The Risk of Cancer Associated with Immunosuppressive Therapy for Skin Diseases

The possible carcinogenic risk of immunosuppressive therapies is an important issue in everyday clinical practise. Carcinogenesis is a slow multi step procedure, thus a long latency period is needed before cancer develops. PUVA therapy is used for many skin diseases including psoriasis, early stage cutaneous T cell lymphoma, atopic dermatitis, palmoplantar pustulosis and chronic eczema. There has been concern about the increased melanoma risk associated to PUVA therapy, which has previously been associated with an increased risk on non-melanoma skin cancer, especially squamous cell carcinoma. The increased risk of basal cell carcinoma (BCC) is also documented but it is modest compared to squamous cell carcinoma (SCC). This thesis evaluated melanoma and noncutaneous cancer risk associated to PUVA, and the persistence of nonmelanoma cancer risk after the cessation of PUVA treatment. Also, the influence of photochemotherapy to the development of secondary cancers in cutaneous T cell lymphoma and the role of short term cyclosporine in later cancer development in inflammatory skin diseases were evaluated. The first three studies were performed on psoriasis patients. The risk of melanoma started to increase 15 years after the first treatment with PUVA. The risk was highest among persons who had received over 250 treatments compared to those under 250 treatments. In noncutaneous cancer, the overall risk was not increased (RR=1.08,95% CI=0.93-1.24), but significant increases in risk were found in thyroid cancer, breast cancer and in central nervous system neoplasms. These cancers were not associated to PUVA. The increased risk of SCC was associated to high cumulative UVA exposure in the PUVA regimen. The patients with high risk had no substantial exposure to other carcinogens. In BCC there was a similar but more modest tendency. In the two other studies, the risk of all secondary cancers (SIR) in CTCL patients was 1.4 (95% CI=1.0-1.9). In separate sites, the risk of lung cancer, Hodgkin and non-Hodgkin lymphomas were increased. PUVA seemed not to contribute to any extent to the appearance of these cancers. The carcinogenity of short-term cyclosporine was evaluated in inflammatory skin diseases. No increased risk for any type of cancer including the skin cancers was detected. To conclude, our studies confirm the increased skin cancer risk related to PUVA treatment in psoriasis patients. In clinical practice, this has led to a close and permanent follow-up of patients treated with PUVA. In CTCL patients, PUVA treatment did not contribute to the development of secondary cancers. We could not detect any increase in the risk of cancer in patients treated with short term cyclosporine, unlike in organ transplant patients under such long-term therapy.

The Relational Self, the Social Bond and the Dynamics of Personal Relationships : A Sociological Analysis

This study analyses personal relationships linking research to sociological theory on the questions of the social bond and on the self as social. From the viewpoint of disruptive life events and experiences, such as loss, divorce and illness, it aims at understanding how selves are bound to their significant others as those specific people ‘close or otherwise important’ to them. Who form the configurations of significant others? How do different bonds respond in disruptions and how do relational processes unfold? How is the embeddedness of selves manifested in the processes of bonding, on the one hand, and in the relational formation of the self, on the other? The bonds are analyzed from an anti-categorical viewpoint based on personal citations of significance as opposed to given relationship categories, such as ‘family’ or ‘friendship’ – the two kinds of relationships that in fact are most frequently significant. The study draws from analysis of the personal narratives of 37 Finnish women and men (in all 80 interviews) and their entire configurations of those specific people who they cite as ‘close or otherwise important’. The analysis stresses the subjective experiences, while also investigating the actualized relational processes and configurations of all personal relationships with certain relationship histories embedded in micro-level structures. The research is based on four empirical sub-studies of personal relationships and a summary discussing the questions of the self and social bond. Discussion draws from G. H. Mead, C. Cooley, N. Elias, T. Scheff, G. Simmel and the contributors of ‘relational sociology’. Sub-studies analyse bonds to others from the viewpoint of biographical disruption and re-configuration of significant others, estranged family bonds, peer support and the formation of the most intimate relationships into exclusive and inclusive configurations. All analyses examine the dialectics of the social and the personal, asking how different structuring mechanisms and personal experiences and negotiations together contribute to the unfolding of the bonds. The summary elaborates personal relationships as social bonds embedded in wider webs of interdependent people and social settings that are laden with cultural expectations. Regarding the question of the relational self, the study proposes both bonding and individuality as significant. They are seen as interdependent phases of the relationality of the self. Bonding anchors the self to its significant relationships, in which individuality is manifested, for example, in contrasting and differentiating dynamics, but also in active attempts to connect with others. Individuality is not a fixed quality of the self, but a fluid and interdependent phase of the relational self. More specifically, it appears in three formats in the flux of relational processes: as a sense of unique self (via cultivation of subjective experiences), as agency and as (a search for) relative autonomy. The study includes an epilogue addressing the ambivalence between the social expectation of individuality in society and the bonded reality of selves.

