers, projects which may end up distorting the nature of evil. Looking to some recent reflections on radical evil, we will argue that the Kantian notion of a perversion of the will and an evil heart help us to understand that radical evil is something that is usually anything but banal, but is a fundamental breach of our normal standards of wrongness and that this quality of excess and the inversion of the moral is what lies at the core of the acts and agents we deem evil. We will conclude by looking at the necessary limits of any abstract discussion of evil in general and how particular evils such as those experienced at Auschwitz cannot even begin to be explained by such accounts, arguing that our discomfort and horror in the face of evil nevertheless remains but that such attempts at reflection and understanding evil remain necessary and urgent

A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

International audienceAdverse childhood experiences (ACEs) have emerged as a major research theme. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. As with many simplified concepts, ACEs present limitations. They include diverse types of exposures, are often considered cumulatively, can be identified using prospective and retrospective approaches, and their multidimensional nature may lead to greater measurement error. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. As a probabilistic and population-level tool, it is not adapted to diagnose individual-level vulnerabilities, an approach which could ultimately exacerbate inequalities. Here, we present a critique of the ACEs framework, discussing its strengths and limits

Big Data and the Study of Social Inequalities in Health: Expectations and Issues

Understanding the construction of the social gradient in health is a major challenge in the field of social epidemiology, a branch of epidemiology that seeks to understand how society and its different forms of organization influence health at a population level. Attempting to answer these questions involves large datasets of varied heterogeneous data suggesting that Big Data approaches could be then particularly relevant to the study of social inequalities in health. Nevertheless, real challenges have to be addressed in order to make the best use of the development of Big Data in health for the benefit of all. The main purpose of this perspective is to discuss some of these challenges, in particular: (i) the perimeter and the particularity of Big Data in health, which must be broader than a vision centerd solely on care, the individual and his or her biological characteristics; (ii) the need for clarification regarding the notion of data, the validity of data and the question of causal inference for various actors involved in health, such data as researchers, health professionals and the civilian population; (iii) the need for regulation and control of data and their uses by public authorities for the common good and the fight against social inequalities in health. To face these issues, it seems essential to integrate different approaches into a close dialog, integrating methodological, societal, and ethical issues. This question cannot escape an interdisciplinary approach, including users or patients

Adverse Childhood Events and Health Biomarkers: A Systematic Review

Background: This systematic review aimed to summarize evidence reporting epigenetic and/or neuro-immuno-endocrine embedding of adverse childhood events (ACEs) in children, with a particular focus on the short-term biological effect of those experiences. Methods: A search was conducted in PsycINFO®, PubMed®, Isi Web of Knowledge and Scopus, until July 2019, to identify papers reporting the short-term biological effects of exposure to ACEs. Results: The search identified 58 studies, that were included in the review. Regarding exposure, the type of ACE more frequently reported was sexual abuse (n = 26), followed by life stressors (n = 20) and physical abuse (n = 19). The majority (n = 17) of studies showed a positive association between ACEs and biomarkers of the immune system. Regarding DNA methylation 18 studies showed more methylation in participants exposed to ACEs. Two studies presented the effect of ACEs on telomere length and showed that exposure was associated with shorter telomere length. Conclusion: Overall the associations observed across studies followed the hypothesis that ACEs are associated with biological risk already at early ages. This is supporting evidence that ACEs appear to get “under the skin” and induce physiological changes and these alterations might be strongly associated with later development of disease.This work was supported by the European Regional Development Fund (ERDF) through the Operational Program Competitiveness and Internationalization and national funding from the Foundation for Science and Technology (FCT), Portuguese Ministry of Science, Technology and Higher Education under the projects BioAdversity: How childhood social adversity shapes health: The biology of social adversity (POCI-01- 0145-FEDER-016838; Reference info:eu-repo/grantAgreement/FCT/9471 - RIDTI/PTDC/DTP-EPI/1687/2014/PT), HIneC: When do health inequalities start? Understanding the impact of childhood social adversity on health trajectories from birth to early adolescence (POCI-01-0145-FEDER-029567; Reference info:eu-repo/grantAgreement/FCT/9471 - RIDTI/info:eu-repo/grantAgreement/FCT/9471 - RIDTI/PTDC/SAU-PUB/29567/2017/PT017/PT). It is also supported by the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Reference info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UID/DTP/04750/2013/PT), PhD Grants info:eu-repo/grantAgreement/FCT/POR_NORTE/SFRH/BD/108742/2015/PT (to SSo) and SFRH/BD/103726/2014 (to VR) co-funded by FCT and the Human Capital Operational Programme (POCH/FSE Program); FCT Investigator contract info:eu-repo/grantAgreement/FCT/CEEC IND 2017/CEECIND/01516/2017/CP1406/CT0001/PT (to SF). We also thank the support of the LIFEPATH project funded by the European Commission (Horizon 2020 Grant No. 633666)

Influenza epidemiology, vaccine coverage and vaccine effectiveness in sentinel Australian hospitals in 2013: the Influenza Complications Alert Network

