Alterations to cognitive function are often reported with depression and anxiety symptoms, yet few studies have examined the same associations with mental well-being. This study examined the association between mental well-being, depression and anxiety symptoms and cognitive function in 1502 healthy adult monozygotic and dizygotic twins, and the shared/unique contribution of genetic and environmental variance. Using linear mixed models, mental well-being was positively associated with sustained attention, inhibition, cognitive flexibility, motor coordination and working memory, whereas depression and anxiety symptoms were (...) associated with poorer sustained attention, inhibition, cognitive flexibility and executive function. Bivariate twin modelling showed well-being shared a small environmental correlation with motor coordination and a small genetic correlation with working memory. Trivariate twin modelling showed well-being shared a small genetic correlation with inhibition, whereas depression and anxiety symptoms shared a small environmental correlation with inhibition. The remaining variance was mostly driven by unique G and/or E variance. Overall, well-being and depression and anxiety symptoms show both independent and shared relationships with cognitive functions but this is largely attributable to unique G or E variance and small shared G/E variance between pairs of variables. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 157-159 [Access article in PDF] Constructing Persons:The Psychopathology of Identity Stephen R. L. Clark Keywords identity, legal fictions, materialism, psychopathology. Steve Matthews argues that the criteria proposed by Stephen Behnke and Walter Sinnott-Armstrong for establishing personal identity in cases of Dissociative Identity Disorder (DID) are flawed. Neither brain identity nor memory convergence are adequate grounds for ascribing identity, even in the absence of (...) DID. Someone suffering from DID is no less responsible than a drunkard for the crimes she commits when not in her right—or at least her usual—mind, and perhaps no more responsible than someone suffering from some other mental disorder. We may decide to punish someone suffering from DID for her crimes only when she and her presumed alter both share a brain (as obviously they do) and might—at least after therapy—have memories in common, and only when the alternate personality that led to the crime is herself sane. But we should not pretend to ourselves that this judgment rests upon a clear and uncontentious notion of identity.It may be that Matthews still shares too much of his opponents' attitude: namely, that there is some matter of fact about identity, or at least some fact about the central principles by which we ascribe or recognize identity. This, at first sight, is the force of his counterexamples: that the Behnke/Sinnott-Armstrong criteria give counterintuitive results and so cannot exactly map the notion that we have in mind. Just so Socrates was able to prove that Justice did not consist in Paying One's Debts, because we would all at once acknowledge that it was not Just (or Right) to restore his sword to a homicidal maniac (or at least that there were real doubts about who it was that really owned the sword). But neither Socrates' nor Matthews' conclusion need be referred to any simple fact. It would not be sensible to say that the maniac had a right to have his sword, or that its keeper had a duty to return it, because we recognize implicitly that the very point of Justice is to do Good. Correspondingly, maybe the real effect of Matthews's counterexamples is to remind us what the point of Judgment is. Is there any matter of fact about identity, or is identity simply a way of saying who it is that should now be held responsible? Joe is not to be held responsible because he is the same person as the one who committed the crime: he is reckoned the same person because he is the one who is here now to be held responsible. That is what it is to be the same person: to be held responsible for what is personally done. [End Page 157]Someone who is not a person at all is not the same person as anyone (although they may be the same creature). And a person is a creature who holds herself responsible, or can do so: who has memories and anticipations to which she lays claim, appropriates as her own. This in turn is possible because (or so it seems) she has acquired the necessary words and customs: because she sees people being held responsible she can also hold herself responsible—or sometimes disclaim all responsibility. She will not always be allowed to escape all blame or credit, merely because her memories are of a self that no longer makes much sense to her, nor even because she has no memories at all of what was done. But this need not be because she is objectively the very same person as the sometime agent; rather, the person she is taken to be is constructed by the legal and moral attitudes of those who judge her. Those attitudes are not necessarily determinate: how exactly the ordinary rules apply in novel cases may be a matter of decision rather than discovery. The connections that ordinarily ground or specify identity are not robust enough to rely upon in DID patients (that, after all, is the trouble). We have to make... (shrink)

