Colloquium — All Welcome



Past Events



Placebo-Controlled Surgical Trials
1 October 2015 - 18:30-20:00

Lecture: David Beard, Professor of Musculoskeletal Sciences, University of Oxford
Comment: David Papineau, Professor of Philosophy, King’s College London

K2.31, King’s Building, Strand, King’s College London

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Video Recording


Lies, Damn’d Lies, and Statistics: Is it possible to communicate cancer risk accurately?
15 October 2015 - 18:30-20:00

Lecture: Steve John, Lecturer, History and Philosophy of Science, University of Cambridge
Comment: Deborah Ruddy, Consultant in Clinical Genetics, Guy’s and St. Thomas’ Hospital

Henriette Raphael House, Function Room, Guy’s Campus

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Abstract:

 

The fact that different ways of presenting the same risk information can have very different effects on patients’ choices raises an ethical challenge: how, if at all, should medical professionals use such “perlocutionary knowledge”? In this paper, I suggest that reflection on the nature of risk estimates poses an even harder problem: which reference classes should physicians use to calculate patients’ risks in the first place? I then sketch one answer to this challenge, based on an account of rational gambling. Unfortunately, this answer seems to conflict with much current medical practice. In the final part of the paper, I try to justify current practice. I conclude with some remarks on the implications of my argument both for clinical ethics and for the philosophy of science.

Abstract Video Recording


Surviving the Sirens: Should there be advance directives for people with Bipolar? -- CANCELLED
29 October 2015 - 18:30-20:00

Lecture: Tania Gergel, Visiting Research Fellow in Ancient Philosophy (Dept. of Classics) and Philosophy of Psychiatry (IoPPN)
Comment: Alexander Ruck Keene, Barrister and Honorary Research Lecturer at the University of Manchester

This event has been cancelled due to illness. It will be rescheduled for a later date.


”Just because I’m paranoid doesn’t mean they’re not out to get me”: The Problem of Defining Delusion
12 November 2015 - 18:30-20:00

Lecture: Dr. Abdi Sanati, Consultant Inpatient Psychiatrist, North East London NHS Foundation Trust
Comment: Dr. Luis Flores, MD, MA, MPhil

King’s Building, K2.31, Strand

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Abstract:

 

Delusions have long been seen as a hallmark of madness, but what makes something a delusion? People have mistaken beliefs without being called deluded, and the beliefs of deluded people can be true. In this talk, these and other difficulties with defining delusion will be explored from the points of view of both theory and clinical practice.

Abstract Video Recording


Cause or Correlation? Causal Evidence in Medicine and Law
28 January 2016 - 18:30-20:00

Lecture: Brendan Clarke, Department of Science and Technology Studies, UCL
Comment: Nicki Cohen, Neuropathologist, GKT Department of Medical Education, KCL

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

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Abstract:

 

How can medical researchers generate reliable knowledge about treatment outcomes? The usual answer to this question is that randomised clinical trials are the best way of doing this. But there are many cases where doing a trial is not possible. In such cases, researchers must rely on other kinds of evidence. However, as is well-known, these kinds of evidence have many shortcomings, such as suffering from confounding and various species of bias. This talk uses methods drawn from the law to explore improved ways of working with imperfect evidence in medicine.

Abstract Video Recording


In Defense of the Social Value Requirement for Clinical Research
11 February 2016 - 18:30-20:00

Lecture: Annette Rid, Department of Social Science, Health, and Medicine, KCL
Comment: Benedict Rumbold, Department of Philosophy, UCL

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

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Abstract:

 

Many commentators and guidelines endorse the view that clinical research should be permitted only when it is socially valuable, meaning that it collects data which can be used to improve health. Despite this widespread endorsement and codification, there has been no systematic analysis of why social value is a necessary condition on acceptable clinical research, and a recent article even suggests it is not necessary. I evaluate the relevant ethical arguments and policy considerations and provide justification for the view that social value is an ethical requirement for the vast majority of clinical research trials, and should be mandated by guidelines and policies for clinical research.

Abstract


Configuring the Participants in Clinical Research
25 February 2016 - 18:30-20:00

Lecture: Norma Morris, Department of Science and Technology Studies, UCL
Comment: John Craven, Philosophy, KCL

K2.31, King’s Building, Strand, King’s College London

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Abstract:

 

Empirical work on participation in clinical research (using qualitative methods) has highlighted some of the configuration work being carried out by and on those taking part. Lay contributors try out different identities and behaviours, and develop conceptions of their role in response to circumstances. Clinical staff have to reconcile the professional demands of research and of care, and adjust as necessary their pre-formed expectations of participants’ needs. They must additionally comply with professional, legal, ethical and governance frameworks and rules. The presentation discusses tensions emerging for the actors, meeting at the confluence of these three streams, in the performance of clinical research.

