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Robinson, who had left a tenured position at San Diego to work with Pauling at Stanford. Instead of working in cramped quarters at the University, they would set up their own research institute nearby. A building was rented, initial financial help was forthcoming, and the Institute for Orthomolecular Medicine was founded in 1973. Once the initial funding had run out, the Institute found itself in financial straits. Soon it was renamed the Linus Pauling Institute of Science and Medicine, with Pauling as president. By this change, it was hoped, fund-raising possibilities would be improved, a hope that proved to be |
In July 1976, Ava Helen underwent surgery for stomach cancer. Instead of post-operative chemotherapy or radiation treatment, she adopted vitamin C therapy to the tune of 10 g per day. She was soon well enough to accompany Pauling on his various travels, but she finally succumbed five years later, in December 1981. Pauling continued to travel, to appear on television, to write, to receive honours, his energy seemed unabated. When quasi-crystals, with forbidden fivefold symmetry, were discovered in 1984, Pauling took a contrary position and argued that the fivefold symmetry seen in Al-M |
The connection between vitamin C and cancer has also become a respectable topic of discussion. It was the subject of a conference organized by the U.S. National Cancer Institute in Washington D.C. in 1990. Vitamins C and E (and other anti-oxidants) inhibit the endogenous formation of TV-nitroso compounds in animals and humans (Bartsch et al. 1988). Such compounds are known to be carcinogenic in animals. Conclusive proof that they are dangerous at the levels naturally present in man is lacking, but the evidence seems suggestive. Thus, although the effectiveness of vitamin C in treating |
The final word about the effect of large doses of vitamin C on health has still to be said. If you have a full, healthy diet, rich with fruit, grains and fresh vegetables, then you probably do not need supplemental vitamins and minerals. But in the modern world many people have, and may even prefer, an unhealthy diet. For them, vitamin supplements are probably beneficial. After all, Pauling not only recommended large doses of vitamin C but also advised people to stop smoking, to eat less and to cut down consumption of sucrose. P a u l i n g t h e m a n Pauling lived a long |
I remember his lectures in Oxford in early 1948. The lecture hall was too small to hold all who wished to attend; there was standing room only. He told those of us who had never studied electrostatics to go home and read Sir James Jeans's book on that subject before coming to his lectures on chemical bonding. I had never studied electrostatics but I stayed, spellbound. I had never heard anyone quite like him, with his jokes, his relaxed manner, his seraphic smile, his slide-rule calculations and his spontaneous flow of ideas. (Only much later did I realize that much of that apparent spont |
Vain? Conceited? Pauling was certainly aware of his own intellectual superiority, but he could be patient in dealing with the slowness of the slow-witted. On the whole, he was fairly tolerant of young, insecure seminar speakers, although, as I remember, he could also be intimidating at times. I am referring here to Pauling in middle age, I am told he became more intolerant in his later years. Political harassment during and after the McCarthy era must have taken its toll. Ambitious? Self-centred? Undoubtedly. Without these traits he would not have been able to accomplish as much as he |
In personal matters he kept most people at a distance. I believe he was basically rather shy. When he talked about science or politics or anything that caught his interest, there was no stopping him, he read widely and was extremely knowledgeable in many areas, a result of having pored over the Encyclopaedia brittanica in his youth? In conversation, one sometimes sensed a faraway look in his eyes; one felt that he was already thinking about something else. Probably he was, and, indeed, he was a formidable thinker, both at the problem-solving level and about fundamentals. With his prodigious memory he could call |
One of the concerns highlighted by the authors of the editorial is the hype in the media, and I can assure you that it was a great surprise to the authors of these papers as well. The study was published in e-pub in February 2013, and the interest from the press and the scientific society was non-existent. We then became worried that the science related to chronic back pain caused by Modic changes would be ignored, as was the discovery of Helicobacter in peptic ulceration. Following that discovery there was a shockingly slow decline in gastric surgery. It took more than a decade before the news that you |
We do agree with the authors regarding most of their comments. It is indeed necessary that the surgical and scientific communities should have a more tempered and objective response to our studies and that much remains to be done. The clinical trial needs to be replicated in a different clinical and scientific setting, and we are aware of several groups in Europe, which are far along in the planning stages of additional trials. The study was not underpowered when comparing antibiotics and placebo, but when comparing single and double-dose regimes a larger population is necessary. We also think that other antibiotics or combinations of antibiotics should be studied. The follow-up study on our paper [ |
[VOL. IX., No. 228 would seem always possible to ascertain the direction under these circumstances. The clouds presented a nlagnificent spectacle, and seemed like gigantic billows upon a boundless ocean. The sun was very hot indeed, and every effort ma8 made to observe a rising motion in the cloud, but entirely without success. Observations of humidity were made with a sling \vet bulb, and the air temperature by a thermometer mith a bulb about two ~llillimetres in diameter. All the experiences indicated, that, mith nlodern appliances of dragqope and anchor, ballooning is entirely |
The deter~llinations were made on March 4, 1885, when the temperature of the air was -12O.6 F., in the following manner : -A hole about four feet square having been cut through the ice (2.55 feet thick), the water within it was thoroughly agitated by stirring fro111 below, and during the actual operation slightly agitated. The thermometer mas held nearly horizontally, the bulb slightly lon-er than the rest of the instrument, just below the surface of the water. When the ice film began to forin at the surface of the water, the corrected reading of the thermometer |
The follovr~ing from one of the local papers here mill show that the peculiar person mho has repeatedly been shown u p iu S c i e l~c eis still at large and at worlr : at least, I presume he is the same person, since it is unlilrely that there is ulore than one such perverse genius abroad. This time he turns a p as a rleaf-mute. attached to the Smithsonian, and named G~R. 31. 1~isi1e.l "The Syracuse (N. Y.) He)-ald says,'A highly educated |
Firstly, all the observations made in doi:10.3390/microorganisms4040038 [1] about the "model/structural model" refer exclusively to material presented in Sections 3.5-3.7 in [2] -none of the comments refer to the experimentally determined crystalline structures of 3,6-DKCMO (PDB code: 4UMW) presented in Sections 3.2 and 3.3. This caveat is also relevant to observations made elsewhere [3, 4]. As evidenced previously [5], misconceptions arise when that important distinction is |
