David Pilgrim

The pathway that controls sexual fate in the nematode Caenorhabditis elegans has been well characterized at the molecular level. By identifying differences between the sex‐determination mechanisms in C. elegans and other nematode species, it should be possible to understand how complex sex‐determining pathways evolve. Towards this goal, orthologues of many of the C. elegans sex regulators have been isolated from other members of the genus Caenorhabditis. Rapid sequence evolution is observed in every case, but several of the orthologues appear to have conserved sex‐determining roles. Thus extensive sequence divergence does not necessarily coincide with changes in pathway structure, although the same forces may contribute to both. This review summarizes recent findings and, with reference to results from other animals, offers explanations for why sex‐determining genes and pathways appear to be evolving rapidly. Experimental strategies that hold promise for illuminating pathway differences between nematodes are also discussed. BioEssays 25: 221–231, 2003. © 2003 Wiley Periodicals, Inc.

An account is provided of the historical context of the work one of the best-known figures in British psychology in the 20th century, Hans Eysenck. Recently some of this has come under critical scrutiny, especially in relation to claims of data rigging in his model of smoking and morbidity, produced from the 1960s to the 1980s. The article places that controversy, and others associated with Eysenck, in the longer context of the shifting forms of epistemological and political legitimacy within British psychology in the past hundred years. Eysenck was both lionised and disparaged during his life and after his death. This account explores that ambiguity in order to discern the challenge for British psychology to maintain disciplinary coherence. An understanding of this fluxing historical picture is guided by the meta-theoretical resource of critical realism.

This paper argues that identity politics is impeding respectful deliberative democracy. Its starting point is an analysis by Loïc Wacquant which problematizes the relationship between race and ethnicity. Wacquant's discussion covers the biological and social ontology of race, the importance of the culture of individualism in the USA and the general limitations of identity politics. I argue that those limitations are the result of restricting the discussion of race to only two of the four planes of social being, namely the plane of group belonging (Bhaskar's interpersonal interactions or relationality) and the plane of unique biographical accounts (Bhaskar's inner being). The other two planes, namely the natural world (Bhaskar's material relations with nature) and socio-economic structures (Bhaskar's social structures), are thereby backgrounded. This absence of engagement with the natural world and socio-economic structures has both analytical and political consequences. This point applies to all forms of identity politics.

ABSTRACTJason Summersell responded to my article – ‘Reclaiming reality and redefining realism: the challenging case of transgenderism’ – by suggesting that I have made an inferential error about ontology. In this paper, I refute his objection and argue that his position does not take seriously the unresolved public policy threat posed by the commercially-inflected and politicized world of trans ideology. The realpolitik of trans-activism contains legal and illegal processes that now suppress a necessary debate about a number of matters: from common sense notions of sex and the findings of biological science; to the rights of women and children.

The discipline of psychology has been poorly represented in critical realist texts to date. This is despite Bhaskar’s use of psychoanalytical concepts to underpin his concept of the dialectic. By comparison, other aspects of social science, such as sociology and economics, have a well-established body of critical realist texts. The original approach to psychoanalysis was analogous to the critical realist ontological-axiological chain. It moved from an ontological problem to an axiological solution. Freud’s eagerness to reframe psychoanalysis within a scientistic, objective framework was perhaps due in part to the difficulties that he faced as European Jew in the fin-de-siècle. The application of the critical realist explanatory critique can contribute to our understanding of how and why the fragmentation of Freud’s legacies emerged. Critical realists should avoid the assumption that psychoanalysis is a unitary body of knowledge; as such, they should consider its various legacies separately.

ABSTRACTMedical diagnosis is sometimes used by critical realists and others as an exemplar of a form of inference across time in which a current empirical observation points backwards to the conditions of its emergence and forwards to a possible future outcome or progression. Accordingly, its practice warrants critical exploration to confirm its legitimacy as a philosophical reference point. The strengths and weakness of the exemplar are appraised using case brief case studies. The limitations of medical diagnosis are discussed in the wider context of the sociology of medical knowledge, the social determinants of ill-health and the role of commercial interests in shaping diagnostic practice. The conclusion is cautious, not nihilistic. Diachronic inference in medicine, as in other disciplines working in and with open systems, can be respected for its advantages to humanity. However, this brings with it the perennial caution of epistemic humility and a needed tolerance of uncertainty..