There are good reasons for being suspicious of the very concept of ‘a religion’, let alone a ‘world religion’. It may be useful for a hospital administrator to know a patient's ‘religion’ – as Protestant or Church of England or Catholic or Buddhist – but such labels clearly do little more than identify the most suitable chaplain, and connote groupings in the vast and confusing region of ‘religious thought and practice’ that are of very different ranks. By any rational, genealogical (...) taxonomy ‘Protestant’, ‘Anglican’, ‘Catholic’ connote species, genera or families within Christianity, which is in turn a taxon within the multivariant tradition traced back to Abraham. ‘Buddhism’ includes as many variants as would ‘Abrahamism’. Most Abrahamists, traditionally, have been theists, but it is difficult not to suspect that Marxist socialism is an atypical variant which has inherited a linear view of time, a contest between the chosen agents of justice and the doomed powers-that-be, and the prospect of a future in which ‘there shall be no more sea’. (shrink)

Many religious people are alarmed about features of the current age - violence in the media, a pervasive hedonism, a marginalization of religion, and widespread abortion. These concerns influence politics, but just as there should be a separation between church and state, so should there be a balance between religious commitments and secular arguments calling for social reforms. Robert Audi offers a principle of secular rationale, which does not exclude religious grounds for action but which rules out restricting freedom except (...) on grounds that any rational citizen would accept. The book describes the essential commitments of free democracy, explains how religious and secular moral considerations can be integrated to facilitate co-operation in a world of religious pluralism, and proposes ideals of civic virtue that express the mutual respect on which democracy depends. Audi offers a balanced and sophisticated treatment of the relations between religion and politics in a modern, secular society. (shrink)

Anyone who wishes to talk about angels has to respond to the mocking question, how many of them can dance on the point of a pin. The answer is: ‘just as many as they please’. Angels being immaterial intellects do not occupy space to the exclusion of any other such intellectual substance, and their being ‘on’ the point of a pin can only mean that they attend to it. The question, however, is not one that concerned our mediaeval predecessors, although (...) it seems as difficult to persuade anyone of this as it is to clear Canute of the charge of insane conceit. (shrink)

R. M. Hare has argued 1 that there are conceivable circumstances in which it would be right not to abolish the institution of slavery: in the imaginary land of Juba established slave-plantations are managed by a benevolent elite for the good of all, no ‘cruel or unusual ’ punishments are in use, and citizens of the neighbouring island of Camaica, ‘free ’but impoverished, regularly seek to become slaves. Hare adds that it is unlikely, given human nature, that ‘masters ’would treat (...) ‘slaves ’humanely, and avoid a gradual corruption of their moral consciousness which would cancel out any possible advantages of the system. Slavery is wrong, he argues, not because it violates ‘fundamental human rights’, but I because it would in practice generally increase misery. (shrink)

I consider reasons for questioning ‘the laws of logic’, and suggest that these laws do not accord with everyday reality. Either they are rhetorical tools rather than absolute truths, or else Plato and his successors were right to think that they identify a reality distinct from the ordinary world of experience, and also from the ultimate source of reality.

