Gerrit Glas

We argue that an understanding of livestock farming as normative practice clarifies how sustainability is to be understood in livestock farming. The sustainability of livestock farming is first approached by investigating its identity. We argue that the economic aspect qualifies and the formative aspect founds the livestock farming practice. Observing the normativity related to these aspects will be the first task for the livestock farmer. In addition, we can distinguish conditioning norms applicable to the livestock farming practice which should be observed for competent performance of the practice. Failing to do justice to this normativity might affect the practice’s sustainability only in the long term—this is especially the case with conditioning norms. Motives to observe normativity have, therefore, the character of an ultimate conviction regarding the flourishing of the practice. Finally, the sustainability of the livestock farming practice crucially depends on the broader food system of which it is part.

Accountability is a norm basic to several aspects of medical practice. We explore here the benefits of a more explicit focus on the virtue of accountability, which as distinct from the state of being held accountable, entails both welcoming responsibility to others and welcoming input from others. Practicing accountably can limit moral distress caused by institutional pressures on the doctor patient relationship. Fostering a mindset that is welcoming rather than resistant to feedback is critical to enhancing a culture of learning. Analysis of failures of accountable practice offers opportunities for improving the delivery of clinical care.

The article investigates the concept of self-illness ambiguity (SIA), which was recently re-introduced in the philosophy of psychiatry literature. SIA refers to situations in which patients are uncertain about whether features (symptoms, signs) of their illness should be attributed to their illness or to their ‘selves’. Identification of these features belongs to a more encompassing process of self- definition and -interpretation. The paper introduces a distinction between the notions of self-relatedness, self-referentiality (or: implicit self-signification), self-awareness and self-interpretation. Each of these notions offers a different perspective on SIA, but these perspectives do not exclude one another. A further distinction will be developed between primary, secondary and tertiary forms of self-referentiality. The practical and conceptual relevance of these distinctions will be illustrated with case vignettes. Throughout the paper our findings will placed in the context of other philosophical work on the self, especially in the field of narrative theory (Ricoeur), phenomenology (Ratcliffe) and philosophy of mind. The article closes with a brief discussion about the appropriateness of the term ambiguity and the potential of SIA as concept in the context of clinical psychiatry. Directions for future work will be indicated.

When we first anticipated the research project concluded with this special issue, about 8 years ago, it seemed timely and appropriate to investigate the opportunities and the challenges of self-management in mental health care. At the time self-management was well on the rise in general health care, offering both empowerment to patients and efficiency and cost-effectiveness to the health care system. It seemed a most promising approach in an era that celebrates individualistic self-reliance. And we were sure about our insight that self-management in mental health care would deserve comprehensive investigation because “the self” that was supposed to do the management would itself be the core problem in psychiatric...

This is the last of three articles on the relationship between science, religion, and professional practice in psychology and psychiatry. The first article highlighted the importance of the distinction between four types of knowledge. In the second article the scope was broadened and amounted to an analysis of the normative structure of professional practices. I showed the relevance of this analysis by investigating its meaning for the notion of restoration, along the dimensions of structure and direction. The I-self relationship played an important role in the conceptualization of the relationship between these two dimensions. In this article I will apply the notion of (normative) practice to science andphilosophy. After a discussion of the views on integration of Nancey Murphy and Ian Barbour (both Christian philosophers) I will briefly introduce some insights of the Dutch (Christian) philosopher Herman Dooyeweerd, who emphasized the primacy of everyday knowledge and experience. In the latter part of the article I will discuss and reject constructivist objections to both the idea of the primacy of everyday knowledge and the normative practice model

Understanding lone actor grievance-fueled violence remains a challenge. We believe that the concept of grievance provides an opportunity to add an engaged, first-person perspective to the assessment of lone actor extreme violence. We propose an enactivist philosophical approach that can help to understand the why and how of the pathway from grievance to violent extremism. Enactivism sees grievance as a dynamic, interpersonal, and context-sensitive construct that indicates how offenders make sense of the world they live in and how under certain circumstances it fuels violent behavior. Hence, grievance should not be understood as a given thing, but as an unfolding experience that involves sense-making through interaction with the environment. This relational and ecological understanding requires another approach than looking at demographic factors or life histories, only from an outsider’s perspective. Enactivism invites us to look at such risk factors as external indices of an ongoing process of active self-regulation and sense-making, and in some cases spiraling toward extreme violence. To understand the mindset of the offender we need to look more in depth at the processes that shape this mindset: why does this person, with this history, in this context, and at this point in time, proceed to use violence? The enactivist approach to the mind offers a complementary framework that may help us to understand the dynamics of grievance as a possible precursor to violent extremism. It also helps to appreciate why the relative unpredictability of the pathway toward lone actor extreme violence is not necessarily a sign of empirical weakness but a matter of principle due to the non-linearity of the processes involved. We end by summarizing how enactivism could contribute to the prevention of extremist violence and research and how it can help to avoid reinforcing stigmas and re-establishing a confirmation bias.