Social Responsibility in Developing New Biotechnology : Interpretations of Responsibility in the Governance of Finnish Biotechnology

The object of the dissertation is to analyse the concept of social responsibility in relation to research and development of new biotechnology. This is done by examining the relevant actors – researchers, administrators, decision-makers, experts, industry, and the public – involved in the Finnish governance of biotechnology through their roles and responsibilities. Existing practises of responsibility in biotechnology governance, as well as the discourses of responsibility – the actors’ conceptions of their own and others responsibilities – are analysed. Three types of responsibility that the actors have assumed are formulated, and the implications of these conceptions to the governance of new biotechnology are analysed. From these different types of responsibility adopted and used by the actors, theoretical models called responsibility chains are constructed. The notion of responsibility is under-theorised in sociology and this research is an attempt to create a mid-range theory of responsibility in the context of biotechnology governance. The research aims to increase understanding of the governance system from a holistic viewpoint by contributing to academic debates on science and technology policy, public understanding of science, commercialisation of research, and corporate social responsibility. With a thorough analysis of the concept of responsibility that is derived from empirical data, the research brings new perspectives into these debates by challenging many normative ideas embedded in discourses. For example, multiple roles of the public are analysed to highlight the problems of consumerism and citizen participation in practise, as well as in relation to different policy strategies. The research examines also the contradictory responsibilities faced by biotechnology researchers, who balance between academic autonomy, commercialisation of research, and reflecting social consequences of their work. Industries responsibilities are also examined from the viewpoint of biotechnology. The research methodology addresses the contradictions between empirical findings, theories of biotechnology governance, and policies in a novel way, as the study concentrates on several actors and investigates both the discourses and the practises of the actors. Thus, the qualitative method of analysis is a combination of discourse and content analysis. The empirical material is comprised of 29 personal interviews as well as documents by Finnish and multinational organizations on biotechnology governance.

Survival in the Rainforest : Change and Resilience among the Punan Vuhang of Eastern Sarawak, Malaysia

This dissertation concerns the Punan Vuhang, former hunter-gatherers who are now part-time farmers living in an area of remote rainforest in the Malaysian state of Sarawak. It covers two themes: first, examining their methods of securing a livelihood in the rainforest, and second looking at their adaptation to a settled life and agriculture, and their response to rapid and large-scale commercial logging. This study engages the long-running debates among anthropologists and ecologists on whether recent hunting-gathering societies were able to survive in the tropical rainforest without dependence on farming societies for food resources. In the search for evidence, the study poses three questions: What food resources were available to rainforest hunter-gatherers? How did they hunt and gather these foods? How did they cope with periodic food shortages? In fashioning a life in the rainforest, the Punan Vuhang survived resource scarcity by developing adaptive strategies through intensive use of their knowledge of the forest and its resources. They also adopted social practices such as sharing and reciprocity, and resource tenure to sustain themselves without recourse to external sources of food. In the 1960s, the Punan Vuhang settled down in response to external influences arising in part from the Indonesian-Malaysian Confrontation. This, in turn, initiated a series of processes with political, economic and religious implications. However, elements of the traditional economy have remained resilient as the people continue to hunt, fish and gather, and are able to farm on an individual basis, unlike neighboring shifting cultivators who need to cooperate with each other. At the beginning of the 21st century, the Punan Vuhang face a new challenge arising from the issue of rights in the context of the state and national law and large-scale commercial logging in their forest habitat. The future seems bleak as they face the social problems of alcoholism, declining leadership, and dependence on cash income and commodities from the market.

