Eisuke Sakakibara

The concept of epistemic injustice provides a theoretical framework for considering the ethical issues arising in interpersonal communication. This article proposes the concept of implicational injustice as a novel type of epistemic injustice. An implicature is a message that a speaker does not explicitly state, but that is implicitly communicated by an utterance. Since the speaker does not explicitly state the implicature, it may be overlooked by the hearer. This oversight of implicature is likely to occur when the hearer prematurely terminates the search for relevance or when there is informational inequality between speaker and hearer. If premature termination or information inequality is caused by the hearer’s prejudice against the speaker or by the undue ignorance of the speaker, the oversight of implicature is deemed an implicational injustice. This article offers several examples of the oversight of implicature and implicational injustice in doctor-patient communication in which patients’ attempts to convey psychosocial messages to their physicians are often overlooked. Implicational injustice can be considered as a novel subtype of epistemic injustice that differs from other subtypes, such as silencing, testimonial injustice, and interpretative injustice. Implicational injustice prevents the sufferer’s full participation in epistemic collaboration and can inflict secondary harm, such as negative effects on clinical decision making.

The notion of epistemic injustice was first applied to cases of discrimination against women and people of color but has since come to refer to wider issues related to social justice. This paper applies the concept of epistemic injustice to problems in the therapeutic relationship between psychiatrists and psychiatric patients. To this end, it is necessary to acknowledge psychiatrists as professionals with expertise in treating mental disorders, which impair the patient’s rationality, sometimes leading to false beliefs, such as delusions. This paper classifies the characteristic features of the therapeutic relationship in psychiatry into three stages: those of a professional–client relationship, those of a doctor–patient relationship, and those of a psychiatrist–psychiatric patient relationship. Epistemic injustice is prevalent in psychiatric care owing to prejudice against patients with mental disorders. However, it is also predisposed by the roles that psychiatrists play in relation to psychiatric patients. This paper suggests some ameliorative measures based on the analysis.

Kengo Miyazono’s Delusions and Beliefs: A Philosophical Inquiry is an attempt to provide a unified account of the nature, pathology, and etiology of delusions. The strength of his book resides in the clarity of arguments and its consistent adoption of a biological explanation of delusions, based on teleo-functionalism about mental states. However, there are some weaknesses in each of his arguments regarding the nature, pathology, and etiology of delusions. Regarding the nature of delusions, teleo-functionalism makes it difficult to confirm that delusions are beliefs. Regarding the pathology of delusions, I suggest that the existence of harmful malfunction is a necessary but not a sufficient condition for a belief to be considered pathological, and that additional evidence is needed to justify the separation of the belief and the holder’s personhood. Regarding the etiology, it is not reasonable to incorporate the prediction error theory into a kind of two-factor theory. Therefore, the details of his arguments require further modification.

BackgroundEnhancement involves the use of biomedical technologies to improve human capacities beyond therapeutic purposes. It has been well documented that enhancement is sometimes difficult to distinguish from treatment. As a subtype of enhancement, neuroenhancement aims to improve one’s cognitive or emotional capacities.Main bodyThis article proposes that the notion of neuroenhancement deserves special attention among enhancements in general, because apart from the notion of treatment, it also overlaps with other concepts such as prevention, pain relief, and pleasure seeking. Regarding prevention, patients’ mental endurance can be enhanced when a patient is prescribed a selective serotonin reuptake inhibitor for the purpose of preventing the relapse of depression following a stressful situation. As for pain relief, psychiatrists use medication to alleviate distress in patients who experience various types of anxiety; the alleviation of distress is equal to psychological pain relief, but is also an enhancement of the patient’s temperamental traits. Regarding pleasure seeking, insidious transition exists between neuroenhancement and pleasure seeking when using psychotropic drugs. It is well known that people use psychostimulants for recreational purposes and to induce overconfidence in one’s performance. The polysemy of psychotropics derives from their effects on human sensibility. Therefore, when using psychotropic agents, psychiatrists should pay close attention to what the agent is used for on each patient in each situation, and explicitly share the continuity and overlap in the purpose of prescribing a medication with the patients to make a better clinical decision.ConclusionsThe notion of neuroenhancement overlaps not only with the notion of treatment, but also with other concepts of prevention, pain relief, and pleasure seeking. The continuity between those concepts makes the issues concerning the prescription of psychotropic drugs subtler. Psychiatrists should explicitly share the continuity with the patients to make a better clinical decision.

Maher proposed in 1974 that schizophrenic delusions are hypotheses formed to explain anomalous experiences. He stated that they are “rational, given the intensity of the experiences that they are developed to explain.” Two-factor theorists of delusion criticized Maher’s theory because 1) it does not explain why some patients with anomalous experiences do not develop delusions, and 2) adopting and adhering to delusional hypotheses is irrational, considering the totality of experiences and patients’ other beliefs. In this paper, the notion of the intensity of experience is reappraised to uphold Maher’s basic conception. Regarding 1), I propose that differences in the intensity of anomalous experience are vital to whether the patient forms delusions, while partially reforming his rationality claim regarding 2). Although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous experience. With the aid of this notion, it is maintained that anomalous experience is sufficient for the development of delusions, at least in some cases of schizophrenia. Compared to other theories of schizophrenic delusion, Maher’s theory, which embraces the notion of intensity of experience, better explains why such irrational mental states as delusions develop from anomalous experiences, and why delusional patients persist in believing specific thematic content.

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with irrational beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy.

Although Kripke’s skepticism leads to the conclusion that meaning does not exist, his argument relies upon the supposition that more than one interpretation of words is consistent with linguistic evidence. Relying solely on metaphors, he assumes that there is a multiplicity of possible interpretations without providing any strict proof. In his book The Taming of the True, Neil Tennant pointed out that there are serious obstacles to this thesis and concluded that the skeptic’s nonstandard interpretations are “will o’ wisps.” In this paper, contra Tennant, I demonstrate how to construct alternative interpretations of the language of algebra. These constructed interpretations avoid Tennant’s objections and are shown to be interdefinable with the standard interpretation. Kripke’s skepticism is, as it were, an incarnate demon. In contrast, it is currently uncertain whether the same technique is generally applicable to the construction of an alternative interpretation of natural language. However, the reinterpretation of those aspects of natural language that directly relate to numbers seems to be a promising candidate for the development of nonstandard interpretations of natural language

D. Davidson argued that shared conventions learned in advance are not essential for the success of communication. In this paper, holding the validity of his contention in suspense, I argue that linguistic conventions play essential roles when communication fails. In everyday communication, when discrepancies are detected between what the speaker intended to inform the hearer and what the hearer actually understood, it becomes necessary to determine whether the speaker or the hearer caused the communication failure. For in everyday communication, the hearer often changes her position based on her misunderstanding about the intention of the speaker, and it is sometimes too late when the hearer realizes the speaker’s true intention. In such cases, it is necessary to determine who is responsible for the hearer’s loss. What the speaker said, which is determined by linguistic conventions, arbitrates the conflict between them. From the fact that shared conventions mainly relate to the evaluation aspect of communication, it follows that the speaker and the hearer need not learn shared linguistic conventions in advance of the conversation, and have only to learn them later, when failures are detected among past communication.