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Multiple Personality and Moral Responsibility”Stephen R. L. Clark (bio)Theaitetos sleeping is not quite “the same” as Theaitetos waking, any more than Alcibiades drunk is Alcibiades sober. Nor am I, at fifty, quite “the same” as Stephen was when he was five. In one way, my sober fifty-year-old waking self can reasonably disclaim responsibility for what Stephen did or seemed to do when he was dreaming, drunk, or (...) five years old. Those other Stephens were not “fully responsible,” were not doing what they freely chose because they chose it—though it would be odd to deny that they were acting willingly. Nor am I now very likely to do the things that—drunk, asleep, or five years old—“I” did: in that sense I can disown those actions and never fully “owned” them anyway. Maybe now I can even disown such actions as I once really owned: once I thought them the right thing, and now I do not.On the other hand, as Stephen Braude says, even children (even, he might have added, dogs) are treated “as if” they are “responsible”: as if, that is, they know what they were doing and may be deterred from doing it again. Should Alcibiades sober be made accountable for what “he” did when drunk? Why not, if this deters him from getting drunk again? Perhaps, as Aristotle suggested, those who do wrong when they are drunk should be fined double the amount. Perhaps those who find it difficult not to drink habitually should be fined ten times the amount. What matters is the amount of money that will put them off, that will force them to “take responsibility” for their own future lives. People who know that they can’t trust themselves when they are drunk, sexually excited, or driving a fast car must put it out of their own power to be in those positions—and if they can’t do that, then others must do it for them. Free men and women “take responsibility,” take charge of their own lives, and wish to be held responsible for what they do and have done. Those who cannot “take control” must, technically, be slaves.There is no point expecting “natural slaves” to take control of their own lives; to measure what they want against what is allowed by society. Such “slaves,” at best, can be controlled by an immediate threat or prize. In a way, it is pointless to punish them, though it may be necessary to imprison, maim, or kill them. Much the same thing may be said of some who are not, strictly, slavish. Should eighty-year-olds be “held responsible” for what they did in their forgotten youth, a world away? They will not be doing it again, and may not, even now, have any greater understanding than the rest of us as to why they did it in the past. “Punishment” in such a case can only [End Page 55] be used to deter others who might follow the same path, to help them to control their lives in ways that do not injure others. Otherwise, we are not strictly speaking of “punishment” at all: perhaps more often than we like to admit, public condemnation, incarceration, or execution is a symbolic elimination of a perceived evil, whether or not we think, or have good grounds for thinking, that the victim is really guilty. The sacrificial victim carries away our anger or unhappiness.Pragmatically, in other words, we punish people for things that—even at the time of the action—they did not control, or which they have long forgotten. For punishment to deter them, they must understand what they are being punished for. For it to reform them, they must accept that the punishment inflicted is just. Those who neither understand nor accept punishment may still be treated harshly, for the sake of others—maimed, or killed, or simply (if we choose to be humane) imprisoned. There are some acts, so Aristotle said, below the level of humanity: such bestiality cannot be punished. It does not follow that the perpetrators should be “free.” Pragmatism permits us to retain the rites of sacrifice, even... (shrink)

Words have determinable sense only within a complex of unstated assumptions, and all interpretation must therefore go beyond the given material. This book addresses what is man's place in the Aristotelian world. It also describes man's abilities and prospects in managing his life, and considers how far Aristotle's treatment of time and history licenses the sort of dynamic interpretation of his doctrines that have been given. The ontological model that explains much of Aristotle's conclusions and methods is one of life-worlds, (...) in which the material universe of scientific myth is no more than an abstraction from lived reality, not its transcendent ground. (shrink)

The notion that metaphorical statements are strictly false suggests that all statements, even those that seemed ‘literal’, are false, as none can ‘literally’ reflect reality. Statements about what we perceive or could perceive rely on evoking sensory images of such ‘visibles’, even though we have no direct access to what others, may perceive. In addition to what is visible, we must also deal with ‘invisibilia’ (both the fantasms that respectable moderns now reject and the realities that lie beyond or before (...) all sentient experience). Talking about such distant or long-ago realities must always be ‘metaphorical’, as they cannot have any of the merely ‘subjective’ properties of experience, nor do they explain those latter properties. Is there some way of confirming the brute conviction that there is a ‘real and intelligible world’, and that we can find it out or describe it ‘literally’? May ‘Reason’ be a route to understanding? But this too is an illusion: we seem never in practice to escape contradictions and had perhaps better turn again to consider the worlds of experience to which we are confined. What we experience is conditioned by our imagination: whether that metaphorical imagination points beyond experience remains uncertain. (shrink)

Twenty years ago, people thought only cranks or sentimentalists could be seriously concerned about the treatment of non-human animals. However, since then philosophers, scientists and welfarists have raised public awareness of the issue; and they have begun to lay the foundations for an enormous change in human practice. This book is a record of the development of 'animal rights' through the eyes of one highly-respected and well-known thinker. This book brings together for the first time Stephen R.L. Clark's major essays (...) in one volume. Written with characteristic clarity and persuasion, Animals and Their Moral Standing will be essential reading for both philosophers and scientists, as well as the general reader concerned by the debates over animal rights and treatment. (shrink)

