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Etymology

The word “metaphysics” derives from the Greek words µet? (metá, “beyond”, “upon” or “after”) and physiká. It was first used as the title for several of Aristotle’s works, because they were usually anthologized after the works on physics in complete editions. The prefix meta- (“after”) indicates that these works come “after” the chapters on physics. However, Aristotle himself did not call the subject of these books “Metaphysics”: he referred to it as “first philosophy.” The editor of Aristotle’s works, Andronicus of Rhodes, is thought to have placed the books on first philosophy right after another work, Physics, and called them “ta meta ta physika biblia” or “the books that come after the [books on] physics”. This was misread by Latin scholiasts, who thought it meant “the science of what is beyond the physical”.

However, once the name was given, the commentators sought to find intrinsic reasons for its appropriateness. For instance, it was understood to mean “the science of the world beyond nature” (physis in Greek), that is, the science of the immaterial. Again, it was understood to refer to the chronological or pedagogical order among our philosophical studies, so that the “metaphysical sciences” would mean “those that we study after having mastered the sciences that deal with the physical world” (St. Thomas Aquinas, Expositio in librum Boethii De hebdomadibus, V, 1).

There is a widespread use of the term in current popular literature which replicates this understanding, i.e. that the metaphysical equates to the non-physical: thus, “metaphysical healing” means healing by means of remedies that are not physical.

Luc Paquin

Metaphysics is a traditional branch of philosophy concerned with explaining the fundamental nature of being and the world that encompasses it, although the term is not easily defined. Traditionally, metaphysics attempts to answer two basic questions in the broadest possible terms:

  • Ultimately, what is there?
  • What is it like?

A person who studies metaphysics is called a metaphysicist or a metaphysician. The metaphysician attempts to clarify the fundamental notions by which people understand the world, e.g., existence, objects and their properties, space and time, cause and effect, and possibility. A central branch of metaphysics is ontology, the investigation into the basic categories of being and how they relate to each other. Another central branch of metaphysics is cosmology, the study of the origin, fundamental structure, nature, and dynamics of the universe. Some include epistemology as another central focus of metaphysics, but others question this.

Prior to the modern history of science, scientific questions were addressed as a part of metaphysics known as natural philosophy. Originally, the term “science” (Latin scientia) simply meant “knowledge”. The scientific method, however, transformed natural philosophy into an empirical activity deriving from experiment unlike the rest of philosophy. By the end of the 18th century, it had begun to be called “science” to distinguish it from philosophy. Thereafter, metaphysics denoted philosophical enquiry of a non-empirical character into the nature of existence. Some philosophers of science, such as the neo-positivists, say that natural science rejects the study of metaphysics, while other philosophers of science strongly disagree.

Luc Paquin

Conclusions

Our health-care systems are undergoing change and, as a result, so are our professions. How we allow this change to affect our clinical practice, our research directions, and our response to consumer advocacy is up to us. We need to educate policy-makers that being fiscally responsible means having a consumer-driven model of intervention focusing on interventions that make real-life differences and minimize the consequences of disease and injury.

While it is clear that the implicit motivation underlying all clinical and research efforts in aphasia is related to increased participation in life, the path to achieving that goal is often indirect. Because LPAA makes life goals primary and explicit, it holds promise as an approach in which such goals are attainable. We invite other speech-language pathologists to join us in discussing and developing life participation approaches to aphasia.

Norma

Criticisms

Williams’ Argument In Detail

In addition to the preceding two arguments against the cogito, other arguments have been advanced by Bernard Williams. He claims, for example, that what we are dealing with when we talk of thought, or when we say “I am thinking,” is something conceivable from a third-person perspective; namely objective “thought-events” in the former case, and an objective thinker in the latter.

Williams provides a meticulous and exhaustive examination of this objection. He argues, first, that it is impossible to make sense of “there is thinking” without relativizing it to something. However, this something cannot be Cartesian egos, because it is impossible to differentiate objectively between things just on the basis of the pure content of consciousness.

The obvious problem is that, through introspection, or our experience of consciousness, we have no way of moving to conclude the existence of any third-personal fact, to conceive of which would require something above and beyond just the purely subjective contents of the mind.