Beyond Words : The European Court of Justice and Legal Certainty in Multilingual EU Law

This study addresses the issue of multilingualism in EU law. More specifically, it explores the implications of multilingualism for conceptualising legal certainty, a central principle of law both in domestic and EU legal systems. The main question addressed is how multilingualism and legal certainty may be reconciled in the EU legal system. The study begins with a discussion on the role of translation in drafting EU legislation and its implications for interpreting EU law at the European Court of Justice (ECJ). Uncertainty regarding the meaning of multilingual EU law and the interrelationship between multilingualism and ECJ methods of interpretation are explored. This analysis leads to questioning the importance of linguistic-semantic methods of interpretation, especially the role of comparing language versions for clarifying meaning and the ordinary meaning thesis, and to placing emphasis on other, especially the teleological, purpose-oriented method of interpretation. As regards the principle of legal certainty, the starting-point is a two-dimensional concept consisting of both formal and substantive elements; of predictability and acceptability. Formal legal certainty implies that laws and adjudication, in particular, must be predictable. Substantive legal certainty is related to rational acceptability of judicial decision-making placing emphasis on its acceptability to the legal community in question. Contrary to predictability that one might intuitively relate to linguistic-semantic methods of interpretation, the study suggests a new conception of legal certainty where purpose, telos, and other dynamic methods of interpretation are of particular significance for meaning construction in multilingual EU law. Accordingly, the importance of purposive, teleological interpretation as the standard doctrine of interpretation in a multilingual legal system is highlighted. The focus on rational, substantive acceptability results in emphasising discourse among legal actors among the EU legal community and stressing the need to give reasons in favour of proposed meaning in accordance with dynamic methods of interpretation including considerations related to purposes, aims, objectives and consequences. In this context, the role of ideal discourse situations and communicative action taking the form of interaction among the EU legal community in an ongoing dialogue especially in the preliminary ruling procedure is brought into focus. In order for this dialogue to function, it requires that the ECJ gives persuasive, convincing and acceptable reasons in justifying its decisions. This necessitates transparency, sincerity, and dialogue with the relevant audience.

The Feminist Transformation of Bioethics : An Analysis of Theoretical Perspectives and Practical Applications in Feminist Bioethics

The purpose of this study is to examine how transformation is defining feminist bioethics and to determine the nature of this transformation. Behind the quest for transformation is core feminism and its political implications, namely, that women and other marginalized groups have been given unequal consideration in society and the sciences and that this situation is unacceptable and should be remedied. The goal of the dissertation is to determine how feminist bioethicists integrate the transformation into their respective fields and how they apply the potential of feminism to bioethical theories and practice. On a theoretical level, feminist bioethicists wish to reveal how current ways of knowing are based on inequality. Feminists pay special attention especially to communal and political contexts and to the power relations endorsed by each community. In addition, feminist bioethicists endorse relational ethics, a relational account of the self in which the interconnectedness of persons is important. On the conceptual level, feminist bioethicists work with beliefs, concepts, and practices that give us our world. As an example, I examine how feminist bioethicists have criticized and redefined the concept of autonomy. Feminist bioethicists emphasize relational autonomy, which is based on the conviction that social relationships shape moral identities and values. On the practical level, I discuss stem cell research as a test case for feminist bioethics and its ability to employ its methodologies. Analyzing these perspectives allowed me first, to compare non-feminist and feminist accounts of stem cell ethics and, second, to analyze feminist perspectives on the novel biotechnology. Along with offering a critical evaluation of the stem cell debate, the study shows that sustainable stem cell policies should be grounded on empirical knowledge about how donors perceive stem cell research and the donation process. The study indicates that feminist bioethics should develop the use of empirical bioethics, which takes the nature of ethics seriously: ethical decisions are provisional and open for further consideration. In addition, the study shows that there is another area of development in feminist bioethics: the understanding of (moral) agency. I argue that agency should be understood to mean that actions create desires.

