Delays in early language development are characteristic of young autistic children, and one of the most recognizable first concerns that motivate parents to seek a diagnostic evaluation for their child. Although early language abilities are one of the strongest predictors of long-term outcomes, there is still much to be understood about the role of language impairment in the heterogeneous phenotypic presentation of autism. Using a person-centered, Latent Profile Analysis, we first aimed to identify distinct patterns of language and social communication (...) ability in a clinic-based sample of 498 autistic children, ranging in age from 18 to 60 months. Next, a multinomial logistic regression analysis was implemented to examine sociodemographic and child-based developmental differences among the identified language and social communication profiles. Three clinically meaningful profiles were identified from parent-rated and clinician-administered measures: Profile 1 “Relatively Low Language and Social Communication Abilities,” Profile 2 “Relatively Elevated Language and Social Communication Abilities,” and Profile 3 “Informant Discrepant Language and Relatively Elevated Social Communication Abilities.” Overall, young autistic children from the lowest-resource households exhibited the lowest language and social communication abilities, and the lowest non-verbal problem-solving and fine-motor skills, along with more features of attention-deficit/hyperactivity disorder and atypical auditory processing. These findings highlight the need for effective community-based implementation strategies for young autistic children from low-resource households and underrepresented communities to improve access to individualized quality care. (shrink)

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges (...) for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the D.S.M. affected by financial links with the pharmaceutical industry? To what extent (...) were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

How should knowledge be analyzed? Compositionally, as having constituents like belief and justification, or as an atomic concept? In making arguments for or against these perspectives, epistemologists have begun to use experimental evidence from developmental psychology and developmental linguistics. If we were to conclude that knowledge were developmentally prior to belief, then we might have a good basis to claim that belief is not a constituent of knowledge. In this review, I present a broad range of developmental evidence from the (...) past decade and discuss some of the implications it has for the proper analysis of knowledge. The orthodox perspective from the developmental literature was one where children fail to understand belief and knowledge concepts until later in childhood, with typical asymmetries in belief attribution and knowledge attribution. But what emerges from both a discussion of newer findings and a contextualization of older findings is a picture of development whereby core competence with belief and knowledge concepts emerges much earlier than previously thought that apparent failures in later childhood may be explained by other aspects of development than conceptual development and that there is no clear evidence that knowledge attributions emerge earlier than belief attributions. (shrink)

A major goal of this work is to specify some steps of the process by which participants maintain coherency in their conversations.The underlying element of the analysis is a construct called a “context space.” Roughly, a group of utterances that refers to a single issue or episode forms the basis for a context space. Superficially, a conversation is a sequence of utterances; at a deeper level it is a structured entity whose utterances can be parsed into hierarchically related context spaces.As (...) a conversation proceeds, each conversant builds a discourse model that includes the conversation's context space structure, a notion of the present discourse topic, and a list of items being focused upon. Conversational coherency depends upon a lack of conflict between the respective models of the participants. Conflicts are prevented by speakers following high level syntactic and semantic relational rules that enable listeners to identify their discourse models. These rules, given in the study, are highly integrated with the view of conversation presented here—a hierarchy of related context spaces. (shrink)

Hate speech and misinformation are rife. How to respond? Counterspeech proposals say: with more and better speech. This paper considers the treatment of counterspeech in Maxime Lepoutre’s Democratic Speech In Divided Times. Lepoutre provides a nuanced defence of counterspeech. Some counterspeech, he grants, is flawed. But, he says: counterspeech can be debugged. Once we understand why counterspeech fails – when fail it does – we can engineer more effective counterspeech strategies. Lepoutre argues that the failures of counterspeech can be theorised (...) using the ideology of salience. Negative counterspeech fails because it reinforces the salience of the very ideas or associations that it contests. His solution? Positive counterspeech – a form of counterspeech which avoids the salience trap. I argue that the salience paradigm is ill-suited to theorise the failures of counterspeech. I suggest some alternatives. Further, I show that these alternative paradigms make importantly different practical recommendations – recommendations concerning how we ought to engineer our counterspeech – from those issued by the salience paradigm. (shrink)

The DSM is the main classification of mental disorders used by psychiatrists in the United States and, increasingly, around the world. Although widely used, the DSM has come in for fierce criticism, with many commentators believing it to be conceptually flawed in a variety of ways. This paper assesses some of these philosophical worries. The first half of the paper asks whether the project of constructing a classification of mental disorders that ‘cuts nature at the joints’ makes sense. What is (...) mental disorder? Are types of mental disorder natural kinds (that is, are the distinctions between them objective and of fundamental theoretical importance, as are, say, the distinctions between the chemical elements)? The second half of the paper addresses epistemic worries. Even if types of mental disorder are natural kinds there may be reason to doubt that the DSM will come to reflect their natural structure. In particular, I examine the extent to which the DSM is theory-laden, and look at how it has been shaped by social and financial factors. Ultimately, I conclude that although the DSM is of immense practical importance it is not likely to become the best possible classification of mental disorders. (shrink)