Secondly, Drs. Littlechild and Isupov's assertion that "In the paper [1] the lead author Willetts has described work carried out by himself and Dr David Kelly prior to 2008" is incorrect. As evidenced below (vide supra), correct facts and timelines are both important matters: therefore, to reiterate the statement made in the "Author Contribution" entry of [1], while Dr. David Kelly's major contribution was to the conception and overall design of the research programme prior to his sudden unexpected death in 2008, most of the subsequent stages (gathering and analysing data, and |
Important to gaining a full comprehension of both the issues raised by Drs. Littlechild and Isupov's Comment and the prior observations made [1,3,4] regarding Isupov et al.'s modelling studies is the fact that the oxidation of reduced flavins by oxygen-dependent enzymes, including Type I and II Baeyer-Villiger monooxygenases (BVMOs: [6] ), has been extensively studied for several decades. Consequently, both structural and functional aspects of a significant number of representative examples, including various flavin-diffusible two-component monooxygenases (fd-TCMOs: |
Both Type I and II BVMOs catalyse the same sequence of key biochemical events involving critical patterns of hydrogen bonding from key active site residues to the reduced flavin N5-H which is crucial for the successive formation and stabilisation of firstly a C4a-hydroperoxyflavin, and subsequently a Criegee intermediate. The relative movement of domains is essential for this series of sequential catalytic steps leading to lactone formation and release [8] [9] [10] [11], and structures typically consist of semi-rigid domains connected via flexible regions or hinges [12, 13]. These are |
Isupov et al.'s study [2] of 3,6-diketocamphane monooxygenase (3,6-DKCMO), an fd-TCMO from camphor-grown Pseudomonas putida NCIMB 10007, determines to a high resolution (1.9 Å and low R-values) the three-dimensional structures of both the native apo enzyme and the corresponding oxidised flavin (FMN)-bound complex, which have been deposited with the PDB (code: 4UWM). In strict contrast, however, their modelling proposals detailed in Sections |
Here, for a second time, as in the case of the mistaken identity of the true nature of 3,6-DKCMO (vide infra), relative timing is a highly relevant issue with respect to Isupov et al.'s deployment of the synthetic α2 dimer [15] to aid in solving the structure of native apo 3,6-DKCMO. This is because Fisher et al.'s 22-year old study [17], from which the synthetic α2 dimer was derived, predates proper appreciation of the relevance of structural allostery in influencing the conformation, and hence the |
In terms of function, the difference between a flavoprotein-type monooxygenase and a flavin-diffusible monooxygenase (vide infra) is crucial. In the specific case of 3,6-DKCMO, this is reflected starkly by the fact that relevant kinetics confirm that the respective Kd values for FMN and FNR differ by >500% [1]. This indicates that while the reduced form of the flavin is bound very tightly in the active site of the enzyme, FMN exhibits poor affinity (as commented on a number of times by Isupov et al. [2 |
The writer pools and preserves sera fixing 4 MHD of complement with an uncholesterinized antigen (Greval, Das and Sen Gupta, 1938; Greval, Chandra and Das', 1940 [Dec., 1943 to the antigen in the case of the fast complement (Greval, Chandra and Very briefly, in the test proper, with a 1 in 5 dilution of the unknown sera, (i) the plain alcoholic heart extract reacts with strongly positive sera only, designated -j?1?j~; (ii) the cholesterinized alcoholic heart extract |
4. The rbc suspension.?Other things being equal, the greater the density of the suspension, the bigger will be the quantity of the complement in 1 MHD, and the less sensitive will be the hsemolytic system. A 5 per cent suspension provides a less sensitive system than a 3 per cent suspension. The density is checked and adjusted if necessary colorometrically (Wyler, 1929; Greval, 1929; Greval, Yesudian and Choudhury, 1930 (Greval, 1927), and the second not only provided an inferior hemoly |
and was comprehensive and covered the full embryology curriculum in an unorthodox didactic style in under 2 hrs". Not accurate: it was not "systems-based" as there was no mention of urinary, reproductive or vascular systems? The critical part of this presentation was the PowerPoint™ slides -these apparently consisted of five or less bullet points, diagrams or both and the presentation also provided "information regarding congenital malformations" and that "there was little additional information to note down that was not present in the slides." Surely impossible that this could take less than two hours? For students learning embryology, sources should be expert and |
Bizarrely, there was no ethical approval for this student-led educational experiment. The "study was independently run and subsequently endorsed through the student-run university societies." Seemingly, neither Cambridge or Birmingham University were aware that this "original research" had been undertaken on their first-year medical students just before critical examinations, when students were at their most impressionable/vulnerable. More curiously, the authors claimed that "students were not required to provide consent to attend the course as it was part of their timetables". If timetabled teaching, why were the universities unaware of the study and why no attribution/acknowledgement of |
These concerns aside, the article was not scholarly. Few medical courses retain a "preclinical basic science teaching" Flexnerian model; 4 modern designs favour integrated programmes, often either case-or problem-based. The paper claimed that "Although speakers in embryology appear confident in teaching the course, these results are discordant with the opinions of medical students as to the effective http://doi.org/10.2147/AMEP.S195286 delivery of the course". To support the first assertion, a PhD thesis by Cassidy was partly cited: 5 a survey of only 34 variously qualified American faculty, teaching a range of |
First, the main objective of our systematic literature review was to conduct a literature search about tremor-control devices using standardized criteria regarding efficacy and comfort in patients diagnosed with essential tremor (ET). We did not include computer software/hardware to control kinetic tremor by using the mouse of a PC, because the scientific literature supporting this technology have included patients with multiple sclerosis exclusively. 2, 3 We also excluded websites that did not include peer-review literature supporting effectiveness. 3 Second, we fully agree with their second statement regarding the lack of publications of negative studies, and independent testing outside the initial developers. It would be interesting to study |
Sigmund Freud's basic philosophical commitments were divided between his aspirations for a positivistic science of the mind (originating in his neuroscience investigations) and an interpretative strategy that rested upon Immanuel Kant's argument about the transcendental relation of mind and nature. While Freud promoted (and later critics assumed) the first position, the Kantian influence has not been generally acknowledged. Yet Kantianism plays a complex role in the development of Freud's thought: the capacity of autonomous reason to detach itself from the natural domain permits scrutiny of nature and oneself, and from that faculty scientific inquiry and moral choice derive. In a parallel structure, |