Søren Kierkegaard’s Critique

The Danish philosopher Søren Kierkegaard provided a critical response to the cogito. Kierkegaard argues that the cogito already presupposes the existence of “I”, and therefore concluding with existence is logically trivial. Kierkegaard’s argument can be made clearer if one extracts the premise “I think” into two further premises:

  • “x” thinks
  • I am that “x”
  • Therefore I think
  • Therefore I am

Where “x” is used as a placeholder in order to disambiguate the “I” from the thinking thing.

Here, the cogito has already assumed the “I”‘s existence as that which thinks. For Kierkegaard, Descartes is merely “developing the content of a concept”, namely that the “I”, which already exists, thinks.

Kierkegaard argues that the value of the cogito is not its logical argument, but its psychological appeal: a thought must have something that exists to think the thought. It is psychologically difficult to think “I do not exist”. But as Kierkegaard argues, the proper logical flow of argument is that existence is already assumed or presupposed in order for thinking to occur, not that existence is concluded from that thinking.

John Macmurray’s Form of the Personal

The Scottish philosopher John Macmurray rejects the cogito outright in order to place action at the center of a philosophical system he entitles the Form of the Personal. “We must reject this, both as standpoint and as method. If this be philosophy, then philosophy is a bubble floating in an atmosphere of unreality.” The reliance on thought creates an irreconcilable dualism between thought and action in which the unity of experience is lost. Thus dissolving the integrity of our selves, and destroying any connection with reality. In order to formulate a more adequate cogito, Macmurray proposes the substitution of “I do” for “I think”. Ultimately leading to a belief in God as an agent to whom all persons stand in relation.
Skepticism

Many philosophical skeptics and particularly radical skeptics would say that indubitable knowledge does not exist, is impossible, or has not been found yet, and would apply this criticism to the assertion that the “cogito” is beyond doubt.

Luc Paquin

Criticisms

There have been a number of criticisms of the argument. One concerns the nature of the step from “I am thinking” to “I exist.” The contention is that this is a syllogistic inference, for it appears to require the extra premise: “Whatever has the property of thinking, exists”, a premise Descartes did not justify. In fact, he conceded that there would indeed be an extra premise needed, but denied that the cogito is a syllogism (see below).

To argue that the cogito is not a syllogism, one may call it self-evident that “Whatever has the property of thinking, exists”. In plain English, it seems incoherent to actually doubt that one exists and is doubting. Strict skeptics maintain that only the property of ‘thinking’ is indubitably a property of the meditator (presumably, they imagine it possible that a thing thinks but does not exist). This countercriticism is similar to the ideas of Jaakko Hintikka, who offers a nonsyllogistic interpretation of cogito ergo sum. He claimed that one simply cannot doubt the proposition “I exist”. To be mistaken about the proposition would mean something impossible: I do not exist, but I am still wrong.

Perhaps a more relevant contention is whether the “I” to which Descartes refers is justified. In Descartes, The Project of Pure Enquiry, Bernard Williams provides a history and full evaluation of this issue. Apparently, the first scholar who raised the problem was Pierre Gassendi. He “points out that recognition that one has a set of thoughts does not imply that one is a particular thinker or another. Were we to move from the observation that there is thinking occurring to the attribution of this thinking to a particular agent, we would simply assume what we set out to prove, namely, that there exists a particular person endowed with the capacity for thought”. In other words, “the only claim that is indubitable here is the agent-independent claim that there is cognitive activity present”. The objection, as presented by Georg Lichtenberg, is that rather than supposing an entity that is thinking, Descartes should have said: “thinking is occurring.” That is, whatever the force of the cogito, Descartes draws too much from it; the existence of a thinking thing, the reference of the “I,” is more than the cogito can justify. Friedrich Nietzsche criticized the phrase in that it presupposes that there is an “I”, that there is such an activity as “thinking”, and that “I” know what “thinking” is. He suggested a more appropriate phrase would be “it thinks.” In other words, the “I” in “I think” could be similar to the “It” in “It is raining.” David Hume claims that the philosophers who argue for a self that can be found using reason are confusing “similarity” with “identity”. This means that the similarity of our thoughts and the continuity of them in this similarity do not mean that we can identify ourselves as a self but that our thoughts are similar.

