Interesting paper. Just some quick draft thoughts 

As far as I understand it the paper and the theories always assume a certain conception of the human being. For your paper it seems as though this  individual is always able to know his or her own mind as if he is a stable unitary identity - as if he or she has a stable and fully aware sense of self, and does not fool him or herself by not knowing (disbelieving) things he actually knows. 

This is an alternative  perspective that thinks of the human being as  intrinsically always struggling with a sense of self, identity, and so has a habit of 'latching on' to beliefs that provide a sense of meaning and stability (e.g. religion, but also any secular obsession can suffice: work, sport, other hobbies, and of course buying and selling, etc.) This is in contrast to the common concept of the rational human as Descartes' cogito, and its faith in its ability to know through science etc.  So this non-stable and, in a sense, divided subject does have a propensity to fool him or herself by not believing things he or she actually knows if it enables him or her to make meaning and construct a stable (ish) sense of self. 

Today many contemporary philosophers and thinkers out there think that capitalism provides the fantasy for this concept of the human being, and individual person,  to latch onto. The fantasy that surplus can be generated as long as we progressively innovate and exchange goods  in the free market. And this surplus, magically generated in exchange, includes surplus life, longevity. The individual is seduced by the promise of life-wealth through technologies that 'save life'. 

This fantasy enables us to know things 'very well' but to behave 'as if' they don't exist. Belief and knowledge, faith and reason, are divided. 

And it is suggested that this fantasy is supported by the irrationality (madness) at the core of the cogito, its megalomaniacal belief in its own all-knowing powers.

So we need theories of irrational belief meaning making theory that takes the divided non-cogito subject as it's basis: 

Here is an example of what a I mean - it's a bit long so only delve if inspired:  

Take breast cancer screening and the issue of overdiagnosis:

Choice, meaning and belief 

Overdiagnosis, as knowledge is 'true' but rendered meaningless (unbelievable) for decision makers under positivist and neoliberal capitalist pressures. 

It is  'evident', as in the Latin, e-videre, made to appear, but only as a ghostly phantom object, only through a mathematical negativity - the failure of screened diagnoses to be matched by cancer 'presentations' in a non-screened population, which only secondarily enables the deduction of  an apparent excess of cancer diagnoses diffusely spread across a screened population. 

As an object overdiagnosis  is uniquely abstract, it cannot be defined as an individual object, it is a non-attributable event and  cannot be experienced as such by any identifiable person, it is not directly observable. Or in Descartes' words it is not 'clearly seen'.  

So for a positivist like (one of its protagonists) the philosopher, in the 1940s,  Rudolf Carnap, it is 'empirically meaningless'.

 

The positivist rationality (version of what truth is) means overdiagnosis, as  abstract does not 'exist', as such, and therefore can only be 'tolerated' (Carnap) as a potential source of further useful ideas, but has no meaning or power to influence practical decision making at policy level. 

Liberalism lends a hand here by ensuring we are apparently free to govern ourselves in the name of national longevity and so  any socialist governmental tendencies are taboo. 

The state/expert/screening programme director etc. says we have clarity, we  'have a figure' for overdiagnosis so women have 'fair' information and can make a balanced. But this is disingenuous and politically/economically  motivated, where Machiavelli's 'effective truth' is in the 'desired result' limited, by a specific (neoliberal positivist) gaze, to 'saving lives from cancer'.  

Instead:

The woman's fear of death is evoked by screening invitations, just as, at the same time, her certainty of death, her certainty of mortality, is removed by the promise of salvation (the cure, and surplus life,  through early diagnosis), at the same time she is expected to face her mortality by being asked to consider and  imagine the screening process is faulty and to imagine experiencing something (overdiagnosis). To imagine, in other words, the combined pointless loss of her breast and a cancerful life, an event that is not actually experienceable by any individual. For her, fear mongering yet seductive establishment marketing pressures, as well as its unimaginable nature,  transforms overdiagnosis into an increasingly meaningless concept, which loses its power to resist the forces of capitalism, the screening cascade and dogma. This does not make for fair decision making. 

Therefore screening asymptomatic women for breast cancer is intrinsically exploitative because the decision making process can never be fair or balanced. The decision to have a screening programme is classically liberal, and capitalist, and positivist so can ignore overdiagnosis even as it says it has 'a figure'  for it. 

The irrationality is in empirical sciences assumption that it can pinpoint the threshold for disease in the asymptomatic person and the exploitation is in  the ruthless enslavement and destruction of women's bodies to maintain capitalist growth and expert power. 

The patient exposed to screening has symptoms dragged from her and is coerced into believing, the capitalist fantasy, and  in the salvatory powers of the cancer industry and into becoming just so much raw material. 

The rationality of positivism and of a liberalism founded on and maintained by a fear of death becomes a necropolitics of healthcare. 

The patient and doctor are intrinsically susceptible to capitalism's fantasy of the possibility of limitless acquisition of surplus life through the repetitive exchange of medical interventions. This is because we are at core always struggling with finding a sense of stable identity. Our identity is provided through making meanings and is always in flux. We should try to bear this in mind when we are implementing population based interventions that prey on our susceptibility to fantasy and belief.

Owen  

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