Psychoanalytic theory begins with the challenge of establishing the basis of psychic cause. Freud argued, on the one hand, humans are subject to unconscious activities (framed within a biological conception), and thus subject to a form of natural determinism. On the other hand, the rational faculty of the ego permits, given proper support and articulation, the means of both understanding the deterministic forces of the unconscious as well as freeing the ego from their authority. Psychoanalysis thus depends on an implicit notion of autonomy, whereby the interpretative faculty would free the analysand from the tyranny of the unconscious in order to pursue the potential of human creativity |
This conception of reason is lifted directly from Kant, and, like Kant, Freud employed this rationality for both epistemological and moral ends. Epistemologically, the study of the (natural) unconscious domain of the mind followed a strategy indebted to Kant's conception of reason, namely, a faculty independent of nature and thus able to study phenomena and generalize laws describing natural causes. And beyond this epistemological formulation, reason's autonomy represented the fundamental requirement for Kant's notion of moral responsibility. Accordingly, Freud relied on reason's autonomy to establish criteria of normative behaviors and, more deeply, reason so configured offers the means for establishing |
I am not suggesting that Freud closely followed Kant to the extent of seeing the categorical imperative, the kingdom of ends, and the negation of selfinterest as the content of some true moral system. Further, I am not arguing that Freud followed Kant in terms of the content of moral philosophy, e.g. he did not subscribe to the renunciation of self-interest as the basis of morals at all. And perhaps most saliently, Freud did not derive 'autonomy' from a conception of the self, i.e. humans are rational and reason permits only one moral law, therefore we are free because we dictate the one moral law |
The voice of the intellect is a soft one, but it does not rest till it has gained a hearing. Finally, after a countless succession of rebuffs, it succeeds. This is one of the few points on which one may be optimistic about the future of mankind, but it is in itself a point of no small importance. And from it one can derive yet other hopes. (Freud, 1927: 53) Notwithstanding reason's standing, its authority remains disputed, even problematic in the Freudian universe, because rationality is always in precarious balance with its counterpoise -the pervasive power of the a-r |
So, as important as the positivist tenets were to Freud's aspirations to create a new science of the mind, an equally compelling commitment was made to Kant. Here, we will explore the fundamental dilemma of reconciling the determinism of the natural world (in this case, the influences of the unconscious) and the autonomy of reason, which bestows moral responsibility and free choice, and how the tension in psychoanalytic thinking arises from these competing visions of human nature, namely, a biologically conceived organism subject to primitive drives and a rational faculty independent of those deterministic forces. Despite the endless battle of these opposing psychic demands, Freud |
References to Kant's Critique of Pure Reason are sprinkled throughout Freud's writings. Indeed, Freud knew Kant well enough to dispute certain basic Kantian precepts (Freud, 1920: 28) and Kantian arguments (Freud, 1990: 110-11), or draw on detailed Kantian insights (Freud, 1905: 12 [Guttman, 1984].) In an unusual nod to Kant, Freud wrote in 1915: In psycho-analysis there is no choice for us to assert that mental processes are themselves unconscious, and to liken the perception of |
Freud saw some connection between Kant's noumenal self and the psychoanalytic unconscious. Neither can be directly perceived, and instead each must be interpreted by emerging phenomena. Clues provided by dreams, slips of the tongue, jokes, neurotic behaviors, etc., then serve psychoanalysis with the desiderata of the unconscious, and while the unconscious cannot be directly observed, like a noumenon we may infer its existence as refracted through psychoanalytic techniques analogous to Kantian categories of understanding. And like Kant's apperception of the ego, the unconscious seems to have a 'unity' -an integrity of its |
In our science as in the others the problem is the same: behind the attributes (qualities) of the object under examination [the unconscious] which are presented directly to our perception, we have to discover something else which is more independent of the particular receptive capacity of our sense organs and which approximates more closely to what may be supposed to be the real state of affairs. We have no hope of being able to reach the latter itself, since it is evident that everything new that we have inferred must nevertheless be translated back into the language of our perceptions, from which it is simply impossible for us to free ourselves. But herein lies the very |
We have discovered technical methods of filling up the gaps in the phenomena of our consciousness, and we make use of those methods just as a physicist makes use of experiment. In this manner we infer a number of processes which are themselves 'unknowable' and interpolate them in those that are conscious to us. (Freud, 1940: 196-7) Here we see Freud adopting the Kantian modification of empiricism, namely, to draw the causative linkage between phenomena, the observer must infer by rational means that, or how, event A causes event B. So by analogy, whereas the physicist employs experiment in which |
Strictly, the Kantian noumenon is empty of content and resides outside nature, postulated but ever mysterious 'in itself'. The Freudian unconscious hardly fulfills that criterion and here we come to an interesting confusion: in his clinical investigations, Freud remained unhesitant in pursuing the unconscious as a natural biological entity (Sulloway, 1979). He followed the scientific logic drawn from physics (e.g. electric effects) and from biology (e.g. variation within species), in which phenomena are witnessed and then accounted for by measuring forces -electromagnetism and natural selection, respectively. As in these |
We must remind ourselves that Freud adamantly rejected the equation of mind with consciousness, which served as the primary scaffolding of those philosophies inspired by Kant. In 'The Ego and the Id' (1923a), he drew a bead on the crucial philosophical issue of defining mind and went to some length to describe, as he had many times previously, the repressed character of the unconscious, the transitory nature of consciousness, the latency of pre-consciousness, and, most beguiling, the utterly different logic employed by the unconscious relative to conscious thought. And most importantly, the unconscious is the mind and psychoanalysis is |
Like the physical, the psychical is not necessarily in reality what it appears to us to be. We shall be glad to learn, however, that the correction of internal perception will turn out not to offer such great difficulties as the correction of external perception -that internal objects are less unknowable than the external world. (Freud, 1915: 171; emphasis added) According to Freud, the tyranny of the despotic unconscious would be broken by reason's autonomy, by its ability to free itself from disguised and hidden psychic forces to discern deterministic causes of overt behaviors and thoughts that hitherto were inaccessible. Reason, in |