The RATAS-project, in the Light of 25 Years of Development Towards Computer-Integrated Construction

In smaller countries where the key players in construction IT development tend to know each other personally and where public R&D funding is concentrated to a few channels, IT roadmaps and strategies would seem to have a better chance of influencing development than in the bigger industrial countries. In this paper Finland and the RATAS-project is presented as a historical case illustrating such impact. RATAS was initiated as a construction IT roadmap project in 1985, involving many of the key organisations and companies active in construction sector development. Several of the individuals who took an active part in the project have played an important role in later developments both in Finland and on the international scene. The central result of RATAS was the identification of what is nowadays called Building Information Modelling (BIM) technology as the central issue in getting IT into efficient use in the construction sector. BIM, which earlier was referred to as building product modelling, has been a key ingredient in many roadmaps since and the subject of international standardisation efforts such as STEP and IAI/IFCs. The RATAS project can in hindsight be seen as a forerunner with an impact which also transcended national borders.

On the Problem of Participation in Strategy: A Critical Discursive Perspective

We still know little of why strategy processes often involve participation problems. In this paper, we argue that this crucial issue is linked to fundamental assumptions about the nature of strategy work. Hence, we need to examine how strategy processes are typically made sense of and what roles are assigned to specific organizational members. For this purpose, we adopt a critical discursive perspective that allows us to discover how specific conceptions of strategy work are reproduced and legitimized in organizational strategizing. Our empirical analysis is based on an extensive research project on strategy work in 12 organizations. As a result of our analysis, we identify three central discourses that seem to be systematically associated with nonparticipatory approaches to strategy work: “mystification,” “disciplining,” and “technologization.” However, we also distinguish three strategy discourses that promote participation: “self-actualization,” “dialogization,” and “concretization.” Our analysis shows that strategy as practice involves alternative and even competing discourses that have fundamentally different kinds of implications for participation in strategy work. We argue from a critical perspective that it is important to be aware of the inherent problems associated with dominant discourses as well as to actively advance the use of alternative ones.

How can a Bourdieusian perspective aid the analysis of MBA education?

There is a lack of integrative conceptual models that would help to better understand the underlying reasons for the alleged problems of MBA education. To address this challenge, we draw on the work of Pierre Bourdieu to examine MBA education as an activity with its own ‘economy of exchange’ and ‘rules of the game.’ We argue that application of Bourdieu’s theoretical ideas elucidates three key issues in debate around MBA education: the outcomes of MBA programs, the inculcation of potentially problematic values and practices through the programs, and the potential of self-regulation such as accreditation and ranking for impeding development of MBA education. First, Bourdieu’s notions of capital – intellectual, social and symbolic – shed light on the ‘economy of exchange’ in MBA education. Critics of MBA programs have pointed out that the value of MBA degrees lies not only in ‘learning.’ Bourdieu’s framework allows further analysis of this issue by distinguishing between intellectual (learning), social (social networks), and symbolic capital (credentials and prestige). Second, the concept of ‘habitus’ suggests how values and practices are inculcated through MBA education. This process is often a ‘voluntary’ one where problematic or ethically questionable ideas may be regarded as natural. Third, Bourdieu’s reflections on the ‘doxa’ and its reproduction and legitimation illuminate the role of accreditation and ranking in MBA education. An analysis of such self-regulation explains in part how the system may turn out impeding change.

