To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Theodor W. Adorno often made reference to Immanuel Kant’s famous essay on enlightenment. Although he denied that immaturity is self-incurred, the first section of this article will show that he adopted many of Kant’s ideas about maturity in his philosophically informed critique of monopoly conditions under late capitalism. The second section will explore Adorno’s claim that the educational system could foster maturity by encouraging critical reflection on the social conditions that have made us what we are. Finally, this article will demonstrate that Adorno links enlightenment to Kant’s idea of a realm of ends.
Long-chain fatty acid oxidation disorders (LC-FAOD) are a group of serious diseases in which patients are at risk of metabolic decompensation, resulting in cardiomyopathy, hypoglycemia and rhabdomyolysis and premature mortality. In addition, LC-FAOD are a burdensome disease that adversely effects quality of life (QoL) via symptoms of muscle pain, fatigue, and a difficult diet. Previous studies have reported improvements in QoL during treatment with triheptanoin as measured by short form (SF) instruments. This study sought to convert the QoL measure into a utility value for a sample of patients with LC-FAOD at baseline and 78 weeks during treatment with triheptanoin.
In an open-label Phase 2 study of triheptanoin (UX007-CL201, NCT01886378), caregivers of patients (n = 9/23 enrolled) or patients aged 18+ years (n = 6/6 enrolled) completed the SF-10 or the SF-12v2, respectively. Component summary scores at baseline and 78-week during treatment period were converted to EuroQol-Five Dimension (EQ-5D) utility (with zero representing death and 1.0 perfect health) using a published conversion algorithm (Lawrence and Fleishman 2004). Generalized linear mixed-effects models with individual-level random effects were used to estimate the utility values.
At baseline, patients’ utility was estimated to be 0.365 (standard error [SE] = 0.090) compared with 0.629 (SE = 0.072) 78-weeks during treatment, a significant improvement (p = 0.0073). In a sensitivity analysis using SF-12v2 data only (that is, only adult patients), utility estimates were 0.498 (SE = 0.084) at baseline versus 0.690 (SE = 0.068) during treatment (p = 0.0499). No patients had a major clinical event during the SF instrument recall period, indicating the benefit was driven by day-to-day improvement in QoL.
Treatment with triheptanoin resulted in a substantial improvement in daily QoL for patients with LC-FAOD. Limitations of this study include that the estimation of utilities is from a single-arm study with small sample sizes and that the assessment of utility was based on a conversion algorithm rather than direct measurement. Nevertheless, results indicate significant improvement in QoL for patients treated with triheptanoin.
Prognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown.
We conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5–8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria.
We enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08–2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02–5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2–88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3–82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2–59.4).
Frailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.
Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.
Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.
Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.
The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
[I]t would be up to thought to see all nature, and whatever would install itself as such, as history, and all history as nature.
Theodor W. Adorno (ND 359)
Decades before the environmental movement emerged in the 1960s, Theodor W. Adorno criticized our destructive and self-destructive relation to nature with the ultimate aim of reshaping that relationship in more mutually beneficial ways. His criticisms originally appeared in a 1932 essay, “The Idea of Natural-History”, where he advanced the project of showing that human history is always also natural history and that non-human nature is entwined with history. This project informs all Adorno's work, including Negative Dialectics and the unfinished, posthumously published Aesthetic Theory. The idea of natural history provides the template for interpretive practice in philosophy: philosophical interpretation “means reading nature from history and history from nature” (HF 134). Philosophy is tasked with demonstrating that human history is linked inextricably to both our own internal, instinctual, nature and non-human nature. But philosophy also shows that nature is historical, not just because nature evolves and constantly changes, but because it has been profoundly – often negatively – affected by human history. Adorno's idea of natural history reveals the dynamic, and potentially catastrophic, interaction between nature and history.
When philosophy reads nature from history, the idea of natural history becomes “the canon of interpretation for philosophers of history” (ND 359; see also HF 125).
In the end, hope, wrested from reality by negating it, is the only form in which truth appears. Without hope, the idea of truth would be scarcely even thinkable, and it is the cardinal untruth, having recognized existence to be bad, to present it as truth simply because it has been recognized.