Abstract


Pain: survival, science and suffering
10 March 2016 - 18:30-20:00

Lecture: Emma Briggs, Florence Nightingale Faculty of Nursing and Midwifery, KCL
Comment: Shawn Vigil, Philosophy, KCL

K2.31, King’s Building, Strand, King’s College London

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Abstract:

 

Our understanding of the nature, mechanisms and meaning of pain has evolved significantly over the last century but its complexity still presents many clinical, ethical and philosophical challenges. Pain is widespread; a universal human experience and the most frequent reason people seek healthcare. Pain has a demonstrable impact on the individual, the family and health and social care systems. This presentation sets the scene for the discussion by exploring the impact and role of pain and the unpredictable relationship between the science and suffering.

Abstract


Mortality
29 September 2016 - 16:30-18:00

LectureDavid Galloway, KCL Philosophy

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

Abstract:

Would it be a good thing for us if we were able to lengthen our lives indefinitely, in excellent physical health? Or would we all, even in the most favourable circumstances, choose eventually to die? If we would so choose, then our mortality is not in itself a bad thing, and immortality is not to be desired. I will discuss factors we might consider in making this choice.

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Essay Contest
Reading Group Video Recording


Were you a part of your mother? The Metaphysics of Pregnancy
13 October 2016 - 16:30-18:00

LectureElselijn Kingma, Department of Philosophy, University of Southampton
Comment: Dr. Shree Datta, Consultant Obstetrician and Gynecologist, King’s College Hospital

New Hunt’s House, G.12, Guy’s Campus

Abstract:

What is the metaphysical relationship between the gestating organism and its embryo/fetus? I compare two views: (1) the fetal container model: the fetus is not part of but merely contained within or surrounded by the gestating organism; (2) the part-whole model: the fetus is part of its gestator. The fetal container model appears to be the received view. It is widely assumed but, I argue, without good argument; this model needs substantial support if it is to be taken seriously. The part-whole model is not presently defended, but I argue that it derives considerable support from a range of biological and physiological considerations. I conclude that the part-whole model has the upper hand and that, if true, this has important consequences for the metaphysics of persons and organisms and, perhaps, ethics and law.

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Video Recording


Delusional Reasoning
27 October 2016 - 16:30-18:00

LectureMatthew Parrott, KCL Philosophy

King’s Building, K-1.56, Strand Campus

Abstract:

In psychiatric textbooks and diagnostic manuals delusions are typically characterized in terms of impaired reasoning or as manifestations of irrationality. Yet it remains unclear what precisely is irrational about delusional patterns of thinking. In this presentation, we will examine several styles of reasoning exhibited in cases of delusion, some of which, as we shall see, appear surprisingly rational. This suggests, I shall claim, that delusional cognition is far more nuanced than standard textbooks and manuals might lead us to believe.

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Video Recording


Surviving the Sirens: Should there be advance directives for people with bipolar?
10 November 2016 - 17:00-18:30

LectureTania Gergel, IoPPN
Comment: Alex Ruck Keene, Barrister

New Hunt’s House, Lecture Theatre 2, Guy’s Campus

Abstract:

Bipolar Affective Disorder is a cyclical condition, with periods of remission and periods of illness, which often involve loss of decision-making capacity and damaging behaviour. For people with Bipolar, a self-binding (advance) directive (SBD), which commits them to treatment during future episodes, even if unwilling, can seem the most rational solution for an imperfect predicament. Nevertheless, efforts to establish a provision for SBDs are hampered by valid, but also paralysing, ethical, clinical and legal concerns. Paradoxically, the rights of people with Bipolar are being ‘protected’ through being denied an opportunity to protect themselves. We will present and discuss a model of an SBD which could represent a legitimate and ethically coherent form of self-determination.