Luc Paquin

Predecessors

Although the idea expressed in cogito ergo sum is widely attributed to Descartes, he was not the first to mention it. Plato spoke about the “knowledge of knowledge” (Greek: nóesis noéseos) and Aristotle explains the idea in full length:

  • But if life itself is good and pleasant (…) and if one who sees is conscious that he sees, one who hears that he hears, one who walks that he walks and similarly for all the other human activities there is a faculty that is conscious of their exercise, so that whenever we perceive, we are conscious that we perceive, and whenever we think, we are conscious that we think, and to be conscious that we are perceiving or thinking is to be conscious that we exist… (Nicomachean Ethics, 1170a25 ff.)

Augustine of Hippo in De Civitate Dei writes Si […] fallor, sum (“If I am mistaken, I am”) (book XI, 26), and also anticipates modern refutations of the concept. Furthermore, in the Enchiridion Augustine attempts to refute skepticism by stating, “[B]y not positively affirming that they are alive, the skeptics ward off the appearance of error in themselves, yet they do make errors simply by showing themselves alive; one cannot err who is not alive. That we live is therefore not only true, but it is altogether certain as well” (Chapter 7 section 20). Another predecessor was Avicenna’s “Floating Man” thought experiment on human self-awareness and self-consciousness.

The 8th Century Hindu philosopher Adi Shankara wrote in a similar fashion, No one thinks, ‘I am not’, arguing that one’s existence cannot be doubted, as there must be someone there to doubt.

Luc Paquin

The Core Values Of LPAA

LPAA is structured around five core values that serve as guides to assessment, intervention, and research.

The Explicit Goal Is Enhancement of Life Participation

In the LPAA approach, the first focus of the client, clinician, and policy-maker is to assess the extent to which persons affected by aphasia are able to achieve life participation goals, and the extent to which the aphasia hinders the attainment of these desired outcomes. The second focus is to improve short-term and long-term participation in life.

All Those Affected by Aphasia Are Entitled to Service

LPAA supports all those affected directly by aphasia, including immediate family and close associates of the adult with aphasia. The LPAA approach holds that it is essential to build protected communities within society where persons with aphasia are able not only to participate but are valued as participants. Therefore, intervention may involve changing broader social systems to make them more accessible to those affected by aphasia.

The Measures of Success Include Documented Life-Enhancement Changes

The LPAA approach calls for the use of outcome measures that assess quality of life and the degree to which those affected by aphasia meet their life participation goals.

Without a cause to communicate, we believe, there is no practical need for communication. Therefore, treatment focuses on a reason to communicate as much as on communication repair. In so doing, treatment attends to each consumer’s feelings, relationships, and activities in life.

Both Personal and Environmental Factors Are Targets of Intervention

Disruption of daily life for individuals affected by aphasia (including those who do not have aphasia themselves) is evident on two levels: personal (internal) and environmental (external). Intervention consists of constantly assessing, weighing, and prioritizing which personal and environmental factors should be targets of intervention and how best to provide freer, easier, and more autonomous access to activities and social connections of choice. This does not mean that treatment comprises only life resumption processes, but rather that enhanced participation in life “governs” management from its inception. In this fundamental way, the LPAA approach differs from one in which life enhancement is targeted only after language repair has been addressed.

Emphasis Is on the Availability of Services as Needed at All Stages of Aphasia

LPAA begins with the onset of aphasia and continues until consumers and providers agree that targeted life enhancement changes have occurred. However, LPAA acknowledges that life consequences of aphasia change over time and should be addressed regardless of the length of time post-onset. Consumers are therefore permitted to discontinue intervention, and reenter treatment when they believe they need to continue work on a goal or to attain a new life goal.

Norma

Interpretation

The phrase cogito ergo sum is not used in Descartes’s Meditations on First Philosophy but the term “the cogito” is used to refer to an argument from it. In the Meditations, Descartes phrases the conclusion of the argument as “that the proposition, I am, I exist, is necessarily true whenever it is put forward by me or conceived in my mind.” (Meditation II)

At the beginning of the second meditation, having reached what he considers to be the ultimate level of doubt – his argument from the existence of a deceiving god – Descartes examines his beliefs to see if any have survived the doubt. In his belief in his own existence, he finds that it is impossible to doubt that he exists. Even if there were a deceiving god (or an evil demon), one’s belief in their own existence would be secure, for there is no way one could be deceived unless one existed in order to be deceived.