Kant's 'criticism of reason' concerns the conditions and limits of human cognition (Velkley, 1989). For Kant, the place of reason, the role of emotions, the intuitions of the spiritual domain, and the ability to understand human psychology each requires a model of the mind that would account for their respective claims to different forms of knowledge. For instance, on what basis could knowledge of the natural world or the moral universe be conceived as legitimate and unified? What schema might tie together the natural world of cause and effect with the moral universe of an agent's exercise of free will? What is the |
Kant attempted to mend these various divisions by first separating reason into two modalities, one that dealt with the natural world and the other to navigate the moral. Although dealing with different domains, reason still functioned as a whole, and Kant posited a faculty of judgment that brought unity to thought. By drawing that synthesis, he provided a rationale -and outlined the ability -for individuals to connect the theoretical (i.e. natural) and practical (i.e. moral) aspects of human reason (Kant, 1987 (Kant, [1790 ). His formulation provided a model by which the natural sciences, anthropology, |
Kant called these rational modalities, respectively, 'pure' (or theoretical) and 'practical' reason. Pure reason applied to the understanding, the Kantian faculty that spontaneously systematizes and organizes those cognitive functions by which humans address and then glean knowledge of the natural world. Such knowledge, as already discussed, is derived from appearancesthe cognitive product or the phenomenon that humans perceive. The noumenon, the thing-in-itself, cannot be known, indeed, it cannot be observed, only 'thought'. Given the success of human cognition to navigate the world and discern its workings, Kant remained confident that the |
A second kind of thought, 'practical' reason, dealt with the moral realm by operating analogously to the workings of pure reason: each was autonomous and thus capable of following its own dictates; each operated with its own particular modes of knowing; and each corresponded to some order -natural or moral. Thus reason's products included discovery of laws, i.e. natural laws through pure reason, as well as the prescriptions of a categorical imperative discerned by practical reason. The consequence of this division was, from Kant's perspective, a way to save belief. But what he in fact did (for those so inclined) was to |
Further parallels appear: Kant meticulously derived reason's 'laws', which include the unrequited search for the unconditioned (the ground or foundation of the world) (Neiman, 1994: 86). Simply, reason becomes 'the capacity to act according to purposes' (ibid.: 88), which is comprised by the search for its own grounding. Further, as Kant argued in the first Critique, by seeking 'its own reflection in nature', (ibid.) reason structures reality according to a human perspective, not as the world really is in any final sense, but only in reason's own terms |
Reason, in order to be taught by nature, must approach nature with its principles in one hand, according to which alone the agreement among appearances can count as laws, and, in the other hand, the experiments thought out in accordance with these principles -yet in order to be instructed by nature not like a pupil, who has recited to him whatever the teacher wants to say, but like an appointed judge who compels witnesses to answer questions he puts to them. (Kant, 1998: 109) Thus the 'concepts of the understanding give order to experience; the principles of reason are the standard by which it |
Indeed, reason has 'complete spontaneity [to] make its own order according to ideas, to which it fits the empirical conditions and according to which it even declares actions to be necessary that yet have not occurred and perhaps will not occur...' (Kant, 1998: 541). Kant goes on to describe how reason possesses its own ordering principles (ibid.: 542), and thereby distinguishes itself from the world that it examines. Further, unlike certain human behaviors that have an obvious empirical content and thus deterministic causality, reason possesses no temporality (or what we perceive as natural causality) |
In pursuing science, Freud was committed to defining the deterministic causation of natural phenomena and when studying unconsciousness, he applied this same principle to follow instinctual drives (Sulloway, 1979). Irrespective of the over-determination (multiple causes) of psychic phenomena and the inaccessibility of the unconscious, which 'has no organization, produces no collective will... [nor] logical laws of thought' (Freud, 1933: 73) (above all, the law of contradiction), psychoanalysis -as a science -would discover the dark workings of the unconscious mind by establishing through |
For Freud, humans exist as a composite of a natural, biological matrix (termed unconsciousness) and another part, the conscious ego. (The biological formulation is discussed below.) Schematically in the last formulation, the rational ego (with its own laws, logic and language) and the a-rational id function with differing causalities through their respective operations and goals. As the id strives for its own aggrandizement, the ego, with its countervailing rationality, attempts to restrict it. Psychoanalysis would empower this rational faculty by penetrating the unconscious to discern its functions through rational inquiry. Simplistically, this schema |
Despite confident assertions, Freud's program operates in ambiguity: given that the self-conscious, rational ego functions autonomously, what grounds that function and by what authority does Reason achieve its adjudicating role? What, indeed, is this ego, this agent, this me, she or he? And more to the point, the philosophical character of Reason and its active personification were also left nebulous, and possibly incoherent, throughout its various characterizations (dating from the early 1890s to the topographical definition described in 'The Ego and the Id' in 1923a). Simply, the ego, the |
Some have argued that Kant held an incoherent theory of self-consciousness as understood on the subject-object model (the so-called reflection model, whereby reflection is analyzed by a two-termed relation between the subject of consciousness and the object of consciousness), because this theory presupposes the self-conscious awareness it attempts to explain; others dispute that Kant even held that position, and instead maintain that a subject/object structure does appropriately apply to an understanding of self-knowledge, which of course is a different problem altogether (Tugendhat, 1986: 55-60; 133-43; Keller, 1998: |
Since Freud himself remained conspicuously silent about any philosophical allegiance beyond'science', he did not present his notion of the unconscious in explicit Kantian terms, 7 nor did he explore the relationship of language and thought, which was to dominate post-Wittgenstein philosophy (Cavell, 1993; Gomez, 2005: 9-15; 103-6) and Lacanian psychoanalysis (Boothby, 2001). 8 More, he actively rejected attempts permitting psychoanalysis to claim legitimacy independent of that paragon of knowledge of his era, science. In short, as Freud regarded philosophy |
However, in other respects Freud's implicit acceptance of Kant's formulation offers a rich philosophical mulch in which to plant psychoanalysis. The theme we will now explore concerns how Freud's philosophy arises from the deepest reaches of his humanistic interests and commitments. In a complex duet, I maintain that (1) even without a sophisticated understanding, Freud appreciated the basic Kantian precepts, and (2) Freud shared with Kant a vision of human beings as committed to a moral venture. I base this interpretation on reading Freud as a modernist, who conceived psychoanalysis fulfilling the quest of moral responsibility. So on this general Kantian view |