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Video Recording


What's wrong with pragmatic trials?
26 January 2017 - 17:00-18:30

LectureNancy Cartwright, University of Durham and University of California, San Diego (Work with Sarah Wieten)

Video Recording

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Abstract:

In principle nothing is wrong with pragmatic trials: trials that ‘seek to determine the effectiveness of an intervention in a real-world setting to inform clinical decision making’ (Roland and Torgerson, 1998). In aid of this, pragmatic trials eliminate some of the exclusion conditions that are usual in what are labelled ‘ideal’ or ‘explanatory’ trials. The trouble comes with the concepts of ‘effectiveness’ and ‘external validity’. Positive results in well-conducted trials, whether ideal or pragmatic, show only that the treatment has worked for some members of the population enrolled in the trial. They cannot establish that it works in general nor what other factors help or hinder. Similarly, a pragmatic trial can establish that the treatment worked in the particular ‘real world’ setting – the one in which it was conducted, not that it works in ‘real world clinical practice’. Nor can they tell us what, if anything, is causally relevant in those settings. What can they do then? We shall argue that pragmatic trial results can be used in just the same way as ‘explanatory’ trial results: in tandem with a great deal of other evidence and theory, especial ‘midrange’ theory, to build credible local claims about how specific populations – or possibly even a specific individual – in specific places and circumstances may respond.
 


Manic Temporality and Decision-Making: A Phenomenological Approach
2 March 2017 - 17:00-18:30

LectureWayne Martin, Department of Philosophy, University of Essex.

Video Recording

Abstract:

The symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight of ideas, hyperactivity. But what is the underlying phenomenological structure of temporal experience in manic episodes? We identify a set of hypotheses about manic temporality formulated by two pioneers in 20th century clinical phenomenology: Eugène Minkowski (1885-1972) and Ludwig Binswanger (1881-1966). We then test, critique, and refine these hypothesis using methods of “second-person phenomenology” in an interview-based study of persons with a history of bipolar disorder and a current diagnosis of mania. We show that Minkowski and Binswanger were wrong to claim that persons experiencing acute mania are somehow trapped in the present moment. But we provide evidence that supports their hypothesis that disturbance in the formal structure of temporal experience is a core feature of mania. Developing a suggestion from Binswanger, we propose an interpretation of manic temporality as involving a distinctive form of protention. We identify consequences of this temporal disturbance for the assessment of decision-making capacity under conditions of mania.

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Privacy, consent and health data: using identifiable health data for secondary purposes ethically, but without consent
16 March 2017 - 17:00-18:30

LectureJames Wilson, Department of Philosophy, UCL

Video Recording

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Abstract:

A number legal regimes (e.g. England’s section 251 of the NHS Act 2006), have a mechanism that allows research involving identifiable health information to proceed without consent for a large population on grounds of the impracticability of gaining consent, even though the same research project would require the consent of all participants were the number of participants significantly smaller. This paper examines the cogency of the reasoning involved in such decisions, arguing that it seems difficult to justify on the assumption that in usual circumstances individuals have a right that their identifiable health information not be used without their consent. If using someone’s identifiable information without their consent would violate their rights if they were a member of a small group, why should it stop being a violation of that person’s rights if the group they are in becomes sufficiently large? I propose instead a new ethical justification for such use of health data, which I call the reasonable trespass account.


Too much medicine: Not enough trust?
6 February 2018 - 17:00-18:30

LectureZoë Fritz and Richard Holton, University of Cambridge.

G.12 New Hunt’s House, Guy’s Campus

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Abstract:

We suggest that ‘too much medicine’, in the shape of both investigations and
treatments, is sometimes offered as a substitute for a trusting relationship. We investigate the
nature of such a relationship, arguing that at its core it involves a transfer of discretion. We
show that there is substantial empirical support for the idea that more trust will reduce the
problem of too much medicine. We then investigate ways in which trust can be built quickly,
concentrating on issues of questioning, and of entrusting uncertainty and treatment. We
conclude by suggesting that using over-treatment as a way of generating trust may itself be an
untrustworthy way of proceeding.


Manufactured Values: Industry Front Groups, Looping Effects, and Regulatory Decisions
13 February 2018 - 17:00-18:30

LectureBennett Holman, University of Yonsei.

Classroom 6, Hodgkin Building, Guy’s Campus

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Abstract:

Evaluating a case to determine whether it is an example of overtreatment frequently
trades on values: “Which side effects are important enough to include in any measurement of
harm? Are some side effects more important than others? Who should decide—patients,
clinicians, or researchers? And what if they disagree?” (Carter et al. 2015). In an effort to deal
with just this issue, the FDA created the patient focus drug program. Combining philosophy
with qualitative methods from the social sciences, our research first examines the October
2014 patient meeting for Flibanserin and female sexual dysfunction. We show that industry-
funded participants presented a unified message that was almost completely distinct from
other participants. We argue that this process can be understood as an example of a “looping
effect” (i.e. women have internalized the industry’s narrative which now genuinely structures
their experience). Setting this case in context of broader efforts by industry to shape the
experience of patient groups, we argue that: At best this significantly complicates efforts to
incorporate patient values into risk/benefit judgments, and at worst, it belies the
presupposition that patient interests are an objective, immutable, and knowable factor to be
incorporated into medical decision making and regulatory decisions.