Theodor W. Adorno (MM 98)
The radical ecologists discussed in Chapter 5 emphasize the unity of nature to the detriment of its diversity. Naess may have conceded that we can debate the nature and limits of the unity of life on this planet, but it is a central tenet of Ecosophy T that life is fundamentally one (1989: 166). Bookchin stressed the unity of nature as well; he gave this idea a Hegelian twist when he argued that nature's unity takes the form of a latent subjectivity that “expresses itself in various gradations, not only as the mentalism of reason, but also as the interactivity, reactivity, and the growing purposive activity of forms” (1991a: 275). And, while Merchant claims that her ethics recognizes both the continuities and the differences between human beings and the rest of the natural world (2003: 217), she views human and non-human nature as identical when she treats them as partners. When she endorses Bohm's process physics, which grounds animate and inanimate matter in the holomovement (ibid.: 209), Merchant again champions unity over diversity.
Adorno recognizes that the damage we have inflicted on nature has been extensive, and predicts that it could assume catastrophic proportions if we continue to behave as we do now: as rapaciously acquisitive creatures whose survival instincts are veering so far out of control that we are now destroying not just what we are trying to preserve but need to survive. What we call progress is forcing hundreds of millions of people to renounce the satisfaction of their needs to the point where they suffer horribly from malnutrition, starvation and preventable diseases. In less severe cases, we are forfeiting far richer, more materially and spiritually fulfilling, lives because mere survival remains our primary goal. For its part, non-human nature lies in ruins because we have imposed goals and purposes on it that are far different from those that it would adopt independently. We have ignored and suppressed nature's autotelic powers.
The looming prospect of environmental catastrophe – the extinction of all life on this planet – now acts as a powerful stimulus to thinking about the changes that must be implemented to ensure the survival of human and non-human nature. As Adorno argues throughout his work, our current idea of progress – the progressive domination of nature – is incompatible with a more emancipated form of progress in which human beings would reconcile themselves with nature (HF 151).
Adorno ventured the claim that the entire programme of Western philosophy consists in self-reflection: “philosophy in general has been the implementation of just this νóησις υοήσεως that he [Aristotle] ascribes to the divine principle as the primal image of all philosophy” (MCP 94–5). He repeats this claim in his lectures on Kant's Critique of Pure Reason: “philosophy is really a matter of ‘thinking on thinking’, as Aristotle defined it” (KCPR 82). But if self-reflection has been the lifeblood of philosophy, Adorno insists that it is not an end in itself. Denouncing Western reason because it effectively condemns thought to thinking itself, he argued that, to escape the sphere of immanence, of narcissistic navel-gazing, thought must become self-critical. He stressed the need for critical self-reflection throughout his work, and dignified it with the name “metaphysics”. Metaphysics should not limit itself to the “self-reflection of thought and of the pure forms of thought”. As self-critical, metaphysics must question the tacit, unexamined “thesis of the whole metaphysical tradition”, namely “whether thought and its constitutive forms are in fact the absolute” (MCP 99).
Metaphysics must question whether, and to what extent, thought can transcend the sphere of concepts to grasp objects. Although philosophy's confidence in its ability to transcend concepts is as “doubtful as ever”, it is both one of philosophy's “inalienable features and part of the naïveté that ails it”.
Indissolubly entwined, nature and history preponderate over individuals and their cognitive activity. Nature preponderates over cognition because our cognitive faculties serve primarily as instruments of adaptation to the natural world. Our concepts themselves are tied to non-conceptual reality; they emerge and develop in our embodied encounters with material objects (ND 11). By extension, nature preponderates over individuals as corporeal beings, driven by instinct and need. Now as in the past, self-preservation runs wild, and reason ends by regressing to nature (ND 289). For its part, history preponderates over cognition, not just because our concepts are intersubjectively sustained constructs with socially conditioned and sedimented histories, but because – as Adorno often put it – individuals are imprisoned in prevailing modes of thought. Finally, this chapter will show that late capitalist society preponderates because it shapes the process of individuation, ensures the material survival of individuals and defines their relation to nature as members of the labour force.