Which moral consequences are implied in conceiving mental health care delivery as a market? It is argued that the market, as a term, does not function as a description of what actually occurs, but as a metaphor, albeit an effective one, which structures the behavior of managers and administrators. Three models of mental health care are described, including the moral principles, which prevail in each of them. In the Dutch situation there, in fact, appears to be a mix of these models. Competition between health care providers according to the principles of the free market burdens the patient-physician relationship, as relation of trust; it offers a potential threat to the principles of justice and solidarity; and to the autonomy of the medical profession. These hazards are illustrated by focusing on different types of markets.

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness manifestations, contextual influences and the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups.

Translation as philosophical program: An explorative reviewWhat does the concept of translation mean in the expression ‘translational neuroscience’? What are the different steps, or components, in the translation of neuroscientific findings to psychiatry? There are serious concerns about the validity and productivity of the traditional idea of a translational pipeline, starting in the fundamental sciences (chemistry, molecular and cellular biology) and ending in the practice of clinical medicine, including psychiatry. The article defends the thesis that the difficulties in the traditional approach result, at least partially, from insufficient reflection on the philosophical premises upon which the concept of translation is based. The linear pipeline model is strongly determined by the traditional biomedical approach to disease. The translation crisis signifies some of the limitations of this approach, especially in the realm of clinical practice and patient experience. The biomedical model suggests that illness manifestations should be conceived as causally determined expressions of an underlying biological derailment or dysfunction. This model lacks the language and conceptual tools to address the role of contextual and person-bound factors in the manifestation of illness. It is only recently that personalized and context-sensitive approaches to psychopathology have gained scientific attention. In the wake of this conceptual and practical reform, network-like approaches to translation have emerged. These network approaches are based on a different conception of transdisciplinarity. They address all stakeholders, by asking them what kind of translation they need. Stakeholders are not only scientists and clinicians, but also patient- and family support groups; and parties that are responsible for the institutional embedding, the financial and logistic infrastructure, and the legal frameworks that support psychiatric care. It is the interaction between science (as producer of knowledge) and the contexts that are supposed to benefit from this knowledge, that should be put at the centre of conceptual reflection. The degree and fruitfulness of this interaction will be decisive for the future of both psychiatry and clinical neuroscience. Philosophy can play an important role in this interaction, by making explicit underlying logical and practical tensions and ambiguities in this interaction.

This is the second of three articles on the relationship between science, religion and professional practice in psychology and psychiatry. The first article pointed out that the weakness of the integration debate consists of lack of awareness of the epistemological distinction between everyday knowledge, professional knowledge, scientific knowledge and philosophical assumptions. This article shows how the integration debate gains new impetus by relating knowledge to practices and by investigating the intrinsic normative nature of professional practices. In the first part of the article I will analyze the structure of professional practices (psychiatry; psychotherapy), in order to gain insight into the role of norms and values in these practices. In the second part I show how the notion of integration can be elaborated upon along the dimensions of structure (levels; functions) and direction (opening-up; disclosure). It appears that the I-self relationship plays a crucial role in the conceptualization of the relation between these two dimensions

In the context of theistic religions, God representations are an important factor in explaining associations between religion/spirituality and well-being/mental health. Although the limitations of self-report measures of God representations are widely acknowledged, well-validated implicit measures are still unavailable. Therefore, we developed an implicit Attachment to God measure, the Apperception Test God Representations. In this study, we examined reliability and validity of an experimental scale based on attachment theory. Seventy-one nonclinical and 74 clinical respondents told stories about 15 cards with images of people. The composite Attachment to God scale is based on scores on two scales that measure dimensions of Attachment to God: God as Safe Haven and God as Secure Base. God as Safe Haven scores are based on two subscales: Asking Support and Receiving Support from God. Several combinations of scores on these latter subscales are used to assess Anxious and Avoidant attachment to God. A final scale, Percentage Secure Base, measures primary appraisal of situations as nonthreatening. Intraclass correlation coefficients showed that the composite Attachment to God scale could be scored reliably. Associations of scores on the ATGR scales and on the explicit Attachment to God Inventory with scores on implicitly and explicitly measured distress partly confirmed the validity of the ATGR scales by demonstrating expected patterns of associations. Avoidant attachment to God seemed to be assessed more validly with the implicit than with the explicit scale. Patients scored more insecure on the composite Attachment to God scale and three subscales than nonpatients.

This is the first of three articles on the relationship between science, religion and professional practice in psychology and psychiatry. This article describes the current debate. I begin with the observation that increasing professionalism of the health care professions seems to lead, almost inevitably, to secularism within these professions. I describe four ways to respond to this secularism. I give a summary of five major approaches to the issue of integration of psychology and religion, as they have emerged in the North-American literature on the subject. I conclude that all these attempts fail at a conceptual level: neither of them provides a sufficient account of the conceptual differences between everyday knowledge, professional knowledge, scientific knowledge and philosophical insight. These differences are important, since they determine the way the relationship between psychology/psychiatry and religion should be conceptualized.