POSTPONED: Scientific Ecosystems and Research Reproducibility
20 March 2018 - 13:00-14:30

NOTICE: This lecture will be postponed due to the UCU strike. Please check back later for updates to when it will be rescheduled, our join our mailing list to be notified (in the footer of the website.)

LectureMarcus Munafò, University of Bristol.

Classroom 6, Hodgkin Building, Guy’s Campus

Abstract:

There have been a number of high profile cases of academic fraud, but a more insidious threat to the integrity of science is the extent to which distortions of scientific best practice increases the likelihood that published research findings are in fact false. There is growing evidence for a range of systemic problems within science, such as flexibility in the analysis of data, selective reporting of study results, publication bias against null results, influence of vested (e.g., financial) interests, and distorted incentive structures. A number of strategies for improving the situation will be discussed.


Is Suicide a Psychiatric Problem?
24 April 2018 - 13:00-14:30

Lecture: Hane Maung, Lancaster University

Room 4.16 Henriette Raphael House, Guy’s Campus

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Video Recording

Abstract:

Suicide is understood as being a complex outcome of multiple interacting factors at multiple levels of organisation, including diverse processes at individual, interpersonal, and environmental levels. Despite this complexity, suicide is commonly framed in contemporary health discourse as primarily being the causal outcome of mental disorder. Accordingly, mental health professionals are granted responsibilities for suicide prevention and can even be held legally liable when suicides occur. This selective emphasis on mental disorder raises philosophical problems. How do we make sense of the messy and murky interactions of factors that are involved in suicide causation? What accounts for our privileging of mental disorder over other factors as the primary cause of suicide? Is the connection between mental disorder and suicide wholly causal or partly the result of how mental disorder is defined? These questions are important, because they call attention to implicit assumptions involved in the way the issue of suicide causation is framed in contemporary health policy. In this talk, I draw on theory from the philosophy of science to unpack some of these assumptions and to explore the extent to which the contemporary view of suicide as being primarily a causal outcome of mental disorder can be sustained.


Understanding our ordinary thought and talk about chronic pain
8 November 2018 - 12:30-14:00

Lecture: Emma Borg, University of Reading

Classroom 6, Hodgkin Building, Guy’s Campus – please note the unusual time.

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Video Recording

 

Please note that any external attendees, i.e. those not currently holding a valid King’s ID card, will need to send their names to Harriet Fagerberg (harriet.fagerberg@kcl.ac.uk) prior to the 6th of November, so that she can notify King’s Estate Security.

 

Abstract:

Pain has a long history of study, from both the philosophical and the scientific perspectives, yet the question of what pain is, and how we conceive of and communicate about it, remains vexed. In this talk, we introduce a new approach to understanding our ordinary thought and talk about (chronic) pain – the so-called ‘polyeidic’ approach – whereby pain thinking is held to involve tacit stances on a number of distinct pain dimensions. We argue briefly that this approach is supported by experimental findings in philosophy and then turn to consider the clinical relevance of the view, suggesting that it provides a better understanding of chronic pain patients and the treatments from which they may benefit.

 


A Plurality During Pregnancy?
22 November 2018 - 17:00-18:30

Lecture: Jonathan Grose, University of Southampton

Strand Campus, Somerset House East Wing, Room SW-2.17

Those not holding a valid King’s ID card can register by emailing Harriet Fagerberg their name prior to the 21st of Nov.

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Video Recording

Abstract:

I argue that the case of mammalian, placental pregnancy is a neglected and significant example of what Clarke calls “the problem of biological individuality”. This example is much closer to home than those typically discussed in the literature. I apply both evolutionary and immunological accounts of individuality to the “counting question”, how many individuals are present during a placental pregnancy? I conclude that evolutionary approaches yield the answer “two”, due to bottlenecking, germ-soma sequestration and sexual recombination. By contrast, an immunological approach answers “one”, due to pervasive interactions during pregnancy. Consequently, pregnancy provides a clear, novel example of the need for a pluralist approach to biological individuality.

 


Sharing Personal Stories in Mental Health Debates
29 November 2018 - 17:00-18:30

Lecture: Lisa Bortolotti, University of Birmingham

Classroom 12, Hodgkin Building at Guy’s Campus

Those not holding a valid King’s ID card can register by emailing Harriet Fagerberg their name prior to the 28th of Nov.