Kant may fairly be credited with the invention of individual autonomy (Schneewind, 1992: 309-41;. His clearest exposition is found in the famous answer to the question 'What is Enlightenment?' to which he answered, 'Enlightenment is mankind's exit from its self-incurred immaturity' or as he further extolled, 'Have the courage to use your own understanding...' (Kant, 1996a: 58-64). He goes on to celebrate the virtues of an independent mind guided by rationality, moral forthrightness and, above all, a |
In an instrumental sense, reason becomes the tool by which humans become moral in each context -Kantian and Freudian. Indeed, the very possibility of self-discovery and moral choice must be predicated on notions of freedom and thereby the two endeavors powerfully resonate despite their differing domains of discourse. So despite the deterministic character of the Freudian universe, he, like Spinoza before him, understood that personal insight and understanding constituted the basic freedom humans possess, and, more, their defining characteristic. The second lesson entailed a moral mandate: insight provided by psychoanalysis allows exercise of choice, which ultimately frees humans to pursue a |
The psychoanalytic venture eventuates in a new life-story, one re-examined historically and redirected into a purposeful future. Freud wrote of this movement in his Introductory Lectures: 'The neurotic who is cured has really become another man, though at bottom, of course, he has remained the same; that is to say, he has become what he might have become at best under the most favorable conditions'(1916: 435). However, as Freud showed so dramatically, 'knowing' through self-consciousness may be totally inadequate to the challenge, and in this analytic scenario, self-consciousness |
... for our capacity to turn our attention on to our mental activities is also a capacity to distance ourselves from them, and to call them into question.... The reflective mind cannot settle for perception and desire, not just as such. It needs a reason. (Korsgaard, 1996: 13) And reason serves the moral, inasmuch as we are constantly judging actions, relationships and choices. Accordingly, this process of self-discovery leads from alienation (because 'I do not at first possess what I am' [Ricoeur, 1970: 45] ) to the |
Freud, in building a case for the moral will as arising from unconscious sources, allows reason various degrees of freedom in determining the ethical framework in which choices must be made. Simply, I am referring to the psychoanalytic process itself, whereby insight and perspective emerge from a new appraisal of personal identity (and moral agency more generally). Reason thus functions as an arbiter of ethical choice, and here we see Freud implicitly accepting the Kantian prescription of moral agency as residing in some autonomous authority of self-responsibility based on reason's autonomy: '[T]he power to judge autonomously -that is freely, (according to principles |
Three cardinal characteristics form Kant's depiction of reason: (1) the antecedent standards of reason are unknown and unknowable; (2) reason is like a currency -ideas must be exchanged, justifications must be accepted, options and choices must be understood, and actions must be explained; and (3) most importantly for Freud's own project,... reason must subject itself to critique in all its undertakings, and cannot restrict the freedom of critique through any prohibition without damaging itself and drawing upon itself a disadvantageous suspicion. Now there may be nothing so important because of its utility, nothing so holy, that it |
While Freud adopts the underlying premise of Kantian freedom, he departs from Kant's philosophical path by assuming a naturalistic stance. Unlike Kant, who sought to recognize and act according to a universal categorical imperative, Freud assigned the placement and character of value (and choice) within the individual's own psychical apparatus. He provided the means by which value and morality were formed and incorporated into the psyche, and he presented a dynamic psychology that accounted for the interplay of values in individual behaviors. In this sense, Freud rejects the universal, pristine idealism of Kant's moral law, and he would decipher the moral domain, not as constituted |
Insofar as Freud devised psychoanalysis to break the causal chain of instinctual drives to come under the rational control (as opposed to repression) of the ego, and thus free choice (as opposed to psychological determinism) might be achieved, a gap opened before him: reasons are not causes; retrospective reconstructions are not causal; interpretation follows its own ways, and the basis of clinical efficacy would seek no firmer grounds than reference to insight. Indeed, Freud never explained, beyond the procedures of disclosure and analysis, how the leap from one domain (natural causation) to the other (moral freedom) might be accomplished. Note |
Freud, while pausing to acknowledge Kant, did not see his own project in the Kantian tradition, not only because he regarded that course of philosophy as hopelessly speculative and contemplative, but more deeply because it was based in idealism. So, identifying himself as a scientist, one firmly committed to the positivist principles of his day (Sulloway, 1979 ), Freud could not abide placement with the unnamed 'philosophers', whom he regarded as following an outmoded school of thought. 12 However, as already discussed, a powerful resonance between Kantianism and Freud's thought underlies psycho |
This problem was eloquently stated at the end of Kant's Second Critique, where he famously mused on the mystery of reason's ability to bridge the moral and natural domains: 'Two things fill the mind with ever new and increasing admiration and reverence... the starry heavens above me and the moral law within me'(1996c: 269; original emphasis). This paradox -the dual characteristic of Man as a creature of the organic world and yet one who exercises free choice independent of natural causation -remains a tension throughout Freud's opus. In sum, the theoretical link between Freudian psycho |
In conclusion, that Freud was indebted to Kantianism in some respects does not make him a Kantian. Indeed, he melded certain Kantian ideas with those derived from a deep appreciation of the biological character of human emotions, and in this respect he must be regarded a Darwinian, closely aligned to Nietzsche, whose philosophy begins not in some dialogical response to Kant, but in reaction against him. 14 Indeed, autonomous individualism, associated with a liberated self, freed from political, religious and social bonds, is a distinctly post-Kantian modification attached during the Romantic era (Tauber, 2001;. Beyond |
This interpretation builds from two distinct notions of autonomy that become fused in Freud's thought. Typically, Nietzsche's moral scheme is usually taken to be almost perfectly opposed to that of Kant, inasmuch as they are presenting two opposing conceptions of autonomy. For Kant the law that is self-dictated is one and universal; for Nietzsche, the revaluation of values replaces the unitary with a radical pluralism, in which a unique expression of one's own personal needs and requirements for 'health' emerge. 15 On this axis, Freud closely aligns with Nietzsche both in the flexibility of the norms governing behavior and perhaps more importantly |