ABSTRACTRecently an acrimonious debate has emerged about transgenderism. Trans-activists defending the full spectrum of the latter have advocated a form of identity politics based upon individual self-definition. However, gender-critical feminists have disputed the legitimacy of these bids for self-determination, especially when considering men who are claiming to be women. These contrasting positions are examined and their political implications explored. The focus of the paper is on the intransitive aspects of sex and the transitive aspects of gender. The former, with rare exceptions, is a binary whereas the latter is open to social negotiation and variation. The article argues that the gender-critical position is broadly aligned with critical realist philosophy, though the counter view is represented in order to clarify this point of reflection. It ends with a discussion of the ‘trans debate’ and the public policy development emerging in its wake.

ABSTRACTThis article introduces the challenges of providing psychological assessments of people seeking asylum in the wake of their reported torture. These challenges invite professionals to consider ontology and epistemology. Critical realism is well-positioned to underlabour for the process of understanding a human rights violation, in which the complainant is both the key, and often sole, witness and claimed victim. For instance, the layered reality of critical realism allows practitioners to use retroduction to describe deeper structures and mechanisms of torture. The judgemental rationality of critical realism allows practitioners to distinguish between competing interpretations of the evidence. Critical realism also avoids both the positivistic assumption that assessors can be value-free; and the relativist social constructionist position that, because assessors cannot av...

ConclusionWe remain perplexed why Loughlin and Pritchard chose to single out our study on lay views of mental health as a basis for attacking relativism generally within social science. We consider that political, epistemological and health policy grounds for a social scientific consideration of lay knowledge are so strong that they negate naïve objectivist critiques which appearl to the reason and thus reasonableness of professional knowledge. Reason and rationality, like reality, are not singular, clear cut and self-evident. Accordingly, it is the responsibility of social scientists to explore the ambiguities and complexities of knowledge held and enacted by a whole range of social groups.

A brief overview is provided of sociological and historical critiques of Western psychiatry before focusing on pre-empirical, non-empirical and empirical aspects of psychiatric diagnosis. These are then discussed using the analytical devices of the ontic fallacy, the epistemic fallacy and generative mechanisms. It is concluded that mental disorders do not really exist but particular presenting problems of unintelligibility, interpersonal dysfunction and common human misery, in particular social contexts, recur in modern life and thus constitute real problems for those intimately implicated and for social order. These require new ways of understanding, beyond the option of deconstruction, which could displace categorical reasoning and be sensitive to causes, meanings and their situated social contexts. The paper concludes with an outline of an alternative future for research into mental health problems, which could be informed by critical realism.

This article tests the adequacy of social constructionism from a critical realist standpoint by examining a single social problem in some detail: child sexual abuse. A continuum of positions in the research literature is explored, ranging from strong social constructionism and its justificatory emphasis deriving from social and historical relativism to a position that, while accepting ‘weak constructionism’, prioritizes the real abiding features of sexual violence against children and the proven harm it creates in any social context. That critical examination of competing views on the topic places a particular emphasis upon the rhetorical power of the conceptualization of concern about child sexual abuse as a ‘moral panic’. The notion of a moral panic brings with it assumptions about the degree of confidence we can have in the extent of child sexual abuse in modernity, its wrongfulness, the assumed harm that accrues to victims and the costs to society in its wake.