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Video Recording

Abstract:

In this paper I consider the use of personally significant stories in public debates about mental health. I offer one example: the debate whether the biomedical model or the trauma-informed approach provides the best account of distress, revived by the launch of the Power Threat Meaning framework. First, I observe how personally significant stories are used and claim that they do not merely offer insight into a first-person experience or illustrate some aspects of distress and autism in a vivid and memorable way, but often constitute arguments for a given viewpoint in the context of heated and polarised debates. Then, I ask what it would take for stories to be good arguments for the viewpoint they support. In the end, I suggest that participants in a public debate have a responsibility to maintain some critical distance from the personally significant stories that are shared within that debate, as such stories can have a powerful influence on the development and outcome of the debate.
 


Making Science Reproducible: Will this time be different?
7 March 2019 - 17:30-19:00

Lecture: Fiona Fidler, University of Melbourne and Hilda Bastian, PLOS One and PubMed

Theatre 1, New Hunt’s House at Guy’s Campus – Followed by a wine reception in the Reception Room in Henriette Raphael House.

Description:
Fiona Fidler, a philosopher and historian of science at the University of Melbourne is currently investigating the “reproducibility crisis” in science and Hilda Bastian, a scientist who has worked for PubMed Health, the PLOS One Human Research Advisory Group, and Wikipedia’s WikiProject Medicine will reflect on past attempts to fix methodological problems in science, and consider how we can best take advantage of the current interest in reproducibility to bring about change.

Registration: Eventbrite

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Radical criticisms of the Biopsychosocial Model, and why we still have it nevertheless
10 October 2019 - 17:00-18:30

Lecture: Derek Bolton, King’s College London

Harris Lecture Theatre, Hodgkin Building, Guy’s Campus, King’s College London

Registration: Eventbrite (only required for attendees without a valid KCL ID)

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Lecture Slides
Audio Recording

Description:

The BPSM has recently been radically criticised by authoritative commentators in e.g. The Lancet and the American Journal of Psychiatry; for being vague, lacking scientific content, useless and philosophically incoherent. This combined with the fact that the BPSM is still so frequently invoked in clinical and healthcare education settings signals a problem in the current conceptual foundations of medicine/healthcare. We keep invoking the BPSM because there is accumulating evidence that psychosocial factors as well as biological factors are relevant to many diseases and their management. Refers e.g. social epidemiology, management of LTCs. I will present the case that the ‘content’ of the BPSM/biopsychosocial medicine is to found in the specifics for particular conditions – in fact just like the content of the Biomedical Model/biomedicine is in its specifics.

Part 1 of 4 in the series

The Biopsychosocial Model: Updating the Model in Response to Major criticisms“.

Led by Derek Bolton, Professor of Philosophy & Psychopathology at the Institute of Psychiatry, Psychology and Neuroscience, until recently Honorary Consultant Clinical Psychologist in SL&M. He has published widely in health sciences and philosophy of psychiatry and medicine. His latest book, co-authored with Professor Grant Gillett (philosopher and formerly neurosurgeon) at Otago, is The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments, published OPEN ACCESS by Springer Palgrave. These lectures will review and apply the main ideas of the book, adapted for health students and educators and interested clinicians.

 


The Biopsychosocial Model as a model of biopsychosocial causal interactions
17 October 2019 - 17:00-18:30

Lecture: Derek Bolton, King’s College London

Harris Lecture Theatre, Hodgkin Building, Guy’s Campus, King’s College London

Registration: Eventbrite (only required for attendees without a valid KCL ID)

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Lecture Slides
Audio Recording

Description:

When George Engel proposed the BPSM – way back in 1977 – he realised that a lot of prejudice had to be overcome to let in psychological and social processes as causal factors. They included physicalism, reductionism, the view that biology was reducible to physics & chemistry, and mind/body dualism. These are deep science theory issues bordering into philosophy. However, current critical commentators in health agree with Engel that for the BPSM to be feasible, these assumptions will need to be ditched & replaced. I propose a way of doing this using current paradigms in biology (crucial role of regulatory mechanisms) and psychology (embodied cognition as agency) + some political philosophy (autonomy & recognition).

Part 2 of 4 in the series

The Biopsychosocial Model: Updating the Model in Response to Major criticisms“.