Under the monopoly conditions that characterize late capitalism, individuals stand in much the same relation to society as particulars stand to universal concepts. Adorno suggests this throughout his work when he refers to society as the “universal”. Where identity thinking summarily subsumes objects under concepts, society reifies individuals, expunging their idiosyncrasies by subsuming them under abstract exchange relations. Adorno emphasizes the isomorphism between identity thinking and exchange relations when he observes that exchange is “fundamentally akin to the principle of identification” because it serves as the “social model” for this principle.
Marx famously asserted that life is not determined by consciousness, but consciousness by life (Marx & Engels 1970: 47). On the orthodox interpretation of this assertion, Marx meant that socioeconomic conditions causally determine what Georg Lukács later called forms of objectivity or thought. Objecting to this interpretation, which implies that all consciousness is false – or ideologically distorted – consciousness, Adorno argues that “the definition of consciousness in terms of being has become a means of dispensing with all consciousness which does not conform to existence” (1967c: 29). When interpreted in a strictly deterministic fashion, Marx's distinction between base and superstructure was used repressively (in the former Soviet Union, for example) to undermine criticism by suggesting that it is impossible to think beyond the given. Against orthodox Marxism, Adorno wants to rescue the “baby” of criticism from the “bathwater” of false consciousness. To denounce all culture as false consciousness would wrongly extirpate “with the false, all that was true also, all that, however impotently, strives to escape the confines of universal practice, every chimerical anticipation of a nobler condition”, thereby bringing about “directly the barbarism that culture is reproached with furthering indirectly” (MM 44).
In Negative Dialectics, however, Adorno gives Marx's claim about the priority of the material life process over consciousness a more positive reading. This claim should not be read as “metaphysics in reverse”, that is, as though it authorized the reduction of consciousness to being, because Marx was primarily criticizing the “delusion that mind … lies beyond the total process in which it finds itself as a moment” (ND 200).
Adorno's work has been variously described as Nietzschean, Weberian, Hegelian, idealist, Marxist and materialist. With equal frequency, commentators have excluded Adorno from one or the other of these camps. So, for example, Stephen Bronner argues that Adorno's work has nothing to do with materialism “unless that concept is configured in the most abstract terms” (1996: 186–7). Some Italian Marxists were even more critical than Bronner, excoriating Adorno as a romantic idealist. This is certainly true of Lucio Colletti, who, as Perry Anderson observes, soundly denounced Adorno (and others as well) for his allegedly Hegelian rejection of materialism (1976: 70). This charge reappears in a different form in Sebastiano Timpanaro's influential On Materialism (1975). Among other things, Timpanaro objects that the Frankfurt School as a whole has an “antimaterialist, anti-Enlightenment, anti-jacobin orientation”. All the school's theorists are pessimistic thinkers who “end up in, or at least tend towards, more or less explicitly religious positions” (ibid.: 19).
These barbed criticisms contradict Adorno's own description of his work as materialist in orientation. Although he would reject Timpanaro's claim that a materialist would never reduce experience to a “reciprocal implication of subject and object”, Adorno advances a version of materialism that agrees in part with Timpanaro's view that materialism involves “above all acknowledgement of the priority of nature over ‘mind’” (ibid.: 34). Furthermore, both Timpanaro and Adorno acknowledge their debts to Marx.
Decades before the environmental movement emerged in the 1960s, Adorno condemned our destructive and self-destructive relationship to the natural world, warning of the catastrophe that may result if we continue to treat nature as an object that exists exclusively for our own benefit. Adorno on Nature presents the first detailed examination of the pivotal role of the idea of natural history in Adornos work. A comparison of Adornos concerns with those of key ecological theorists social ecologist Murray Bookchin, ecofeminist Carolyn Merchant, and deep ecologist Arne Naess reveals how Adorno speaks directly to many of todays most pressing environmental issues. Ending with a discussion of the philosophical conundrum of unity in diversity, Adorno on Nature also explores how social solidarity can be promoted as a necessary means of confronting environmental problems.