Extensive and diverse conceptual work towards developing a definition of ‘mental disorder’ was motivated by the declassification of homosexuality from the Diagnostic and Statistical Manual in 1973. This highly politicised event was understood as a call for psychiatry to provide assurances against further misclassification on the basis of discrimination or socio-political deviance. Today, if a definition of mental disorder fails to exclude homosexuality, then it fails to provide this safeguard against potential abuses and therefore fails to do an important part (...) of the work it was intended to do. We argue that fact-based definitions of mental disorder, relying on scientific theory, fail to offer a robust definition of mental disorder that excludes homosexuality. Definitions of mental disorder based on values do not fare better: these definitions are silent on questions about the diagnostic status of individuals in oppressive societies and over-inclusive of mental or behavioural states that happen to be negatively valued in the individual's social context. We consider the latest definition proposed for the Diagnostic and Statistical Manual-5 in light of these observations. We argue that definition fails to improve on these earlier deficiencies. Its inclusion in the manual may offer false reassurance against repetition of past misclassifications. We conclude with a provocation that if candidate definitions of mental disorder are unable to exclude homosexuality, it might perhaps be preferable not to attempt a definition at all. (shrink)

Autonomy and the Situated Self offers a critique of contemporary mainstream bioethics and proposes an alternative framework for the exploration of bioethical issues. It also contrasts two conceptions of autonomy, one based on a liberal model but detached from its political foundation and one that is responsive to the concerns of virtue ethics and connected to the concept of human flourishing.

Autonomy and the Situated Self offers a critique of contemporary mainstream bioethics and proposes an alternative framework for the exploration of bioethical issues.

It is necessary to recognize the variety of levels at which values and norms may inappropriately affect the equity of the transplantation process, including candidate selection. Using a revised, richer concept of objectivity, adopted from Longino's work in the philosophy of science and empirical studies of candidate selection, this paper examines what sort of objectivity can be obtained in the transplant candidate selection process, and the closely related question of how selection can occur in an equitable manner. This concept of (...) objectivity requires that transformative criticism occur so that (1) the conceptual and normative commitments underlying selection may be articulated and perhaps challenged, and (2) the relationship between those commitments and criteria for candidate selection may be examined and justified, or revised. Through such transformative criticism, a greater degree of objectivity may be attained, which in turn will increase the likelihood of equity. (shrink)

This article describes a new prenatal genetic test that is painless, early, and increasingly available. State legislatures have reacted by prohibiting abortion for reason of fetal sex or of fetal diagnosis and managing genetic counseling. This article explores these legislative responses and considers how physicians and genetic counselors currently communicate post-testing options. The article then examines the challenges ahead for genetic counseling, particularly in light of the troubling grip of abortion politics on conversations about prenatal diagnosis.

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a framework of analysis. Cultural (...) theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

This paper presents results from a survey of 344 individuals who engage in climate change mitigation action, contributing to debates about whether it is necessary to promote 'nature experiences' and biospheric values to encourage pro-environmental behaviour. We investigate three factors - values, motivations and formative experiences - that underlie such behaviour, but that usually have been considered in isolation from each other. In contrast to previous studies of environmentalists' significant life experiences, outdoor/nature experiences were not frequently mentioned as being influential. (...) Altruistic concerns about climate change impacts on future human generations and on poorer or more vulnerable people were considered more motivating than other reasons for action. There was no significant difference in how respondents rated altruistic and biospheric values. Variations in responses from those involved in 'biospherically-oriented' organisations (such as traditional environmental or conservation organisations) versus those involved in climate change groups suggest that there are different routes into climate change mitigation action, and our results show that it is not essential to cultivate biospheric values or the love of nature to encourage such action. (shrink)

Kant claims in the third Critique that one can make about wine the merely subjective judgment that it is agreeable but never the universally valid judgment that it is beautiful. This follows from his views that judgments of beauty can be made only about the formal (spatiotemporal) features of a representation and that aromas and flavors consist of formless sensory matter. However, I argue that Kant's theory permits judgments of beauty about wine because the experience displays a temporal structure: the (...) aromas and flavors evolve over the course of a tasting from the bouquet through the palate to the finish. An analogy with music, which Kant describes as 'a play of sensations in time', illuminates how wine qualifies as an object of pure judgments of taste: the 'structure' of a wine can be compared to harmonic structure, and its development throughout the taste can be compared to the unfolding of melody and harmonic progression. (shrink)

The stage is often a space where artists engage in experiments with identity politics. Plays like Welcome to Thebes appear to present global human engagement and a cultural exchange of ideas. However, using European narrative structures as a playground to explore Africana political issues highlights the limitations to cross-cultural exchange between aesthetic paradigms. This essay first articulates a conflict between European and Africana aesthetics and then offers an analysis of gender dynamics operating in the play Welcome to Thebes, arguing that (...) performative conditions not only constrain racialized realities, but also limit the possibility of cross-cultural performances of history. (shrink)