Led by Derek Bolton, Professor of Philosophy & Psychopathology at the Institute of Psychiatry, Psychology and Neuroscience, until recently Honorary Consultant Clinical Psychologist in SL&M. He has published widely in health sciences and philosophy of psychiatry and medicine. His latest book, co-authored with Professor Grant Gillett (philosopher and formerly neurosurgeon) at Otago, is The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments, published OPEN ACCESS by Springer Palgrave. These lectures will review and apply the main ideas of the book, adapted for health students and educators and interested clinicians.

 


Applications of the updated the Biopsychosocial Model (I): Theorising the social gradient in health
24 October 2019 - 17:00-18:30

Lecture: Derek Bolton, King’s College London

Lecture Theatre 2, New Hunts House, Guy’s Campus, King’s College London

Registration: Eventbrite (only required for attendees without a valid KCL ID)

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Lecture Slides
Audio Recording

Description:

The Marmot Review of health inequalities “does not have much medicine in it”. Meaning: the aetiological risks for many kinds of health condition & implications for prevention targets are social and psychological – as well as biological. How e.g. can lower (perceived) social status make you sick? These issues will be tackled using the updated biopsychosocial model outlined in the previous lecture. We will note that the familiar current hypothesised stress-related mechanisms are thoroughly biopsychosocial.

Part 3 of 4 in the series

The Biopsychosocial Model: Updating the Model in Response to Major criticisms“.

Led by Derek Bolton, Professor of Philosophy & Psychopathology at the Institute of Psychiatry, Psychology and Neuroscience, until recently Honorary Consultant Clinical Psychologist in SL&M. He has published widely in health sciences and philosophy of psychiatry and medicine. His latest book, co-authored with Professor Grant Gillett (philosopher and formerly neurosurgeon) at Otago, is The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments, published OPEN ACCESS by Springer Palgrave. These lectures will review and apply the main ideas of the book, adapted for health students and educators and interested clinicians.

 


Applications of the updated the Biopsychosocial Model (II): Theorising biomedicaly hard to reach conditions
31 October 2019 - 17:00-18:30

Lecture: Derek Bolton, King’s College London

Lecture Theatre 2, New Hunts House, Guy’s Campus

Registration: Eventbrite (only required for attendees without a valid KCL ID)

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Audio Recording

Description:

As set up here (as by Engel) biopsychosocial medicine would help itself to biomedicine – but add some – psychosocial factors – into the mix. Biomedicine manages some conditions at some stages very well by itself. But there is a long list of high service demand conditions/stages/complaints for which this is probably not the case. Examples were referred to in the first lecture, and include aetiology of many conditions – as last week. Also includes management of LTCs. Also includes pain and distress and activity limitations that have no biomedically detectable cause and which have – as is increasingly realised – central nervous system involvement. The updated BPSM would link biomedical science (biology below the neck) with neuroscience (biopsychology above the neck) – interacting with social task demands and resources.

Part 4 of 4 in the series

The Biopsychosocial Model: Updating the Model in Response to Major criticisms“.

Led by Derek Bolton, Professor of Philosophy & Psychopathology at the Institute of Psychiatry, Psychology and Neuroscience, until recently Honorary Consultant Clinical Psychologist in SL&M. He has published widely in health sciences and philosophy of psychiatry and medicine. His latest book, co-authored with Professor Grant Gillett (philosopher and formerly neurosurgeon) at Otago, is The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments, published OPEN ACCESS by Springer Palgrave. These lectures will review and apply the main ideas of the book, adapted for health students and educators and interested clinicians.

 


Medicalisation of Female Sexual Desire
14 November 2019 - 17:00-18:30

Lecture: Jacob Stegenga, University of Cambridge

Large Committee Room, Hodgkin Building, Guy’s Campus, King’s College London

If you do not have a KCL ID, please register (free) at this Link.

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Description:

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire.
 


Offers, requests and certainties (in the prevention and treatment of cancer, for example)
28 November 2019 - 17:00-18:30

Lecture: Stephen John, University of Cambridge

Bush House (S) 2.02, Strand Campus

If you do not have a KCL ID, please register (free) at this Link.

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Description:

Doctors are sometimes permitted to give patients early detection tests which are not judged safe and effective enough to be used in screening programmes. Pharmaceutical companies are sometimes permitted to give patients drugs which are not yet approved by regulators. On the face of it, these cases seem examples of a more general phenomenon explored in recent philosophy of science under the heading of “inductive risk”, where appropriate standards of certainty are fixed by non-epistemic aspects of our situation. However, standard discussions of inductive risk focus on the consequences of different epistemic errors. This doesn’t look like a helpful way of thinking through our cases. This paper suggests an alternative: that there is a difference between the ethics of responding to requests and the ethics of making an offer. In the former case, considerations of autonomy are key; in the latter, considerations of non-maleficence. In turn,these deontic differences have important epistemic implications. This paper develops these ideas, noting their relevance to a range of practices around the prevention, detection and treatment of cancer.
 


