Video Archive (List)

2018 Annual Sowerby Lecture
13 November 2018 – 19:30-21:00

Reflections on why I want what I want from research and researchers — as a patient

Lecture: Sir Iain Chalmers

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

Video Recording

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Abstract:

A quarter of a century ago, I decided to ask myself what I wanted—as a patient—from health research and researchers. In a BMJ paper I stated that I wanted decisions about my health care to be informed by ‘reliable evidence’. I also noted that people are bound to vary in what they regard as ‘reliable evidence’, and that a leap of faith would anyway always be needed in judging what the effects of health care options would be for me, as an individual. But I also made clear that, for me, ‘reliable evidence’ would usually mean evidence derived from systematic reviews of carefully controlled evaluative research, assembled with an awareness of the ways in which biases and the play of chance can play us false.

I suggested in the paper that there had been too little support for the kind of applied health research that I felt I needed to inform my health care choices. And I gave examples of the damaging consequences that can result from insufficient attention to reducing the effects of biases and the play of chance.

My lecture will revisit the themes I addressed 25 years ago and reflect on why—as a patient—I still want what I wanted from research and researchers quarter of a century ago.

 

About the Speaker:

Iain Chalmers was founding director of the National Perinatal Epidemiology Unit (www.npeu.ox.ac.uk) between 1978 and 1992, and founding director of the UK Cochrane Centre (www.uk.cochrane.org) between 1992 and 2002. Since 2003, he has coordinated the James Lind Initiative, which developed the James Lind Alliance between 2004 and 2013 (www.jla.nihr.ac.uk). Iain edits The James Lind Library (www.jameslindlibrary.org) and Testing Treatments international English (www.en.testingtreatments.org); he co-organised with Paul Glasziou the 2014 Lancet series on reducing waste and adding value in biomedical research (www.rewardalliance.net); and he is a co-investigator with Andy Oxman and colleagues in Norway and East Africa of the Informed Health Choices Project (www.informedhealthchoices.org).

 

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.

 

 

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.

 

2017 Annual Sowerby Lecture
9 November 2017 – 19:30-21:00

Mental Health and Justice: Classical and Romantic perspectives

Lecture: Gareth Owen – King’s College London, Institute of Psychiatry, Psychology and Neuroscience

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Video Recording

Abstract:

Psychiatry has long attracted interpretations from cool, detached perspectives valuing objectivity (Kraepelin, Freud, Beck) to hotter, embodied perspectives valuing subjectivity (Reil, Laing, Foucault).

These two perspectives (‘classical’ and ‘romantic’) are now expressing themselves in psychiatry’s meeting point with law with different approaches taken to the decision-making of the mentally ill. A recent ‘classical’ achievement in this area is the Mental Capacity Act (2005) which lays out a test of decision-making capacity within a legal framework that has been described as “a masterpiece of legal clarity”. A recent romantic achievement has been the UN Convention on the Rights of Persons with Disabilities which emphatically asserts a social model of mental illness in which society, not the brain, is the true source of disabilities.

This lecture will probe the subjectivity of some disorders of mind and brain. What, for example, is it like to be a decision-maker under conditions of brain injury unaware of one’s deficits or a person with affective disorder fluctuating between experiences of the future as intensely dark and intensely bright? And how should others respond? It aims to use these forms of human experience to challenge the single mindedness of both classical and romantic perspectives and draw out implications for psychiatry as a branch of medicine interacting with law and society.

 

About the Speaker:

Dr Gareth Owen leads the Wellcome Trust funded Mental Health and Justice Project – a collaborative research endeavour spanning psychiatry, law, ethics, neuroscience and social science/public policy. The project takes an interdisciplinary approach to the core dilemma of respecting vs. protecting the decision-making of people with mental disabilities or disorders. He did undergrad studies in physics, philosophy and medicine and post grad psychiatry training at the Maudsley.

 

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.

 

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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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.
 

 

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

 

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

 

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

 

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