  • But I have convinced myself that there is absolutely nothing in the world, no sky, no earth, no minds, no bodies. Does it now follow that I, too, do not exist? No. If I convinced myself of something [or thought anything at all], then I certainly existed. But there is a deceiver of supreme power and cunning who deliberately and constantly deceives me. In that case, I, too, undoubtedly exist, if he deceives me; and let him deceive me as much as he can, he will never bring it about that I am nothing, so long as I think that I am something. So, after considering everything very thoroughly, I must finally conclude that the proposition, I am, I exist, is necessarily true whenever it is put forward by me or conceived in my mind. (AT VII 25; CSM II 16-17)

There are three important notes to keep in mind here. First, he claims only the certainty of his own existence from the first-person point of view – he has not proved the existence of other minds at this point. This is something that has to be thought through by each of us for ourselves, as we follow the course of the meditations. Second, he does not say that his existence is necessary; he says that if he thinks, then necessarily he exists (see the instantiation principle). Third, this proposition “I am, I exist” is held true not based on a deduction (as mentioned above) or on empirical induction but on the clarity and self-evidence of the proposition. Descartes does not use this first certainty, the cogito, as a foundation upon which to build further knowledge; rather, it is the firm ground upon which he can stand as he works to restore his beliefs. As he puts it:

  • Archimedes used to demand just one firm and immovable point in order to shift the entire earth; so I too can hope for great things if I manage to find just one thing, however slight, that is certain and unshakable. (AT VII 24; CSM II 16)

According to many Descartes specialists, including Étienne Gilson, the goal of Descartes in establishing this first truth is to demonstrate the capacity of his criterion – the immediate clarity and distinctiveness of self-evident propositions – to establish true and justified propositions despite having adopted a method of generalized doubt. As a consequence of this demonstration, Descartes considers science and mathematics to be justified to the extent that their proposals are established on a similarly immediate clarity, distinctiveness, and self-evidence that presents itself to the mind. The originality of Descartes’s thinking, therefore, is not so much in expressing the cogito – a feat accomplished by other predecessors, as we shall see – but on using the cogito as demonstrating the most fundamental epistemological principle, that science and mathematics are justified by relying on clarity, distinctiveness, and self-evidence. Baruch Spinoza in “Principia philosophiae cartesianae” at its Prolegomenon identified “cogito ergo sum” the “ego sum cogitans” (I am a thinking being) as the thinking substance with his ontological interpretation. It can also be considered that Cogito ergo sum is needed before any living being can go further in life”

Luc Paquin

In Descartes’s Writings

Meditations on First Philosophy

In 1641, Descartes published (in Latin) Meditations on first philosophy in which he referred to the proposition, though not explicitly as “cogito ergo sum” in Meditation II:

  • Latin: “… hoc pronuntiatum: ego sum, ego existo, quoties a me profertur, vel mente concipitur, necessario esse verum.”
  • English: “.. this proposition: I am, I exist, whenever it is uttered from me, or conceived by the mind, necessarily is true.”

Principles of Philosophy

In 1644, Descartes published (in Latin) his Principles of Philosophy where the phrase “ego cogito, ergo sum” appears in Part 1, article 7:

  • Latin: “Sic autem rejicientes illa omnia, de quibus aliquo modo possumus dubitare, ac etiam, falsa esse fingentes, facilè quidem, supponimus nullum esse Deum, nullum coelum, nulla corpora; nosque etiam ipsos, non habere manus, nec pedes, nec denique ullum corpus, non autem ideò nos qui talia cogitamus nihil esse: repugnat enim ut putemus id quod cogitat eo ipso tempore quo cogitat non existere. Ac proinde haec cognitio, ego cogito, ergo sum, est omnium prima & certissima, quae cuilibet ordine philosophanti occurrat.”
  • English: “While we thus reject all of which we can entertain the smallest doubt, and even imagine that it is false, we easily indeed suppose that there is neither God, nor sky, nor bodies, and that we ourselves even have neither hands nor feet, nor, finally, a body; but we cannot in the same way suppose that we are not while we doubt of the truth of these things; for there is a repugnance in conceiving that what thinks does not exist at the very time when it thinks. Accordingly, the knowledge, I think, therefore I am, is the first and most certain that occurs to one who philosophizes orderly.”