On Validators for Psychiatric Categories
5 December 2019 - 17:00-18:30

Lecture: Miriam Solomon, Temple University (USA)

Council Room, King’s College London, Strand

If you do not have a KCL ID, please register (free) at this Link.

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Audio Recording

 
Description:

The concept of a validator for a psychiatric category developed in the second half of the twentieth century and is still in use. Surprisingly, the term “validator” has never been explicitly defined in the psychiatric literature. Moreover, although lists of different kinds of validators have often been stated, there has been no explicit discussion in the literature about how different kinds of validator evidence should be aggregated in a decision about how to create, revise, or remove a psychiatric category. The goal of this paper is to trace the development of the concept of a psychiatric validator, showing how our understanding has changed over time. With this in mind, I evaluate possible recommendations for aggregating validator evidence.
 


Induction and Necessary Connections in Medical Research
21 January 2020 - 17:30-19:00

Lecture: Marius Backmann, London School of Economics

Bush House (S) 2.02, Strand Campus

If you do not have a KCL ID, please register (free) at this Link.

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Audio Recording

 
Description:

Some necessitarians have claimed that they could justify induction by
introducing necessary connections. By analysing the reasoning in randomised
clinical trials (RCTs), I argue that this view does not accurately represent
scientific practice.

The basic model of necessitarian solutions to the problem of induction is as
follows: First we infer from the fact that all Fs have so far been Gs via an
inference to the best explanation (IBE) that there is a necessary connection
between F-ness and G-ness. We then deductively infer from this necessary
connection that all Fs are Gs.

Nancy Cartwright and Eileen Munro offer an idealised reconstruction of
randomized clinical trials broadly along these lines. First, we infer from
evidence that a treatment has a ‘stable capacity’, i.e. a modal dispositional
property, to produce an outcome. Second, we deductively infer the efficacy of
the treatment outside the test environment from the existence of this stable
capacity. Cartwright and Munro argue that RCTs alone are no basis to support
these sorts of inferences, and hence do not deserve the status of a gold standard
for medical research.

Against this, I argue we should not try to give a deductive reconstruction of
RCTs. We ampliatively infer the causal relevance of the treatment in the sample
from the fact that the desired outcome is more prevalent in the test group than
in the control group. The further inference that the treatment will be causally
relevant in the population will also always be ampliative, because we cannot
possibly have the necessary information to make it deductive.
Moreover, the necessitarian analysis of inductive practice is inapplicable
where there are no modal properties that could be inferred to, as is, e.g., the case
in meta-studies.
 


Mental Health Without Wellbeing
28 January 2020 - 17:00-18:30

Lecture: Dr Anna Alexandrova, University of Cambridge (paper co-authored with Sam Wren-Lewis)

Greenwood Classroom, Greenwood Theatre Building, Guy’s Campus

If you do not have a KCL ID, please register (free) at this Link.

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Description:

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes the initiatives for the sake of mental health are aimed just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall wellbeing. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of wellbeing is too demanding and potentially oppressive. As a compromise we sketch out a middle position. On this view mental health is a primary good, that is the psychological preconditions of pursuing any conception of the good life, including wellbeing, without being identical to wellbeing.
 


Can Clinical Knowledge Be a Model for Human and Social Sciences?
11 February 2020 - 17:00-18:30

Lecture: Philippe Lacour, Universidade de Brasilia and Collège International de Philosophie

B4 (North Wing), Strand Campus

If you do not have a KCL ID, please register (free) at this Link.

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Description:

My goal in this presentation is to make sense of the rising clinical trend in Social and Human Sciences, which one could reassess as the emergence of Clinical Reason. Both the traditional difficulty to define the clinical method, and its growing application to Human and Social Sciences raise quite complex questions. However, despite the increasing development of the literature on the subject, the history, scope, actors, institutions, and conceptual aspects of clinical knowledge remain virtually unexplored. In fact, the clinical method challenges traditional conception of epistemology and theoretical reason because of its ambition of a knowledge aiming at a singularity (which is not merely the individual), positively (and not as the negative of a structure), directly (and not after a detour through a universal category) and with its content (not in its mere form). When implied in Social and Human Sciences, clinical approaches offer new opportunities, but also come across problems, such as the role of intuition, interpretation or subjectivity. In this presentation, my goal is precisely to provide an appropriate epistemological concept able to fully tackle the particularities of clinical knowledge, in its specific operations, methods and limits. I will insist on the interpretive and casuistic nature of clinical knowledge, which should provide the basis for future endeavours in Social and Human Sciences.
 


