The Mental Mechanisms of Patient Adherence to Long-Term Therapies: Mind and Care

1 Introduction: The doctor, her patient, and their reasons.- 1. Adherence and nonadherence to therapies: A definition ; 2. Nonadherence: How frequent is it? ; 3. The consequences of nonadherence; 4. Scope of the book; 5. Some simple explanations for nonadherence; 6. A typology of adherence? Analogous or homologous phenomena; 7. The real question; 8. From behavior to action; 9. A philosophical interpretation of adherence to long-term therapies.- 2 The classic view ;1. Determinants of nonadherence to long-term therapies; 2. Behavioral models of patient adherence; 3. Limitations of psychological models; 4. A new perspective; 5. Psychology and philosophy, in search of mental mechanisms; 6. Observation and explanation; 7. Patient and agent.- 3 Intentionality ; 1. What is 'in your head'; 2. A mental puzzle and its formation; 3. Actions: A causal theory.- 4 An intentionalist model of adherence ; 1. Therapeutic agency; 2. An intentionalist model of adherence; 3. The pivotal role of emotions in patient adherence; 4. Bringing action into play: Volition.- 5 The dynamics of intentionality 1. Motivational force; 2. Self-control; 3. The force of habit; 4. Intention, decision, and willpower; 5. The dynamics of intentionality.- 6 Medical irrationality ; 1. Akrasia; 2. Patient nonadherence as a case of akrasia; 3. Another example of irrationality: The denial of illness; 4. Logical mechanisms of irrationality.- 7 Time and adherence: A principle of foresight ; 1. The effect of time; 2. The principle of foresight; 3. The appearance of adherence; 4. A physiopathological point of view; 5. A top-down model of adherence.- 8 An intentionalist account of doctor-patient relationship and biomedical ethics; 1. Philosophical analysis of doctor-patient relationship; 2. The principle of charity; 3. Adherence and autonomy.- 9 Doctors' clinical inertia as myopia ; 1. Clinical inertia: Definition and logical description 2. Empirical evidence: The paradigm case of psychological insulin resistance; 3. Empathy and sympathy 4. The paradox of empathy in medical care; 5. Another conception of sympathy; 6. Care, sympathy,; beneficence, and love; 7. Care as a special form of sympathy; 8. The respective values of immediacy and future; 9. Empathy, sympathy, and the ethical dynamics of the pa-tient-doctor relationship; 10. A model of chronic care involving patient education and trust; 11. Conclusion: Mind and Care.- 10 Conclusion: Adherence Generalized ; 1. A choice between two actions; 2. Generalization of the problem; 3. Defining adherence by its explanation; 4. Eros and Thanatos.