Descartes’s margin note for the above paragraph is:

  • Latin: “Non posse à nobis dubitari, quin existamus dum dubitamus: at que hoc esse primum quod ordine philosophando cognoscimus.”
  • English: “That we cannot doubt of our existence while we doubt, and that this is the first knowledge we acquire when we philosophize in order.”

Other Forms

The proposition is sometimes given as dubito, ergo cogito, ergo sum. This fuller form was penned by the eloquent French literary critic, Antoine Léonard Thomas, in an award-winning 1765 essay in praise of Descartes, where it appeared as “Puisque je doute, je pense; puisque je pense, j’existe.” In English, this is “Since I doubt, I think; since I think I exist”; with rearrangement and compaction, “I doubt, therefore I think, therefore I am”, or in Latin, “dubito, ergo cogito, ergo sum”.

A further expansion, dubito, ergo cogito, ergo sum – res cogitans (“… – a thinking thing”) extends the cogito with Descartes’s statement in the subsequent Meditation, “Ego sum res cogitans, id est dubitans, affirmans, negans, pauca intelligens, multa ignorans, volens, nolens, imaginans etiam et sentiens …”, or, in English, “I am a thinking (conscious) thing, that is, a being who doubts, affirms, denies, knows a few objects, and is ignorant of many …”. This has been referred to as “the expanded cogito”.

Luc Paquin

The Origins Of LPAA

Functional and Pragmatic Approaches

LPAA draws on ideas underlying functional and pragmatic approaches to aphasia nad shares some common values with those who take a broad approach to functional communication treatment by focusing on life participation goals and social relationships. In our view, however, the term “functional” does not do justice to the breadth of this work. In addition, the term is often used narrowly to mean “functional independence in getting a message across”. Although LPAA recognizes the value of this type of impairment-level work, it should form part of a bigger picture where ultimate goal for intervention is re-engagement into everyday society.

Human Rights Issues and Consumers’ Goals

LPAA is a means of addressing unmet needs and rights of individuals with aphasia and those in their environment. Indeed, the Americans with Disabilities Act (ADA), signed into law on July 26, 1990, requires that physical and communication access be provided for individuals with aphasia and other disabilities and allows them legal recourse if they are blocked from accessing employment, programs, and services in the public and private sectors.

In 1992, ASHA provided guidelines for a “communication bill of rights” (National Joint Committee for the Communicative Needs of Persons with Severe Disabilities). Its preface states that “all persons, regardless of the extent or severity of their disabilities, have a basic right to affect, through communication, the conditions of their own existence”. Communication is defined as “a basic need and basic right of all human beings”. ASHA thus views communication as an integral part of life participation.

Emphasis on Competence and Inclusion

LPAA philosophy embraces a view of treatment that emphasizes competence and inclusion in daily life, focusing as much on the consequences of chronic disorders as on the language difficulty caused by the aphasia. Along with other movements in education and health care, LPAA shifts from a focus on deficits and remediation to one of inclusion and life participation. Such international changes in focus point to the need to address the personal experience of disability and promote optimal life inclusion and reintegration into society.

Changes in Reimbursement and Service Delivery

Health care and reimbursement in America have undergone an unprecedented overhaul. Financial exigencies have led to an emphasis on medically essential treatments and others seen as likely to save on future health care costs. Many of the incentives in this model result in the provision of efficient short-term minimal care, rather than the longer term, fuller care supported in the past.

LPAA represents a fundamental shift in how we view service delivery for people confronting aphasia. Since LPAA focuses on broader life-related processes and outcomes form the onset of treatment, service delivery and its reimbursement will require novel means that stand outside most current practices. We are confident that cost-sensitive and therapeutically effective models are possible. Our purpose in this introductory article is to prompt a discussion with providers and consumers as to whether life participation principles and values should play a more central role in the delivery and reimbursement of future service delivery for all those affected by aphasia.

Norma

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