Words have determinable sense only within a complex of unstated assumptions, and all interpretation must therefore go beyond the given material. This book addresses what is man's place in the Aristotelian world. It also describes man's abilities and prospects in managing his life, and considers how far Aristotle's treatment of time and history licenses the sort of dynamic interpretation of his doctrines that have been given. The ontological model that explains much of Aristotle's conclusions and methods is one of life-worlds, (...) in which the material universe of scientific myth is no more than an abstraction from lived reality, not its transcendent ground. (shrink)

Dennett's Consciousness Explained presents, but does not demonstrate, a fully naturalized account of consciousness that manages to leave out the very consciousness he purports to explain. If he were correct, realism and methodological individualism would collapse, as would the very enterprise of giving reasons. The metaphors he deploys actually testify to the power of metaphoric imagination that can no more be identified with the metaphors it creates than minds can be identified with memes. That latter equation, of minds with meme?complexes, (...) rests for its meaning on the existence of real minds, which are not to be equated with the thoughts they have. (shrink)

Stephen R. L. Clark; XIV*—On Wishing there were Unicorns, Proceedings of the Aristotelian Society, Volume 90, Issue 1, 1 June 1990, Pages 247–266, https://doi.o.

Immortality is a subject which has long been explored and imagined by science fiction writers. In his intriguing new study, Stephen R.L.Clark argues that the genre of science fiction writing allows investigation of philosophical questions about immortality without the constraints of academic philosophy. He reveals how fantasy accounts of issues such as resurrection, disembodied survival, reincarnation and devices or drugs for preserving life can be used as an important resource for philosophical inquiry and examines how a society of immortals might (...) function through a reading of the vampire myth. _How to Live Forever_ is a compelling study which introduces students and professional philosophers to the possibilities of using science fiction in their work. It includes extensive suggestions for further reading, both fictional and philosophical, and examines the work of such major science fiction authors as _Arthur C. Clarke, Frank Herbert, Larry Niven, William Gibson_, and _Colin Wilson_. (shrink)

1. Believing Enough to Think The Scottish system of university education requires most aspirants to an Ordinary Degree to study some philosophy. Philosophers in Scottish Universities must therefore contend with enormous first-year classes, stocked with youngsters who have little real desire to be philosophers, or even to philosophize. Some years ago, at Glasgow, a question in the final exam was as follows: ‘“Philosophy is of no use, and so should not be studied.” Discuss’. A couple of hundred students answered, more (...) or less fluently, that one should not assume that what was of no use should not be studied, since some things were worth studying in their own right, but that in any case the study of philosophy was useful since it helped one to question what authoritative figures said. No essayist, apparently, saw any paradox in this reply, which was, of course, taken word for word from the professor's lectures. (shrink)

"In this engaging study Professor Clark sets out to show that there are good philosophical reasons for theism, and Christian theism in particular. He travels the breadth of our intellectual engagement with the world, from ethics to scientific knowledge, and his journey is vigorously argued, fresh, lively and readable. He explores the assumptions which underpin our philosophical and everyday thinking alike, examines the construction of the arguments used to support them, and tests the sturdiness and the makeup of their props (...) and foundations." --Cover. (shrink)