The National Influenza Program aims to reduce serious morbidity and mortality from influenza by providing public funding for vaccination to at-risk groups. The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at 14 sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with confirmed influenza, estimates vaccine coverage and influenza vaccine protection against hospitalisation with influenza during the 2013 influenza season. In this observational study, cases were defined as patients admitted to one of the sentinel hospitals, with influenza confirmed by nucleic acid testing. Controls were patients who had acute respiratory illnesses who were test-negative for influenza. Vaccine effectiveness was estimated as 1 minus the odds ratio of vaccination in case patients compared with control patients, after adjusting for known confounders. During the period 5 April to 31 October 2012, 631 patients were admitted with confirmed influenza at the 14 FluCAN sentinel hospitals. Of these, 31% were more than 65 years of age, 9.5% were Indigenous Australians, 4.3% were pregnant and 77% had chronic co-morbidities. Influenza B was detected in 30% of patients. Vaccination coverage was estimated at 81% in patients more than 65 years of age but only 49% in patients aged less than 65 years with chronic comorbidities. Vaccination effectiveness against hospitalisation with influenza was estimated at 50% (95% confidence interval: 33%, 63%, P<0.001). We detected a significant number of hospital admissions with confirmed influenza in a national observational study. Vaccine coverage was incomplete in at-risk groups, particularly non-elderly patients with medical comorbidities. Our results suggest that the seasonal influenza vaccine was moderately protective against hospitalisation with influenza in the 2013 season. This work i

Adverse childhood experiences and adult mood problems: evidence from a five-decade prospective birth cohort

Background Retrospectively recalled adverse childhood experiences (ACEs) are associated with adult mood problems, but evidence from prospective population cohorts is limited. The aims of this study were to test links between prospectively ascertained ACEs and adult mood problems up to age 50, to examine the role of child mental health in accounting for observed associations, and to test gender differences in associations. Methods The National Child Development Study is a UK population cohort of children born in 1958. ACEs were defined using parent or teacher reports of family adversity (parental separation, child taken into care, parental neglect, family mental health service use, alcoholism and criminality) at ages 7–16. Children with no known (n = 9168), single (n = 2488) and multiple (n = 897) ACEs were identified in childhood. Adult mood problems were assessed using the Malaise inventory at ages 23, 33, 42 and 50 years. Associations were examined separately for males and females. Results Experiencing single or multiple ACEs was associated with increased rates of adult mood problems after adjustment for childhood psychopathology and confounders at birth [2+ v. 0 ACEs – men: age 23: odds ratio (OR) 2.36 (95% confidence interval (CI) 1.7–3.3); age 33: OR 2.40 (1.7–3.4); age 42: OR 1.85 (1.4–2.4); age 50: OR 2.63 (2.0–3.5); women: age 23: OR 2.00 (95% CI 1.5–2.6); age 33: OR 1.81 (1.3–2.5); age 42: OR 1.59 (1.2–2.1); age 50: OR 1.32 (1.0–1.7)]. Conclusions Children exposed to ACEs are at elevated risk for adult mood problems and a priority for early prevention irrespective of the presence of psychopathology in childhood

Adverse childhood experiences and early life inflammation in the Avon Longitudinal Study of Parents and Children

BACKGROUND: Adverse childhood experiences (ACEs) have been associated with poorer health across the life course. Previous studies have used cumulative risk scores (ACE scores) or individual ACEs but these two approaches have important shortcomings. ACE scores assume that each adversity is equally important for the outcome of interest and the single adversity approach assumes that ACEs do not co-occur. Latent class analysis (LCA) is an alternative approach to operationalising ACEs data, identifying groups of people co-reporting similar ACEs. Here we apply these three approaches for ACEs operationalisation with inflammation in childhood with the aim of identifying particular ACEs or ACE combinations that are particularly associated with higher inflammation in early life. METHODS: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we compare ACE scores, single adversities and LCA-derived ACE clusters in their relationships with Interleukin-6 at age 9 (n = 4935) and C-Reactive Protein (CRP) at age 9 (n = 4887). ACEs included were parental separation/divorce, parental alcohol problems, parental mental health problems, parental offending, inter-parental violence, parental drug misuse, and physical, emotional and sexual abuse. RESULTS: Two thirds of the sample reported at least one ACE. Mother’s mental health problems was the most frequently reported ACE (32.3 %). LCA identified four ACE classes – ‘Low ACEs’ (81.1 %), ‘Maternal mental health problems’ (10.3 %), ‘Maternal mental health problems and physical abuse’ (6.3 %) and ‘Parental conflict, mental health problems and emotional abuse’ (2.4 %). Parental separation/divorce was associated with higher IL-6. Parental alcohol problems, paternal mental health problems, parental convictions and emotional abuse were associated with lower levels of IL-6. Associations for paternal mental health problems and emotional abuse were only observed for boys. ACE score and LCA-derived ACE classes were not associated with differences in IL-6. Girls in the ‘Maternal mental health problems’ cluster had lower CRP levels. CONCLUSIONS: Specific adversities and adversity combinations are important for differences in childhood inflammation. Some associations were only observed for girls or boys

Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults.

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (e.g. depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (e.g. attractions, identities and behaviour) with various patterns (e.g. directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (e.g. gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people