Growth and Convergence: The case of China

Growth and Convergence: The Case of China Since the initiation of economic reforms in 1978, China has become one of the world’s fast-growing economies. The rapid growth, however, has not been shared equally across the different regions in China. The prominent feature of substantial differences in incomes and growth rates across the different Chinese regions has attracted the attention of many researchers. This book focuses on issues related to economic growth and convergence across the Chinese regions over the past three decades. The book has eight chapters. Apart from an introduction chapter and a concluding chapter, all the other chapters each deal with some certain aspects of the central issue of regional growth and convergence across China over the past three decades. The whole book is organized as follows. Chapter 1 provides an introduction to the basic issues involved in this book. Chapter 2 tests economic growth and convergence across 31 Chinese provinces during 1981-2005, based on the theoretical framework of the Solow growth model. Chapter 3 investigates the relationship between openness to foreign economic activities, such as foreign trade and foreign direct investment, and the regional economic growth in the case of China during 1981-2005. Chapter 4, based on data of 31 Chinese provinces over the period 1980-2004, presents new evidence on the effects of structural shocks and structural transformation on growth and convergence among the Chinese regions. Chapter 5, by building up an empirical model that takes account of different potential effects of foreign direct investment, focuses on the impacts of foreign direct investment on China’s regional economic performance and growth. Chapter 6 reconsiders the growth and convergence problem of the Chinese regions in an alternative theoretical framework with endogenous saving behavior and capital mobility across regions. Chapter 7, by building up a theoretical model concerning comparative advantage and transaction efficiency, focuses on one of the potential mechanisms through which China achieves its fast economic growth over the past few decades. Chapter 8 concludes the book by summarizing the results from the previous chapters and suggesting directions for further studies.

The Nature of Learning about Customers in a Customer Service Setting - A Study of Frontline Contact Persons

The starting point of this thesis is the notion that in order for organisations to understand what customers value and how customers experience service, they need to learn about customers. The first and perhaps most important link in an organisation-wide learning process directed at customers is the frontline contact person. Service- and sales organisations can only learn about customers if the individual frontline contact persons learn about customers. Even though it is commonly recognised that learning about customers is the basis for an organisation’s success, few contributions within marketing investigate the fundamental nature of the phenomenon as it occurs in everyday customer service. Thus, what learning about customers is and how it takes place in a customer-service setting is an issue that is neglected in marketing research. In order to explore these questions, this thesis presents a socio-cultural approach to understanding learning about customers. Hence, instead of considering learning equal to cognitive processes in the mind of the frontline contact person or learning as equal to organisational information processing, the interactive, communication-based, socio-cultural aspect of learning about customers is brought to the fore. Consequently, the theoretical basis of the study can be found both in socio-cultural and practice-oriented lines of reasoning, as well as in the fields of service- and relationship marketing. As it is argued that learning about customers is an integrated part of everyday practices, it is also clear that it should be studied in a naturalistic and holistic way as it occurs in a customer-service setting. This calls for an ethnographic research approach, which involves direct, first-hand experience of the research setting during an extended period of time. Hence, the empirical study employs participant observations, informal discussions and interviews among car salespersons and service advisors at a car retailing company. Finally, as a synthesis of theoretically and empirically gained understanding, a set of concepts are developed and they are integrated into a socio-cultural model of learning about customers.

Moral Education in the Japanese Primary School Curricular Revision at the Turn of the Twenty-first Century: Aiming at a Rich and Beautiful Kokoro

This study examines values education in Japanese schools at the beginning of the millennium. The topic was approached by asking the following three questions concerning the curricular background, the morality conveyed through textbooks and the characterization of moral education from a comparative viewpoint: 1) What role did moral education play in the curriculum revision which was initiated in 1998 and implemented in 2002? 2) What kinds of moral responsibilities and moral autonomy do the moral texts develop? 3) What does Japanese moral education look like in terms of the comparative framework? The research was based on curriculum research. Its primary empirical data consisted of the national curriculum guidelines for primary school, which were taken into use in 2002, and moral texts, Kokoro no nôto, published by the Ministry of Education in the same context. Since moral education was approached in the education reform context, the secondary research material involved some key documents of the revision process from the mid-1990s to 2003. The research material was collected during three fieldwork periods in Japan (in 2002, 2003 and 2005). The text-analysis was conducted as a theory-dependent qualitative content analysis. Japanese moral education was analyzed as a product of its own cultural tradition and societal answer to the current educational challenges. In order to understand better its character, secular moral education was reflected upon from a comparative viewpoint. The theory chosen for the comparative framework, the value realistic theory of education, represented the European rational education tradition as well as the Christian tradition of values education. Moral education, which was the most important school subject at the beginning of modern school, was eliminated from the curriculum for political reasons in a school reform after the Second World War, but has gradually regained a stronger position since then. It was reinforced particularly at the turn of millennium, when a curriculum revision attempted to respond to educational and learning problems by emphasizing qualitative and value aspects. Although the number of moral lessons and their status as a non-official-subject remained unchanged, the Ministry of Education made efforts to improve moral education by new curricular emphases, new teaching material and additional in-service training possibilities for teachers. The content of the moral texts was summarized in terms of moral responsibility in four moral areas (intrapersonal, interpersonal, natural-supranatural and societal) as follows: 1) continuous self-development, 2) caring for others, 3) awe of life and forces beyond human power, and 4) societal contribution. There was a social-societal and emotional emphasis in what was taught. Moral autonomy, which was studied from the perspectives of rational, affective and individuality development, stressed independence in action through self-discipline and responsibility more than rational self-direction. Japanese moral education can be characterized as the education of kokoro (heart) and the development of character, which arises from virtue ethics. It aims to overcome egoistic individualism by reciprocal and interdependent moral responsibility based on responsible interconnectedness.

Which Narrative? The Case of the Narrative Subject in Fifteenth-Century Altarpieces

The development of the altarpiece towards the end of the late medieval period added a new decorous and conspicuously visual element to the church interior. The altarpiece became the prime location for iconic – i.e. non-narrative – images, but almost from the beginning narrative images were part of the altarpiece in the form of small-scale pictures placed underneath or next to an iconic image in the centre. In the fifteenth century the format of the altarpiece gradually changed, and simultaneously with the development of the unified picture field some new narrative subjects began to appear on the central panel as the main subject of the altarpiece. During the course of the fifteenth century, narrative subjects became increasingly frequent and accepted subjects for altarpieces. In this article I will focus on the problem of the narrative altarpiece, a seeming contradiction of terms. As narrative subjects were transferred from their usual location to the central field of the altarpiece, traditionally reserved for the iconic image, the narrative was included in a new context and expected to assume the function of the altarpiece. How did a narrative image function in this context, and what kind of audience did it serve? Since the questions involved in the issue are complex, I will focus on the biblical narrative of The Visitation as a case study, and use two well-known Florentine altarpieces from the fifteenth century as examples of the interpretative choices open to the viewers of these altarpieces.

The struggle for protection of environmental refugees: who's responsibility? Discourses from the United Nations and Non-governmental organizations

This thesis identifies, examines and problematizes some of the discourses that have so far come to light on the issue of protection for environmental refugees. By analyzing the discourses produced by the United Nations Office of the High Commissioner for Refugees (UNHCR) and two non-governmental organizations - the Environmental Justice Foundation (EJF) and Equity and Justice Working Group Bangladesh (EquityBD), I examine the struggling discourses that have emerged about how protection for environmental refugees has been interpreted. To do this, I rely on Ernesto Laclau and Chantal Mouffe's theory and method of discourse analysis. The results show that responsibilization is the main point of struggle in the discussions on the protection of environmental refugees. As a floating signifier, it was utilized by the discourses produced by the UNCHR and the selected NGOs in contingent ways and with different political objectives. The UNHCR discourse responsibilized both the environmental refugees for their own protection and the individual states. The EJF and EquityBD, by contrast, allocated responsibility for the protection of environmental refugees to the international community. These contingent understandings of responsibilization necessitated different justifications. While the EJF discourse relied on humanitarianism for the assistance of environmental refugees, the EquityBD discourse constructed a rights based, more permanent solution. The humanitarian based discourse of the EJF was found to be inextricably linked with the neoliberal discourse produced by the UNHCR. Both these discourses encouraged environmental refugees to stay in their homelands, undermining the politics of protection. Another way in which protection was undermined was by UNHCR's discourse on securitization. In this context, climate change induced displacement became threat to developed countries, the global economy and transnational classes. The struggling discourses about who/what has been allocated responsibility for the protection of environmental refugees also meant that identities of the displaced be constructed in specific ways. While the UNHCR discourse constructed as voluntary migrants and predators, the EJF and EquityBD discourses portrayed them as victims. However, even though the EJF discourse constructed them as victims, their reliance on humanitarianism could also be interpreted as a way of giving the environmental refugee a predator like identity. These discourses on responsibilization and identity formation clashed with each other in the aim of achieving a hegemonic position in discussions and debates about the protection of environmental refugees.

Theorizing the Nature of Reflection

For the past decades reflection has been the buzzword of adult and higher education. Reflection is facilitated in many practices and there is abundant research on the issue. Despite the popularity of the concept, the reasons why bringing about reflection in educational practices is difficult remain unclear. The prevailing theories inform of the process in its ideal form. However, to a great extent, they fail to offer conceptual tools for understanding and working with the actualities of reflection. The aim of the doctoral thesis was to explore the challenges and prerequisites of reflection in order to theorize the nature of reflection. By the term reflection it is here referred to becoming aware of and questioning the assumptions that orient our thinking, feelings and actions. The doctoral thesis consists of five studies that approach these questions from different viewpoints and within different contexts. The methods involve both a philosophical and an empirical approach. This multifaceted approach embodies the aim of both gaining a more thorough grasp of the phenomenon and to develop the methodology of researching reflection. The theory building is based on conceptual analysis and rational reconstruction (see Davia 1998; Habermas 1979; Rorty1984) of Mezirow s (1981; 1991; 2000; 2009) theory of transformative learning. In order to explore the aspects which, based on the analysis, appeared insufficiently considered within Mezirow s theory, Damasio s (1994; 1999; 2003; 2010) theory on emotions and consciousness as well as Clausewitz s (1985) view on friction are used as complementary theories. Empirical analyses are used in dialogue with the theoretical, in order to challenge and refine the emerging theorization. Reflection is examined in three different contexts; regarding university teachers pedagogical growth, involuntarily childless women recovering from a life-event crisis, and soldiers preparing to act in chaotic situations of the battlefield as well as recovering from it. The choice of these contexts is based on Mezirow s notion of disorienting dilemma as a trigger for reflection. This notion indicates that reflection may more naturally emerge in association to life-event crises or other cumulative sets of instances, which bring our worldview and beliefs under question. Nevertheless, reflection is often being promoted in educational contexts in which the trigger conditions may not readily prevail. These contextual issues as well as the differences between the facilitated and non-facilitated contexts have not, however, been considered in detail within the research on reflection (or transformative learning). The doctoral thesis offers a new perspective into reflection which, as a further development on Mezirow s transformative learning theory, theorizes the nature of reflection. The developed theory explicates the prerequisites and challenges to reflection. The theory suggests that the challenges of reflection are fundamentally connected to the way the biological life-support system affects our thinking through emotions. While depicting the mechanisms that function as a counterforce to reflection, the developed theory also opens a perspective for considering possibilities for carrying out reflection, and suggests ways to locate and deal with the assumptions to be reflected on. The basic dynamic of the challenges to reflection was explicated by conceptually bridging the gap between Mezirow s and Damasio s theories, through exploring the connections between the meaning perspective and the biological functions of emotions. The concepts of comfort zone and edge-emotions were formed so as to depict the emotional orientation of our thinking, as part of the explanation of the nature of reflection.