In this general scheme, a complex duet is played out between Kant and Nietzsche, where psychoanalysis offers a promissory note: take one's history in hand to command the effect of emotional traumas to declare a liberation and the forthright assertion of personal autonomy for a life of meaningful love and work. Here we hear most clearly the call of Nietzsche's Zarathustra, who demands that humans strive towards some as yet unrealized ideal. The notion that such a venture is feasible, that it is morally inspired, that it serves to actualize human potential, has carried forth the Romantic expression of individuality to become a cred |
Because of the freedom conferred by autonomous reason, humans might not only realize moral choice and accept moral responsibility (Kant's undertaking), but Romantics added that humankind might also perfect itself according to its own dictates. At this juncture, we witness an important transition in the evolution of moral philosophy, which carries Freud far from Enlightenment ideals and aligns him with Nietzsche, where Kantian reason is balanced against a biological construction, and morality thereby shifts from enacting some universal moral order to a radical individualism. On this view, Freud is placed between Kant (commitment to reason's autonomy) and Nietzsche (the biological imperative |
1 According to Kant, because the shape of reality is partly formed by the mediation of the observer, the things in themselves are insurmountably a translation or an interpretation. The self thus emerges, since in the idea of a thought, every mental content embeds the notion of a subject that has an immediate and intuitive unity. Kant refers to this unity as the 'Transcendental Unity of Apperception' (Kitcher, 2006). Apperception in this sense means'self-consciousness', and transcendental indicates that the unity of the self is known as the presupposition of all (self-) |
(Note, the level at which Kantian philosophy is interpreted and applied remains a formidable challenge, not only because common consensus about much is not available, but, more to the point, the degree of detail and explanation of the various perspectives must vary according to the philosophical sophistication [and interest] of the readership. Here, I have endeavored to strike a balance between a fair account of Kant's transcendentalism and its application to a [hypothetical] non-professional philosophical reader, with secondary resources offered to supplement my synoptic summaries.) 2 Kant took the 'pure subject' of Descartes and Locke -and the |
In direct response to Hume, the transcendental argument moves from the nature of experience back to understanding the subject of experience, that is, it arrives at a view of what we must be like in order to have experience as we do. Thus, the observing subject is defined by inference: the self is observed as the external world is known, even as ultimate reality remains elusive. The noumenon, whether subject or object, is an existent; though in itself an unknowable, it is an inferred reality that reason must postulate. Transcending experience and all rational knowledge, reason must assume the existence of noumena |
We know two things about what we call our psyche (or mental life): firstly, its bodily organ and scene of action, the brain (or nervous system), and on the other hand, our acts of consciousness, which are immediate data and cannot be further explained by any sort of description. Everything that lies between is unknown to us, and so the data do not include any direct relation between these two terminal points of our knowledge. If it existed, it would at most afford an exact localization of the processes of consciousness and would give us no help towards understanding them. (Freud, 1940: 144-5) So |
Obviously, for Freud, the two represented two entirely different modalities to express the ethical, one as a liberator, the other as part of a despotic unconscious experience. In the topographical model, the super-ego is the repository of moral consciousness, 'an agency... in the ego which confronts the rest of the ego in an observing, criticizing and prohibiting sense' (Freud, 1939: 116). In this last articulation, Freud described the super-ego as 'the successor and representative of the parents (and educators) who superintended the actions of the individual in his first |
[T]he super-ego is the vehicle of the phenomenon we call conscience. Mental life very much depends on the super-ego's being normally developed -that is, on its having become sufficiently impersonal. And that is precisely what it is not in neurotics.... Their super-ego still confronts their ego as a strict father confronts a child; and their morality operates in a primitive fashion in that the ego gets itself punished by the super-ego. Illness is employed as an instrument for this self-punishment, and neurotics have to behave as though they were governed by a sense of guilt which |
Even in the non-neurotic case, the super-ego's chief function'remains the limitation of satisfactions' (Freud, 1940: 148). For Freud, the individual always remains his focus, and more particularly, individual welfare, and thus the restrictions imposed on the pleasure principle through the super-ego faculty always require a mediation; sometimes successful, sometimes not. 11 However, it is important to note that he did not mean by 'autonomy' a'selfdetermination of the person as a person or of the I as an I, but a self-determination of reason' ( |
Reasoning... is simply a matter of striving for principled autonomy in the spheres of thinking and of action. Autonomy in thinking is no morebut also no less -than the attempt to conduct thinking (speaking, writing) on principles on which all others whom we address could also conduct their thinking.... Autonomy in action is no more -but also no less -than the attempt to act on principles on which all others could act.... Kantian autonomy is neither derived from antecedently given but unjustified account of reason (hence unreasoned), nor lacking in structure (hence |
In early 1957, Schrieffer, then a 25-yearold graduate student, wrote down a quantum-mechanical wave function that accounted for the behaviour of electrons in superconductors. With his thesis adviser John Bardeen and postdoc colleague Leon Cooper, he published the now-famous BCS wave function and the full theory of superconductivity less than a year laternamed BCS after the trio, who shared the Nobel prize (J. Bardeen, L. N. Cooper and J. R. Schrieffer Phys. Rev. 108, 1175; 1957). The work |
Bardeen suggested Schrieffer try his hand at understanding superconductivity. This was a risky proposition. After the initial success of quantum theory in describing ordinary conductors, insulators and semiconductors, there had been countless attempts to explain superconductors and all had failed. But the timing was right. Bardeen, with his then-postdoc David Pines, had studied the effect of phonons (quantized sound waves) on metals, showing that they mediated an attractive interaction between electrons. Cooper found that this attractive interaction could lead to the formation of bound pairs of electrons. However, Cooper's theory described only the formation |
Throughout his career, Schrieffer displayed the same flair as in his brilliant wave function insight. In 1979, he and his colleagues showed that certain conducting polymers could exhibit excitations with electrical charge, but no spin (the magnetic moment of each electron is called its spin). The opposite could also occur: excitations could have spin, but no charge. It was a revelation that the two fundamental properties of electrons, charge and spin, could be split apart. This deconstruction has since been discovered at many other frontiers of condensed-matter physics. A later collaboration showed that a second example of deconstructed electrons, the fraction |