The mass childhood immunization programme has traditionally been viewed as a safe and effective preventative measure by health promoters, primary health care professionals and governments. This consensus has meant that immunization has rarely been viewed as ethically problematic. A number of recent changes in the context of the delivery of health care, particularly the emphasis on consumerism and the effect of the marketization of services, makes timely an examination of ethical, social and political issues. This article examines four main grounds for problematizing the mass childhood immunization programme. These are: clinical research evidence about the safety and efficacy of vaccines; the masking of wider social and political determinants of ill health; the contradictory strictures about collective and individual rights in relation to immunization; and the uniqueness of childhood immunization as a physical intrusion into a healthy body. The implications of these ethical issues are discussed in relation to informed consent and the need for a 'greenfield' review that includes the views of dissenting parents, lawyers and moral philosophers, as well as health professionals. Les promoteurs de santé, les soignants et les gouvernements ont tous traditionellement vu le programme d'immunisation globale des enfants comme sain et efficace. Cela voulait dire que l'immunisation a rarement posé un problème éthique. Pourtant, actuellement des changements dans les contextes de la distribution des soins, le consumérisme et de l'effet de la commercialisation des services de santé, exigent une revue des problèmes éthiques, sociaux et politiques. Cet article discute quatre éléments problématiques du programme d'immunisation globale: les données des recherches médicales sur la sûreté et l'efficacité des vaccins; la dissimulation des déterminatifs sociaux et politiques des maladies; les critiques contradictoires des droits individuels et collectifs concernant l'immunisation; et le caractère unique de l'immunisation des enfants comme une intrusion physique dans un corps sain. Les effets de ces questions éthiques sont repris en rapport du consentement informé et de la nécessité d'une revue 'verte' qui comprend les vues des parents dissidents, des juristes, des philsophes et des membres des professions soignantes. Das Massenimpfungsprogramm von Kindern wurde allgemein von Gesundheits behörden, medizinischem Fachpersonal und Regierungen als sichere und wirksame Vorbeugungsmassnahme betrachtet. Diese Uebereinstimmung bedeutete, dass Imp fungen selten ein ethisches Problem darstellten. Eine Anzahl von Aenderungen im Gesundheitswesen - besonders im Hinblickin auf Konsum und Marktwirtschaft im Dienstleistungsbereich - berechtigen jedoch zu einer Untersuchung der ethischen, sozialen und politischen Fragen. Dieser Artikel untersucht vier Hauptgründe, die das Massenimpfungsprogramm für Kinder in Frage stellen: Forschungsergebnisse über die Sicherheit und Wirksamkeit der Impfstoffe; die Verschleierung von andern sozialen und politischen Krankheitsursachen; die widersprüchlichen Anordnungen über kollektive und individuelle Rechte mit Bezug auf die Impfungen; und die aussergewöhnliche Art der Impfung als physische Verletzung eines gesunden Körpers. Die Bedeutung dieser ethischen Fragen werden hier diskutiert im Zusammenhang mit der informierten Vereinstimmung und der Notwendigkeit eines 'grünen' Ueberblickes, der die Ansichten andersdenkender Eltern, Rechtsanwalte, Philosophen und Gesund heitsexperten einschliesst

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable to the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers.

`This is a very important book.... This is a book that clearly challenges those of us who subscribe to a view of the self in relationship with society to examine ourselves and our practices and respond appropriately' - Self & Society This pioneering book demonstrates that counselling and psychotherapy cannot be separated from the social conditions and context in which practitioners and their clients operate. Until now, no single text has brought together and considered the two areas of psychotherapy and social science in conjunction. The book opens with a discussion of the points of convergence and divergence between psychotherapy and social science. David Pilgrim then concentrates on the rela.

This article begins with arguments evident at the time of writing about the 5th revision of the Diagnostic and Statistical Manual of the American Psychiatric Association. The historical lineages of those arguments are international and not limited to the USA. The concern with psychiatric diagnosis both internationally and in the USA came to the fore at the end of the Second World War with the construction of the American Psychiatric Association’s Diagnostic and Statistical Manual and the World Health Organization’s classification of ‘Diseases, Injuries and Causes of Death’. However, the linkage between categories of morbidity, assumptions about natural biological categories and treatment specificity with ‘magic bullets’ emerged in the middle of the 19th century in physical medicine. This article explores the legitimacy of current psychiatric diagnoses in the light of that international, not national, history of medical knowledge. In conclusion it explores judgements about current cultural imperialism and an older picture of Eurocentrism, which is now being refracted in more recent globalizing knowledge-claims about mental disorder.

We remain perplexed why Loughlin and Pritchard chose to single out our study on lay views of mental health as a basis for attacking relativism generally within social science. We consider that political, epistemological and health policy grounds for a social scientific consideration of lay knowledge are so strong that they negate naïve objectivist critiques which appearl to the reason and thus reasonableness of professional knowledge. Reason and rationality, like reality, are not singular, clear cut and self-evident. Accordingly, it is the responsibility of social scientists to explore the ambiguities and complexities of knowledge held and enacted by a whole range of social groups