Vitalism and the Resistance to Experimentation on Life in the Eighteenth Century

There is a familiar opposition between a ‘Scientific Revolution’ ethos and practice of experimentation, including experimentation on life, and a ‘vitalist’ reaction to this outlook. The former is often allied with different forms of mechanism – if all of Nature obeys mechanical laws, including living bodies, ‘iatromechanism’ should encounter no obstructions in investigating the particularities of animal-machines – or with more chimiatric theories of life and matter, as in the ‘Oxford Physiologists’. The latter reaction also comes in different, perhaps irreducibly heterogeneous forms, ranging from metaphysical and ethical objections to the destruction of life, as in Margaret Cavendish, to more epistemological objections against the usage of instruments, the ‘anatomical’ outlook and experimentation, e.g. in Locke and Sydenham. But I will mainly focus on a third anti-interventionist argument, which I call ‘vitalist’ since it is often articulated in the writings of the so-called Montpellier Vitalists, including their medical articles for the Encyclopédie. The vitalist argument against experimentation on life is subtly different from the metaphysical, ethical and epistemological arguments, although at times it may borrow from any of them. It expresses a Hippocratic sensibility – understood as an artifact of early modernity, not as some atemporal trait of medical thought – in which Life resists the experimenter, or conversely, for the experimenter to grasp something about Life, it will have to be without torturing or radically intervening in it. I suggest that this view does not have to imply that Nature is something mysterious or sacred; nor does the vitalist have to attack experimentation on life in the name of some ‘vital force’ – which makes it less surprising to find a vivisectionist like Claude Bernard sounding so close to the vitalists

Sexual Identity at the Limits of Liberalism: The Politicization of Nature in the Work of Karl Heinrich Ulrichs (1825-1895)

This paper describes the historical emergence of the modern concept of sexual identity. I focus on the nineteenth-century German jurist Karl Heinrich Ulrichs, who defended the legal rights of “Urnings” (roughly similar to homosexual men). Wary of the strength of the German liberal tradition, he wanted to achieve the liberal goal of ending the prosecution of same-sex sex without actually having to repeal what were profoundly illiberal laws. He argued that Urnings have their own “nature,” and therefore that laws that condemn “unnatural” sex do not apply to them. An Urning who engages in same-sex sex is following his nature. With this argument Ulrichs created a legally-defined category for men who love men. This was the first step toward the modern concept of (homo)sexual “identity.

How to Be a Pervert: A Modest Philosophical Critique of the Diagnostic and Statistical Manual of Mental Disorders

This paper is divided into three parts. I begin with a short history of the way American psychiatrists have defined mental disorder in general, and paraphilias (sexual perversions) in particular, from the 1950s to 2013. I look at how the different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have articulated (or in the case of the future DSM-5, will articulate) the distinction between health and disease. In the second part I suggest how psychiatrists might want to modify their approach to the definition of mental disorder. In the third part I explain why the paraphilias in particular should be removed from the current psychiatric classification of diseases

How to Be a Pervert: A Modest Philosophical Critique of the Diagnostic and Statistical Manual of Mental Disorders

This paper is divided into three parts. I begin with a short history of the way American psychiatrists have defined mental disorder in general, and paraphilias (sexual perversions) in particular, from the 1950s to 2013. I look at how the different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have articulated (or in the case of the future DSM-5, will articulate) the distinction between health and disease. In the second part I suggest how psychiatrists might want to modify their approach to the definition of mental disorder. In the third part I explain why the paraphilias in particular should be removed from the current psychiatric classification of diseases.Este documento está dividido em três partes. Inicia com uma breve história da forma em que psiquiatras americanos vêm definindo o transtorno mental, em geral, e os desvios sexuais (paraphilia), em particular, entre 1950 e 2013. Observa-se como as diferentes edições do Diagnostic and Statistical Manual of Mental Disorders (DSM) articulam (ou no caso do futuro DSM-5, articularão) a diferença entre saúde e doença. Na segunda parte, sugere-se como os psiquiatras gostariam de modificar sua aproximação à definição de transtorno mental. Na terceiraEste documento está dividido en tres partes. Inicio con una breve historia de la forma en que psiquiatras americanos han definido el trastorno mental en general, y las parafilias (perversiones sexuales) en particular, entre 1950 y 2013. Veo cómo las diferentes ediciones del Diagnostic and Statistical Manual of Mental Disorders (DSM: Manual diagnóstico y estadístico de trastornos mentales) han articulado (o en el caso del futuro DSM-5, articularán) la distinción entre salud y enfermedad. En la segunda parte sugiero cómo los psiquiatras querrían modificar su aproximación a la definición de trastorno mental. En la tercera parte explico cómo las parafilias en particular deberían ser eliminadas de la actual clasificación de enfermedades

La patientèle sourde et malentendante face au système de santé

En Suisse, près d’une personne sur cent présente une limitation importante ou complète de l’ouïe, alors qu’environ 13% de la population est affectée par une malentendance plus ou moins importante. La littérature révèle de nombreuses inégalités sociales de santé 1 entre population entendante et population sourde et malentendante (détresse psychologique, comorbidité, santé sexuelle, prise en charge des maladies chroniques, maltraitance, accès aux messages de prévention, etc.). Par ailleurs, l’observation fait état de l’existence d’une réalité encore très largement méconnue : les personnes dites « sourdes » tendent à former une véritable communauté, au bénéfice d’un système de communication complet, et partageant un ensemble de normes et de valeurs culturelles. La difficulté évidente d’accès aux soins pour cette population commande la mise en place, pour l’heure balbutiante, d’adaptations au sein du monde sociosanitaire permettant une communication efficiente et une prise en charge adéquate

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

Abstract Background Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations. Methods This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention. Results Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients. Conclusions Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment