Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

This understanding of dirty hands should dispell the air of paradox so often associated with it. Dirty hands is a genuine moral problem, but not a conceptual one. The temptation to see it as a conceptual one arises from a hasty acceptance of these assumptions:Moral criticism is appropriate if and only if we can always do what is right. If we cannot do X or avoid doing Y, we cannot be criticized for failing to do X or for doing Y.We (...) are always free to avoid moral compromise since goodness is a matter of having the will to do what is right.We are morally compromised if and only if we either intentionally do what is wrong, or if we do what is right for the wrong reasons.As a general description of conscientiousness, these conditions are uncontroversial. However, conscientiousness does not exhaust the moral realm. The problem with the individuals in the cases above is not that they are guilty of being unconscientious. They are conscientious and still cannot avoid dirtying themselves.The Kantian aspiration to render ourselves invulnerable to moral compromise is well-intentioned and deserves our respect insofar as it alerts us to the importance of struggling with courage and imagination against evil. But to the extent that it rejects or ignores the possibility of moral tragedy, the Kantian conception paints too optimistic and artificial a picture of the human condition. We are complicated creatures with diverse and often conflicting ethical loves. Rigging our ethical theories to eliminate such conflicts does nothing to change life as real-life moral agents experience it. As with any kind of theory, we need to be careful about unwittingly deforming the world in order to make it conform to the beloved castles we so often build in the air. (shrink)

Three studies were conducted to explore the psychological determinants of COVID-deterrent behaviors. In Study 1, using data collected and analyzed both before and after the release of COVID-19 vaccines, mask-wearing, other preventative behaviors like social distancing, and vaccination intentions were positively related to assessments of the Coronavirus Behavioral Health Mindset ; belief in the credibility of science; progressive political orientation; less use of repressive and more use of sensitization coping; and the attribution of COVID-19 safety to effort rather than ability, (...) powerful forces, fate, or luck. In Study 2, favorable COVID-19 vaccination intentions were related to greater willingness to work, lower emotional distress, and greater customer experience mindset. Study 3 examined the personality and motives of individuals who volunteered to help deliver COVID-19 inoculations to the local community. The vaccine-giving volunteers, especially those with prosocial motives, had high CVBHM scores, belief in the credibility of science, low use of repressive coping, greater attribution of COVID-19 protection to effort, low likelihood of voting conservative, were older, and had more education than others. The majority of public health volunteers expressed prosocial motives to help people or join a cause, but many expressed the personal motives of getting the COVID-19 vaccination for themselves, conveying a public image of compassion, or structuring time. Based on the three research studies, a COVID-19 Mindset Hierarchy model is proposed to integrate the results. (shrink)

It cannot be denied that a correct notion of justice is very relevant to the solution of most modern problems. The constant appeal to the rights of individuals and groups of individuals and the widespread practice of injustice bear witness to this. Yet the very frequency with which the terms justice and injustice are used has, one fears, reduced those words to mere labels for whatever claim it is desired to make or deny, without regard for the existence of an (...) objectively just order in public and private life. There is need then of a reaffirmation of the idea of justice and an application of its principles, in terms suitable to our modern modes of thought, to current problems of human relationships. (shrink)

According to the ideological surround model of research, a more “objective” psychology of religion requires efforts to bring etic social scientific and emic religious perspectives into formal dialog. This study of 245 Iranian university students illustrated how the dialogical validity of widely used etic measures of religion can be assessed by examining an emic religious perspective on psychology. Integrative Self-Knowledge and Self-Control Scales recorded two aspects of the “Perfect Man” as described by the Iranian Muslim philosopher Mortazā Motahharī. Use of (...) these instruments in correlation and multiple regression procedures identified Intrinsic, Extrinsic Personal, Religious Interpretation, Extrovertive Mysticism, Prayer Fulfillment, Universality, Connectedness, and Religiosity Scales as adaptive in their implications for a Muslim psychology of religion. Religious Crisis had maladaptive and Extrinsic Social, Introvertive Mysticism, and Quest Scales had ambiguous implications. These data illustrated how etic forms of understanding can clarify and can be clarified by emic insights. (shrink)

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

The current work builds a definition of irritability from both academic definitions and lay perspectives. In Study 1, a quantitative content analysis of academic definitions resulted in eight main content categories. In Study 2, a community sample of 39 adults participated in qualitative interviews. A deductive thematic analysis resulted in two main themes. The first main theme dealt with how participants positioned irritability in relation to other negative states. The second dealt with how participants constructed irritability as both a loss (...) of control and as an experience that should be controlled. The discussion integrates the findings of both studies and provides a concise, but comprehensive definition. (shrink)

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

Jennifer Hornsby has defended the Reasons-Knowledge Thesis : the claim that \-ing because p requires knowing that p, where the ‘because’ at issue is a rationalising ‘because’. She defends by appeal to the thought that it provides the best explanation of why the subject in a certain sort of Gettier case fails to be in a position to \ because p. Dustin Locke and, separately, Nick Hughes, present some modified barn-façade cases which seem to constitute counterexamples to and undermine Hornsby’s (...) way of motivating it by rendering their alternative Reasons-Explanation Thesis a better explanation of Hornsby’s datum. This paper defends and Hornsby’s argument for it against those objections. First, I point out that their supposedly intuitive verdict about the relevant barn-façade cases is not as intuitive as they think. Second, I point out that even if we share the intuition: we have strong reason to doubt the verdict anyway. And finally, I point out that since is independently implausible, the two problems can be tackled anyway. (shrink)

We can contrast rationalising explanations of the form S φs because p with those of the form S φs because S believes that p. According the Common Kind View, the two sorts of explanation are the same. The Disjunctive View denies this. This paper sets out to elucidate the sense in which the Common Kind Theorist asserts, but the Disjunctivist denies, that the two explanations are the same. I suggest that, in the light of the distinction between kinds of explanation (...) and particular explanations, the relevant sameness thesis is ambiguous, thus giving us two distinct versions of the Common Kind View. I then argue that the only direct arguments for Disjunctivism available in the literature fail because they only succeed in undermining one version of the Common Kind View. I finish, however, by providing a fresh argument for the Disjunctive View which aims to undermine both versions of its competitor. (shrink)

Here is a surprisingly neglected question in contemporary epistemology: what is it for an agent to believe that p in response to a normative reason for them to believe that p? On one style of answer, believing for the normative reason that q factors into believing that p in the light of the apparent reason that q, where one can be in that kind of state even if q is false, in conjunction with further independent conditions such as q’s being (...) a normative reason to believe that p. The primary objective of this paper is to demonstrate that that style of answer cannot be right, because we must conceive of believing for a normative reason as constitutively involving a kind of rationality-involving relation that can be instantiated at all only if there is a known fact on the scene, which the agent treats as a normative reason. A secondary objective, achieved along the way, is to demonstrate that in their Prime Time Errol Lord and Kurt Sylvan do not succeed in undermining the factoring picture in general, only a simple-minded version of it. (shrink)

It is now standard in the literature on reasons and rationality to distinguish normative reasons from motivating reasons. Two issues have dominated philosophical theorising concerning the latter: (i) whether we should think of them as certain (non-factive) psychological states of the agent – the dispute over Psychologism; and (ii) whether we should say that the agent can Φ for the reason that p only if p – the dispute over Factivism. This paper first introduces a puzzle: these disputes look very (...) much like merely verbal disputes about the meaning of phrases like `S’s reason’ in motivating reasons ascriptions, and yet charity requires us to think that something substantive is afoot. But what? The second aim of the paper is to extract substantive theses from certain natural arguments for Psychologism and Anti-Factivism – theses which are versions of a controversial view of the nature and normative structure of rationality. The paper ends by arguing against these substantive theses on phenomenological and ethical grounds. The upshot is that proponents of Psychologism and Anti-Factivism are either engaged in the project of defending merely verbal theses or they’re engaged in the project of defending false substantive ones. (shrink)

We show, using the fine structure of K, that the theory ZF + AD + X R[X K] implies the existence of an inner model of ZF + AD + DC containing a measurable cardinal above its Θ, the supremum of the ordinals which are the surjective image of R. As a corollary, we show that HODK = K for some P K where K is the Dodd-Jensen Core Model relative to P. In conclusion, we show that the theory ZF (...) + AD + ¬DCR implies that R† exists. (shrink)

The primary focus of Susanne Mantel’s excellent 'Determined by Reasons' is to develop a distinctive abilities-based account of acting in response to normative reasons, one which is clearly modelled on extant ability-theoretic accounts of knowledge. This review sketches Mantel’s account and raises a worry: that the account fails to characterise the sort of abilities constitutively involved in responding to reasons because it allows that agents can act for the reason that p even if their belief that p is not accessible (...) to conscious reasoning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 353 proportionalism that Finnis's theological argument exploits. In this regard, there is no moral theory, good or bad, which overreaches so far as proportionalism does. Princeton University Princeton, New Jersey ROBERT P. GEORGE Faithful Persuasion: In Aid of a Rhetoric of Christian Theology. By DAVID S. CUNNINGHAM. Notre Dame: University of Notre Dame Press, 1991. Pp. xvii + 312. $29.95 (cloth) ; $16.95 (paper). The relation (...) between words and the Word has always been of in· terest in Christian theology. Earlier in this century a school of writers approached " the Bible as literature " with a view to bringing Scripture into a more persuasive relation with literature at large, but their insistence on the rigorous exclusion of dogmatic elements from literary scrutiny impoverished their work. A later set of procedures and perspectives on rhetoric and language in their relation to reality was bet· ter able to allow the utterances of a text's speakers their own integrity, whether sacred or secular. In any case, a thematic interpretation of the founding texts of Christianity, influenced by Aristotle's Rhetoricwhere form is a means for persuasively communicating an idea-content -had long predominated in ecclesial usage, germane as it was to the didactic concerns of the Church. An alternative tradition, more indebted to Aristotle's Poetics, where form, content, and functions are treated as factors making for the indissoluble whole which is the literary work, has been less conspicuous-though its offer of initiation into the " world " of the sacred writers gives it great exegetical potential. The text's "word " should be encountered at the level of its own patterned imagery and wrought design. In the appreciation of the Gospels this has become in recent decades a commonplace. However, as the T. S. Eliot scholar Helen Gardner warned, one should not so react against the older approach as to treat the biblical text as the product of a disembodied imagination, rather than a human being writing a work that might make his readers "wise unto salvation." David S. Cunningham's Faithful Persuasion extends this discussion of the propriety or impropriety of a rhetorical approach to Scripture to the discourse of Christian theology as a whole. The intent is a laudable one but its execution vitiated, to my mind, by the excessive concessions to scepticism from which the author sets out. Because his theological epistemology, aware of the limitations of the propositions in which we assert the truths of faith, will grant those assertions no more than a 354 BOOK REVIEWS (continuously) revisable character, he falls back on an account of theology as rhetoric so as to make the best of a bad job. For persuasion is what we use when we know demonstration is hopeless. As a result, Professor Cunningham's study, which could most usefully have "placed" a variety of theologies of past, present, and, prospectively, future on the spectrum of (onto-) logic, poetic, and rhetoric, concludes instead that theology must regard itself as rhetorical or perish! This inevitably narrows the several services theologies of different kinds can perform for the Church. Imagine how biblical studies would be reduced were the exegete only to treat his text as paraenesis, and never as history or as a symbolic world. Nonetheless, on the way from its (as I find) unsatisfactory startingpoint and to its depressing conclusion, Faithful Persuasion has worthwhile points to make about a number of authors (of various periods) and topics, though it might have made them more persuasively (its author's key term) had the intended audience (middle-brow or academic?) been more clearly viewed in advance. AIDAN NICHOLS, O.P. Blackfriars Cambridge, England Church and Culture: German Catholic Theology, 1860-1914. By THOMAS FRANKLIN O'MEARA, O.P. Notre Dame/London: University of Notre Dame Press, 1991. Pp. x + 260. $35.95 (cloth). " In 1925, Baden's Kultusminister, a Protestant, began an address to the Gorresgesellschaft in Heidelberg by describing this era: ' Brave men like Hertling, Schell, Julius Bachem, and Carl Muth, shook the German Catholic world in order to lead it out of its fortress, to lead it again into the midst of the life and activity of the entire people, even when this seemed at... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:354 BOOK REVIEWS (continuously) revisable character, he falls back on an account of theology as rhetoric so as to make the best of a bad job. For persuasion is what we use when we know demonstration is hopeless. As a result, Professor Cunningham's study, which could most usefully have "placed" a variety of theologies of past, present, and, prospectively, future on the spectrum of (onto-) logic, poetic, and (...) rhetoric, concludes instead that theology must regard itself as rhetorical or perish! This inevitably narrows the several services theologies of different kinds can perform for the Church. Imagine how biblical studies would be reduced were the exegete only to treat his text as paraenesis, and never as history or as a symbolic world. Nonetheless, on the way from its (as I find) unsatisfactory startingpoint and to its depressing conclusion, Faithful Persuasion has worthwhile points to make about a number of authors (of various periods) and topics, though it might have made them more persuasively (its author's key term) had the intended audience (middle-brow or academic?) been more clearly viewed in advance. AIDAN NICHOLS, O.P. Blackfriars Cambridge, England Church and Culture: German Catholic Theology, 1860-1914. By THOMAS FRANKLIN O'MEARA, O.P. Notre Dame/London: University of Notre Dame Press, 1991. Pp. x + 260. $35.95 (cloth). " In 1925, Baden's Kultusminister, a Protestant, began an address to the Gorresgesellschaft in Heidelberg by describing this era: ' Brave men like Hertling, Schell, Julius Bachem, and Carl Muth, shook the German Catholic world in order to lead it out of its fortress, to lead it again into the midst of the life and activity of the entire people, even when this seemed at first strange and uncomfortable ' " (pp. 159f.). Even to many theologians, the era in question-the last four decades of the nineteenth century through the outbreak of the "Great War"is comparatively unknown. There has been, of course, renewed interest in prominent theological figures like John Henry Newman, but his German-speaking contemporaries are for the most part strangers to the English-speaking world. And this is the first reason why this book is important: it describes a forgotten world of a century or so ago, yet one whose theological problematic was strikingly similar to our own. The " contours " of this period, deftly described in the first part of this book, were both varied and complex. Politically speaking, during the nineteenth century, " Germany " changed from an assortment of BOOK REVIEWS 355 geographically contiguous minor and medium-sized states to an Empire dominated by Prussia. Such a political re.arrangement had ecclesiastical implications: Roman Catholics, who previously had been the majority in places like Bavaria found themselves a persecuted minority during the Kulturkampf under Bismarck. And like many other victims of persecution, Roman Catholics adopted a "fortress mentality"fearful of Berlin, which was influenced by both the Lutheran Reformation and the Enlightenment, and mesmerized by Rome, which was coming under the increasing influence of neoscholasticism in doctrine and ultramontanism in discipline. German Catholic theologians found themselves in a quandary: what direction should they take? Many, like Joseph Kleutgen, took refuge in Rome; a few, like Joseph Schnitzer, found the appeal of Berlin more attractive; still others, however, tried to steer an independent course in dialogue with the culture of their day. The second and major part of this book focuses on five such theologians: Matthias Joseph Scheeben, Alois Schmid, Paul Schanz, Herman Schell, and Carl Braig. Scheeben (1835-88), "the best known and the most read in the first half of the twentieth century " (p. 53), pursued an independent route in seeking a " transcendent synthesis " incorporating both patristic and idealist thought; indeed, his lengthy Mysteries of Christ"ianity continued to enjoy a certain popularity up till the time of Vatican II, though more as a resource for spiritual reading than as a work of systematic theology. Like Newman, Scheeben's thought was sui generis, "and inspired the most divergent evaluations " (p. 65) ; unlike Newman, Scheeben has few disciples today. In contrast to Scheeben, the other four theologians attempted to emerge from the " fortress " of Roman Catholic defensiveness and to engage the historical and philosophical currents of their age. The... (shrink)

Die Synagoge ist das dritte der fünf großen byzantinischen Lexika: Kyrill, Hesych, Synagoge, Photios, Suda. Im Kyrill-Lexikon war erstmals der Wortschatz der heidnischen, hellenistischjüdischen und frühen christlichen griechischen Literatur gesammelt. Es ist in Hesych nachträglich eingearbeitet; etwa ein Drittel des „Hesych“ stammt aus „Kyrill“. Kyrill ist in der Synagoge exzerpiert; etwa 80 Prozent ihrer Glossen lassen sich auf ihn zurückführen, und sie kann durchaus als Kyrill-Rezension angesehen werden, wie es in einer ihrer Handschriften geschieht (vgl. p. 19, 49). Die Synagoge (...) ist nahezu vollständig in Photios und Suda eingearbeitet, und zwar nach der zweiten ihrer beiden überlieferten Rezensionen. (shrink)

Cunningham and Kavic [1] rightly note that standard accounts of surgical complications—ours included—have focused on postoperative events [2, 3]. As they point out, this postoperative focus leaves open the question of how we should categorize adverse intraoperative events. They argue that we should distinguish between two types of adverse intraoperative events: those that introduce additional risk of postoperative complications and those that do not. On their account, adverse intraoperative events that introduce additional risk of postoperative complications are intraoperative complications, (...) whereas those that do not are simple errors. Cunningham and Kavic say little about why we might want to make this distinction. We take it that the underlying purpose is to focus attention on the importance of diligence in surgical performance. Gawande defines diligence as ‘‘the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles’’ [4, p. 8]. It is clear that diligence in surgery requires us to attend not just to those adverse intraoperative events that lead to postoperative complications but also to adverse intraoperative events that increase the risk of postoperative complications. We wholeheartedly agree about the importance of diligence in surgery, both in the intraoperative and the.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Laughing at Nothing: Humor as a Response to NihilismWill SlocombeLaughing at Nothing: Humor as a Response to Nihilism, by John Marmysz. 209 pp. Albany: SUNY Press, 2003; $54.50 cloth, $17.95 paper.Nihilism has become a (relatively) more popular theme in academia in recent years. Aside from the revival of standby texts such as Goudsblom's Nihilism and Culture and Rosen's Nihilism, there has been a glut of books in areas (...) as diverse as economics (Ritzer's The Globalization of Nothing), theology (Cunningham's Genealogy of Nihilism), and theory (Clemen's The Romanticism of Contemporary Theory). John Marmysz's contribution, Laughing at Nothing, is a refreshing change inasmuch as he invites us to laugh at nihilism and, in effect, to laugh with him at much of the scholarly work on nihilism. Primarily philosophical in tone, Laughing at Nothing is an academic treatise on nihilism and humor, an exploration of contemporary American culture, and a plea for understanding in a hostile environment.Marmysz is determined, as few others are, to see a positive potential in nihilism. Although he never uncovers a "positive" nihilism, he is willing to accept the idea that nihilism may be a valuable cultural concept. In his introduction, he stresses the fact that most critics of nihilism "underplay the constructive and positive role of nihilism in both individual and collective human history" (p. 10). This book attempts to undermine such trite interpretations of nihilism; evident from his observation that, "too often scholars proceed to draw conclusions about nihilism itself on the basis of philosophies that are, in fact, very poor models" (p. 11). This is an important point, and one to which I will return.All exegeses on nihilism must include a history of the concept to orient the reader within the given intellectual milieu, and Marmysz's is no exception. Moving comfortably from late eighteenth-century debates between Friedrich Jacobi and Johann Fichte to contemporary theories by Michael Gillespie, Cornel West, Yukio Mishima, and Karen Carr, Laughing at Nothing guides the reader through the intricacies of the arguments in three brisk chapters without [End Page 449] ever sacrificing clarity. This is no mean feat given the task that Marmysz has taken upon himself: to summarize more than 200 years of history and avoid the pitfalls of saying that nihilism is an aspect of modernity is a significant achievement (and one for which I am grateful).For most readers, however, the most important part of Laughing at Nothing will be Marmysz's own definition of nihilism, which is essentially thwarted idealism: "The full impact of the problem of nihilism strikes only when an individual passionately desires ultimate meaning, value, and purpose, but believes those things to be out of reach" (pp. 84-85). There are thus two elements to a nihilistic worldview: an idealized desire for a better world coupled with a belief that this can never be realized—"the real world is denigrated in comparison to the ideal, and the ideal is believed to be hopelessly out of reach" (p. 85). This, for Marmysz, is the basis of a "nihilistic incongruity," upon which the solution—humor—is founded.After Marmysz's treatment of a history of nihilism, it is unsurprising that his discussion of humor is as accomplished, skilfully navigating theories of Kant, Freud, Bergson, and Morreall. Marmysz's treatment of "incongruous" humor is impressive, basing itself on the idea that "humor allows us to confront incongruities and, instead of being overwhelmed by them, to understand them in an unusual and original fashion" (p. 152). For this reason, humor creates "the capacity to make incongruities unthreatening and to interpret them in a manner that produces amusement" (p. 153). This is, of course, critical to avoid the potential problems of nihilistic incongruity. Through an analysis of jokes, and the application of different theories about humor, Marmysz demonstrates that the "solution" to nihilism is disarmingly simple: we must learn to laugh at ourselves. Marmysz writes: "Nihilism reminds us that humans are not gods, and that despite all our accomplishments and wonders of civilization, humans cannot alter the fact that they only possess a finite amount of mastery and control over their own destinies... (shrink)