Whether churches should be demolished, rebuilt, restored or preserved is a contentious issue. Some hold that the needs of a present worshipping community should take precedence over antiquarian or aesthetic interest, others that we owe a debt to the ages. Arguments mirror those between developers and environmentalists. It is argued here that it is not abstract rights that matter, but a sense of history, and of the sacred. Church buildings and landscapes are to be maintained not as museum pieces but (...) as living elements of a humane piety. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minds, Memes, and MultiplesStephen R. L. Clark (bio)AbstractMultiple Personality Disorder is sometimes interpreted as evidence for a radically pluralistic theory of the human mind, judged to be at odds with an older, monistic theory. Older philosophy, on the contrary, suggests that the mind is both plural (in its sub-systems or personalities) and unitary (in that there is only one light over all those lesser parts). Talk of gods and (...) demons has been a way of arranging elements of human mind and motivation. The one light, or center, is something which requires mental discipline to discover rather than being immediately obvious. This indeed is what even Descartes (sometimes blamed for introducing the notion of a simple, transparent self) really intended. Discovering or uncovering the Self is a psychotherapeutic as well as a philosophical imperative.Keywordsconsciousness, gods, Multiple Personality Disorder, passivity, thought alienationMultiple Personality 1The phenomena popularly identified as evidence of “multiple personality disorder” are strangely attractive. The stories suggest that those who provide, who are, the evidence for this disorder are usually in acute distress, but those who wish to believe in it find the idea almost exhilarating. Most of us would rather wish to think that we had undeveloped possibilities, that it would be exciting to be a married academic today, a celibate bus-driver tomorrow and a teenage hooligan on Sundays. The impulse to put aside our duties, or our habits, can be a powerful one, and only the sober thought that we would not, after all, succeed in keeping our lives separate keeps us single. The notion that there are people who take the risk, that our bodies could house a multitude, is one we would wish to believe. At the same time, we wish to remember that such divisions bring their own problems, and as easily suspect that those who apparently succeed in dividing themselves up must have suffered serious trauma in the past, and be plagued by missed appointments and self-hatred in the present. Some of us believe that “multiple personality” reveals a truth about us all, that none of us is actually the simple, heroic self that we pretend: “the self” is only an occasionally concordant swarm of impulses, easily divided. Others of us suspect that it is a wish to avoid responsibility, and guilt, that causes some of us to pretend not to be the selves that actually we are (see Rycroft 1987).On earlier occasions (notably Clark 1991b), I have myself expressed some doubt about reports of Multiple Personality Disorder, and suggested that they should be seen as fictions or dramatic representations (whether by the patient or the reporter) which should not be judged as “true” or “false,” but rather as “interesting” or “pernicious.” Stephen Braude, in a recent excellent book, seems at first to side with the true believers: it is absurd, he suggests, not to believe the many reports of fugue, discordance and fully developed multiples (Braude 1991; see also Wilkes 1984, [End Page 21] Brennan 1990). Maybe a few such reports are over-credulous: it would not be surprising that the occasional clever criminal successfully pretended not to know what an alien other did with his body. But there are, he says, too many independent records to disbelieve, and not only the distant stories of Miss Beauchamp (Prince 1908) or Eve (Thigpen & Cleckley 1954, 1957). Since the 1970s the number of reported cases has been rising again. It may be that some, many, or all the cases are artifacts, in the sense that the doctor’s expectations helped to produce or develop the varied personalities: “when a client walks into the therapist’s office and sits down, the expectation framework of the therapist immediately comes into play” (Crabtree 1985, 211; see also Hawthorn 1983). But the evidence is also compatible with the thought that psychotherapeutic fashion now allows the therapist to notice, rather than invent, the phenomena. Multiples often wish to conceal their condition, it is said, and only observers alerted to the possibility will notice them. Conscious or half-conscious role-playing, which would perhaps be less philosophically interesting, cannot explain more than a few of the cruder cases.In short... (shrink)

Stephen R. L. Clark; XIV*—On Wishing there were Unicorns, Proceedings of the Aristotelian Society, Volume 90, Issue 1, 1 June 1990, Pages 247–266, https://doi.o.

Stephen R. L. Clark; XV*—God, Good and Evil, Proceedings of the Aristotelian Society, Volume 77, Issue 1, 1 June 1977, Pages 247–264, https://doi.org/10.1093/ar.

It has been argued that if non-human animals had rights we should be obliged to defend them against predators. I contend that this either does not follow, follows in the abstract but not in practice, or is not absurd. We should defend non-humans against large or unusual dangers, when we can, but should not claim so much authority as to regulate all the relationships of wild things. Some non-human animals are members of our society, and the rhetoric of 'the land (...) as a community' is an attempt, paralleling that of humanism, to create the moral ideal of Earth's Household. But wild animals should be considered as Nozick's 'independents' and have correspondingly fewer claims on our assistance than members of our society. They still have some claims, often strong ones. (shrink)

Explores and criticizes contemporary models for an environmentally-conscious theology, such as goddess worship, national socialism and process philosophy. The author argues that Christian faith, and other great religions of the world, already teach respect for the sanctity of God's creation.

A discussion of why a strong doctrine of 'reason' may not be worth sustaining in the face of modern scientific speculation, and the difficulties this poses for scientific rationality, together with comments on the social understanding of religion, and why we might wish to transcend common sense.

A study of Plotinus's use of myth and metaphor, with special attention to the historical context and therapeutic use of his work.