Re-valuing Death - Postponed until further notice
17 March 2020 - 17:00-18:30

Lecture: Robin Durie, University of Exeter (Member of the Lancet Commission on the Value of Death)

Large Committee Room, Hodgkin Building, Guy’s Campus

If you do not have a KCL ID, please register (free) at this Link.

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Description:

The Lancet Commission on The Value of Death argues that contemporary society has developed an unhealthy relationship with death due in part to the over-medicalisation of death and dying. Amongst the signs of this unhealthy relationship are the ever increasing amounts of healthcare budgets that are spent on prolonging the lives of those who are dying, with seemingly little or no regard for the quality of the life being prolonged; the investment in the search for immortality amongst the very richest in society, at the same time as the poorest are denied access to even the most basic provision of palliative care; and the gradual shift of the experience of dying from communities and families to hospitals. The core problem of this Lancet Commission is one to which philosophy can make a unique contribution, not least because philosophy has, from its very inception in the work of Plato, understood itself as a “practice for death”. And yet, philosophers such as Spinoza have also argued that “philosophy thinks of death least of all things”. In the first part of this discussion, I will explore this tension in philosophy’s approach towards death; then, I will draw on some more contemporary thinkers, such as Georges Canguilhem, in order to develop a philosophical position from which it may be possible to begin valuing death anew.
 


Mental Illness and Creativity - Online
24 March 2020 - 17:00-18:30

Lecture: Alexander Bird, King’s College London

Online Videoconference

Video Recording

Description:

Romantic authors saw creative genius as close to madness, since madness frees the mind from constraints and convention and allows truly original thought to flourish. I look at the evidence for the frequently remarked on correlation between madness and creativity. Is there such a correlation? And if so does it confirm the romanticist view of the relationship between the two?
 


What is Medicine if Not Precise? - Online
28 May 2020 - 17:00-18:15

Lecture: Kathryn Tabb, Bard College

Online Videoconference (Zoom)

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Video Recording

Description:

Precision (or personalized) medicine is often described as a “paradigm shift” or “revolution” in modern medical research and, increasingly, clinical practice. It is broadly understood to refer to the use of biomarkers (often genetic signatures) to match patients up with effective treatments, along with the biomedical research that makes such clinical innovations possible. In this talk I offer a conceptual analysis of “precision” as a term meant to unite a set of medical ideals: big data, reduction, and taxonomic revision. Through a comparison of two fields to which the term has been enthusiastically applied — oncology and psychiatry — I show how the presumption that these ideals are concomitantly realizable in contemporary medicine is rhetorically powerful but not, ultimately, convincing. Determining that “precision” should be seen an ideal for medicine rather than a new paradigm, I go on to consider what ideal it intends to replace. While advocates of precision medicine often characterize it in opposition to traditional practices and methods that are vague, careless or nonspecific, I argue that the true opponent of precision medicine — that is, the sort of medicine that stands to lose the most by its ascendency — is general. And this, I conclude, should concern us.
 


Mad by design: Rethinking psychiatry outside dysfunction - Online
11 June 2020 - 17:00-18:15

Lecture: Justin Garson, Hunter College and the Graduate Center City University of New York

Online Videoconference (Zoom)

Registration: Please register at this link by 12pm on the 11th of June, to gain an access link. (All times are London BST / GMT+1)

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Video Recording

Description:

We often think of the history of psychiatry as involving little more than a clash between two opposing “paradigms,” a biological (brain-based) and a psychological (mind-based) one. Here, I present a very different framework for thinking about psychiatry’s history; this is in terms of a clash between what I call “madness-as-dysfunction” and “madness-as-strategy” paradigms. According to the madness-as-dysfunction paradigm, when someone has a mental disorder it is because something in that person’s mind or brain cannot perform its function, goal, or job. Madness-as-strategy, on the contrary, sees at least some mental disorders as having a purpose or function for the individual: madness, here, is not the failure of a function, but its fulfillment. After elaborating this distinction, I sketch a way of rewriting psychiatry’s history in terms of this clash, from Renaissance thinkers such as Robert Burton to the evolutionary psychologists of today. Finally, I draw out some implications for current philosophical theorizing about psychiatry, and in particular, with respect to Wakefield’s influential evolutionary account of disorder.