In 1980, he moved to the University of California, Santa Barbara, and joined the newly formed Institute for Theoretical Physics. Here, between 1984 and 1989, he served as its second director, helping to establish its strong reputation as a centre for theoretical physics research. His final move in 1992 was back to Florida, where he took a state-wide professorial position in the Florida State University System. From that year until 2006 he was the first chief scientist of the National High Magnetic Field Laboratory at Florida State University in Tallahassee, where he had a crucial role in establishing the new facility |
Schrieffer was equally known for his warmth, charm, generosity and brilliance. When Bob discussed physics, his eyes would twinkle and a boyish demeanour would shine through. This enthusiasm and provision of wise counsel to younger physicists never waned. His unique style is captured, as if in a photograph, by the BCS wave function. ■ Nick Bonesteel and Gregory Boebinger are professors of physics who were colleagues of Schrieffer's at the National High Magnetic Field Laboratory and Florida State University. e-mails: bonestee@magnet.fsu.edu; gsb@magnet.fsu.edu J. Robert Schrie |
With the advent of pay for performance and quality standards, family doctors are now in the business of data reporting. We are paid to report "quality measures" and meet their targets. In the United States, where lawmakers, employers, and patients agree that the cost of healthcare is unsustainable, the government and industry are joining forces to enact structural and payment forms like meaningful use of electronic health records, pay for performance, and the patient centered medical home, which aims to transform the delivery of primary care. These programs reward healthcare providers with new computer systems and added management fees with the expectation of lower costs and measurable improvements in health. But this shift |
It is reported that physicians spend, on average, 11 minutes with their patients 1 and listen to their chief complaint for only 22 seconds before taking control of the interview. 2 During these brief encounters, to what or to whom do doctors attend? A structured history of the present illness taken by the medical assistant? The chronic disease flowsheets? A checklist of overdue prevention measures? Doctors have risen to their rank through a fierce competitiveness: we are experts at knowing what to know for the purposes of the test. Increasingly, we are graded on our performance on meeting national guidelines for the control of weight, blood pressure, smoking |
True confession: I was an early adapter of electronic health records. When our practice purchased the first version in 2000, I was dazzled by how simple, legible, organized, encyclopedic, and beautiful it was. I wasn't alone. Despite the hefty price tag, increasing numbers waded into the market, from small office managers to hospital chief executives to national vendors of clinical services. Then came President Obama's economic stimulus package. The Hi-Tech Act of 2009 offered financial incentives for the purchase and "meaningful use" of electronic health records and earmarked $3.6bn (£2 |
I had seen the paper form before as part of other employee wellness programs. But I never knew what inspired it until I read a New Yorker essay about America's best known television doctor, Dr Oz. 5 His "fifteen minute physical" identified what doctors, patients, and now employers seem to regard as the key markers of health. They have become the central focus of most insurance covered annual examinations in the US. Never mind that annual exams do not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes. 6 Never mind that the individual components, taken out of context, tell us little about the future |
Take weight. According to a recent meta-analysis, being overweight or having low level obesity carries a lower risk of death than being "normal" weight. Only with higher degrees of obesity does the risk of death rise. 7 And this news is no exception. Large longitudinal studies have reversed our long held beliefs and recommendations with regard to the routine use of estrogen and progesterone, calcium, and vitamin D, 8 stents and coronary artery bypass, 9 aspirin, niacin, 10 and fenofibrates. 11 Our efforts at intensive control of blood pressure and blood sugar in type 2 diabetes can back |
14 Science seldom gives us lasting pearls. One critical observer of the scientific method put it bluntly, "We like to pretend that our experiments define the truth for us. But that's often not the case. Just because an idea is true doesn't mean it can be proved. And just because an idea can be proved doesn't mean it's true. When the experiments are done, we still have to choose what to believe. 15 Most of what really works in medicine is comprehensible, even to our patients. Nothing is more beneficial than helping smokers quit; it easily adds 10 years to a young person's life. |
What is health? Or is that a fair question to ask experts on disease? Wendall Berry refers to health as membership. 18 In other words, health is tied to our sense of connection to community. When disease disrupts the bonds of those connections, or requires that they be broken (as for the addict or victim of domestic violence), the doctor's job is to ease and facilitate the patient's transition. We are agents of change, from disease to health, from brokenness to a more connected, responsive, and responsible whole. Imagine for a moment that we could redesign our job and the dataset we utilize. What would it |
Similarly, adverse childhood experiences have been shown to be associated with adult health outcomes. When Vincent Felitti directed a weight loss program for Kaiser Permanente he found that though most participants lost weight, the dropout rate was unacceptably high. Follow-up interviews revealed that many of them had been sexually abused as children and they connected this with subsequent weight gain. As Felitti remembers it, "the counterintuitive aspect was that, for many people, obesity was not their problem; it was their protective solution to problems that previously had never been discussed with anyone." 21 Along with Robert Anda of the Centers for Disease Control, Felitti |
Over the past two decades, William Miller and Stephen Rollnick have revolutionized the way in which healthcare workers perceive their role in behavioral change. They call their approach "motivational interviewing" and see it as a directive, client centered counseling style that encourages patients to change their behavior by exploring and resolving ambivalence. Patients are not blind to the risks of their behavior or the benefits change. They simply find themselves stuck in habits both harmful and rewarding. Miller and Rollnick have identified four therapeutic behaviors that are consistently beneficial in helping patients make lasting change: the expression of empathy; the revelation of discrepancies between patients' problem behaviors and their stated |
Lastly, let's ask our patients if their concerns have been heard, our findings explained, their needs addressed. Post visit surveys might answer these questions and teach us how to better communicate with our patients and expedite our duties. 26 It is not too late to retool the primary care workshop, to redesign the "product" that patients are clamoring for. Some experimentation has already begun. Practitioners of direct primary care have eliminated the health insurance middlemen by offering annual subscriptions. Patients receive affordable primary care; doctors receive an adequate income and sufficient time to spend with their patients. 27 Eric Topol has pioneered the use |
"I would take us all back a thousand years," Dr Oz mused in a recent interview, "when our ancestors lived in small villages and there was always a healer in that village-and his job wasn't to give you heart surgery or medication but to help find a safe place for conversation." 5 In all fairness, Dr Oz may not be acquainted with primary care or its village healers. If he was, he might find a safe place for conversation and discover what we are learning about connection, childhood trauma, doctor-patient relationships, and the facilitation of change. If we are to remain the masters of our own creation-the |
t is an honor for me to outline the background and contributions of Mrs. Elizabeth Croll, who was selected as an ASPS Patient of Courage in 2016. Her story is a true inspiration to plastic surgeons, as well as a role model for patients by converting unforeseen tragedy into betterment of the community. After a tragic accident in which she suffered severe maxillofacial trauma in 1997, she has undergone multiple reconstructive surgical procedures. She has been courageous throughout the process as she rebuilds her face and demonstrates an unwavering commitment to her career, her community, and access to medical care for indig |
At age 28, Elizabeth received her MBA from the Harvard Business School in 1997 (Fig. 1). One month later, just before beginning her new job post-MBA, she was struck by an oncoming boat and suffered severe facial trauma, resulting in an open skull injury with loss of her right eye, accompanied by periorbital bone loss, maxillary fractures, and significant facial lacerations. Elizabeth's initial surgery consisted of tracheotomy for airway management, right orbital enucleation, stabilization of the facial fractures, and cranioplasty to cover the exposed brain. During the next |
Despite her relative success in community and business endeavors, Elizabeth was plagued with ongoing deterioraReceived for publication May 3, 2017; accepted May 26, 2017 While receiving care and treatment at University Hospitals of Cleveland I came to appreciate the unique abilities that enabled Elizabeth to make so many ongoing contributions to the community, despite the time demands of her work and medical care. The families I had worked with at Rainbow Babies and Children's Hospital were developing a foundation to help underprivileged children who had suffered from trauma or birth defects. The purpose of the foundation was not only to insure that afflicted children receive proper medical care but also |
From the very beginning of his career, Sandage was a star. His 1953 PhD thesis reversed the thinking of the day that faint'main sequence' stars started their lives as red giants; his measurements of the M3 globular cluster led to the conclusion that the opposite order was correct. This was a revolution in the understanding of stellar evolution. Sandage continued to work on determining the distances and ages of clusters, as well as on the properties of their variable stars -the RR Lyrae and Cepheid stars -all his life. He was one of the first to use supernovae to measure very large distances |
On the back of these predictions, Sandage single-handedly mounted a giant programme to extend the Hubble diagram, which charts redshifts of galaxies (a measure of how fast they are moving away from Earth) against their relative distances. This became the crucial piece of evidence that helped to dispel doubts about whether very large redshifts are really caused by cosmic expansion, or by some as-yet-unknown physics. Such doubts, fostered by Hubble himself, became prevailing when the stunningly large redshifts of quasars were discovered in 1963. Sandage's work was instrumental in settling the debate in |
The entire process brought to mind (remember I am a journal editor and cannot help it) the issue of how cognitive and confirmation biases influence everything that we do in life. Cognitive bias is a systematic pattern of deviation from norm or rationality in judgment, whereas confirmation bias is the interpretation of information in a way that confirms one's preconceptions (2). We, as humans, see our environment through the personal lens of how we have learned to adapt to the world we live in, which may explain how people are able to create their own personal realities that allow them to interpret the same set of facts and come to different conclusions. This |
The guiding principal that governs editorial decision-making at JACC: Basic to Translational Science is our focus on publishing scientific studies that we believe will lead to new therapies. As an Editorial Board, we are aware that translational science is at best an imperfect science, to which we assiduously attempt to apply a balanced and rigorous editorial process in an effort to advance new concepts and therapies. What I have learned from watching the proceedings in Washington, DC, is that cognitive and confirmation biases exist in all aspects of our lives, including how we interpret scientific data, and that, as Editor-in-Chief, I need to remain ever |
First of all, I will explain how quantum mechanics and its statistical interpretation arose. At the beginning of the twenties, every physicist, I think, was convinced that Planck's quantum hypothesis was correct. According to this theory energy appears in finite quanta of magnitude hv in oscillatory processes having a specific frequency v (e.g. in light waves). Countless experiments could be explained in this way and always gave the same value of Planck's constant h. Again, Einstein's assertion that light quanta have momentum hv/c (where c is the speed of light) was well supported by experiment (e.g. through the Compton |
In 1913 Niels Bohr had solved the riddle of line spectra by means of the quantum theory and had thereby explained broadly the amazing stability of the atoms, the structure of their electronic shells, and the Periodic System of the elements. For what was to come later, the most important assumption of his teaching was this: an atomic system cannot exist in all mechanically possible states, forming a continuum, but in a series of discrete « stationary » states. In a transition from one to another, the difference in energy E mEn is emitted or absorbed as a light quantum hv,, (according to whether E m is greater or |
Theoretical physics maintained itself on this concept for the next ten years. The problem was this: an harmonic oscillation not only has a frequency, but also an intensity. For each transition in the array there must be a corresponding intensity. The question is how to find this through the considerations of correspondence? It meant guessing the unknown from the available information on a known limiting case. Considerable success was attained by Bohr himself, by Kramers, Sommerfeld, Epstein, and many others. But the decisive step was again taken by Einstein who, by a fresh derivation of Planck's radiation formula, made it transparently clear that |
In Göttingen we also took part in efforts to distil the unknown mechanics of the atom from the experimental results. The logical difficulty became ever sharper. Investigations into the scattering and dispersion of light showed that Einstein's conception of transition probability as a measure of the strength of an oscillation did not meet the case, and the idea of an amplitude of oscillation associated with each transition was indispensable. In this connection, work by Ladenburg 1, Kramer 2, Heisenberg 3, Jordan and me 4 should be mentioned. The art of guessing correct formulae, which deviate from the classical formulae, |
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