I set out to read the book of Joshua together with its most literal interpreters – those who enacted a version of the war for the Promised Land – and suggest that interpretations of the book are always bound up with current ideas about war and territorial rights. In particular, I analyze how David Ben-Gurion, the first Prime Minister of Israel, and his Bible study group parsed the book of Joshua and argue that their interpretations, like the book of Joshua (...) itself, represent projections of nationalist desire onto a varied, multifarious social setting. Joshua’s conquest and Israel’s founding narrative both involve military narratives generated in order to obscure the presence of non-nationals. In the next stage of the argument, I suggest that the story of the conquest itself attests to the very fluid social setting that it aims to overcome. Just as Ben-Gurion appealed to Joshua as precedent and the contemporary State of Israel looks to Ben-Gurion as a model, post-nationalists can locate a paradigm in the selfsame founding myths. (shrink)

This article proposes to reconceive moral education on the model of spiritual practice. Such an education would be defined not by its content—that is, explicit instruction about moral rules or particular virtues—but rather by the form of its constituent activities. Drawing on the works of both Plato and Foucault, the article addresses questions about the epistemic complexity of virtue raised in Mark E. Jonas and Yoshiaka Nakzawa’s A Platonic Theory of Moral Education. It then goes on to suggest that the (...) form of spiritual practice is uniquely suited to the cultivation of virtue understood on their Platonic model. (shrink)

ABSTRACTThe eighteenth century was a peaceful era for East Asia, ruled by the emperors of Ching. However, intellectuals who refused to accept the Great Ching order appeared in Chosŏn and Japan. They developed homeland-centric ideologies. This article compares the Han Wŏn-chin ‘s Chosŏn-centrism with the Motoori Norinaga ’s Japan-centrism. There is a lot of research about the Norinaga’s Japan-centrism in Japanese academia, which contains both aspects of the culture theory and order theory. In Korea, however, discourse about Chosŏn-centrism is still (...) ongoing argument under the concept of ‘Chosŏn’s Sino-centrism ’. I would like to pay attention to that, although homeland-centrism is constructed with two aspects, which are theories of international order and culture, the Chosŏn’s Sino-Centrism related discourse only discuss about culture theory aspect. Therefore, comparing Japan-centrism, which contains both culture and order parts, I will point out the problem of Chosŏ.. (shrink)

Increasingly, Deaf activists claim that it can be good to be Deaf. Still, much of the hearing world remains unconvinced, and continues to think of deafness in negative terms. I examine this debate and argue that to determine whether it can be good to be deaf it is necessary to examine each claimed advantage or disadvantage of being deaf, and then to make an overall judgment regarding the net cost or benefit. On the basis of such a survey I conclude (...) that being deaf may plausibly be a good thing for some deaf people but not for others. (shrink)

Normative reasons for action are considerations that count in favor of actions. They are the considerations that determine what an agent should do in a given situation. If the agent acts on these considerations, they justify her action. This paper concerns accounts of normative reasons that separate the explanation of why a particular reason counts in favor of an agent’s performing some action from the content of that reason. Elements of this explanation of why the reason is a reason are (...) “background conditions” on that reason, rather than part of the reason itself. (shrink)

This chapter begins with the discussion of one of the earliest texts in the Western tradition to explore the relations between philosophy and pedagogy, Plato's Symposium. In this text, love (or more properly, eros) plays the mediating role, turning a love of wisdom into a pedagogical erotics that enables a journey of enlightenment. The author refers to the work of more recent thinkers, including Hannah Arendt, Jean‐François Lyotard and Luce Irigaray. The author's suggestion is that by approaching Symposium through their (...) work, this text can yield insights that are helpful for contemplating the educational process in a more contemporary context. In Symposium, the initial expulsion of the flute‐girl is undercut by Diotima's later inclusion as an apparently privileged female voice. ‘Diotima's speech’ is intriguing for many reasons, not least because it is the only place in Plato's known oeuvre where a woman takes on the part of the philosopher. (shrink)

The only Israelis this generation of Palestinians know are soldiers and settlers. For them, Israel is no more than a subsidiary of an army that knows no limits and settlements that know no borders.Recipient of the UNESCO Guillermo Camo World Press Freedom Prize in 2003, Amira Hass is the only Jewish Israeli correspondent on Palestinian affairs to live among the people about whom she reports. The child of Holocaust survivors, Hass prefers the title "expert in Israeli occupation," and, as such, (...) is relentless in her quest for both truth and justice. (shrink)

The purpose of the current research was to examine strategies of persuasion used by Arabic-speaking and Hebrew-speaking boys and girls to determine the relative contributions of culture and gender in determining communication styles. Children were asked to write a letter to a male or female peer asking for a gender-stereotyped or a gender-neutral gift. Four meta-categories were identified: formality, self-focus, other-focus, and gift-focus. For each meta-category except gift-focus, there were significant main effects and interactions. Language group was significant for formality (...) and other-focus but not for self-focus. Importantly, there were several interactions between participant gender, target gender, and gender-stereotypy of gift, but these did not interact with language group. The results were discussed in the context of children’s socialization to the ethos of musayara and dugri in Arabic-speaking and Hebrew-speaking culture. (shrink)

BackgroundPatients with COVID-19 may feel under pressure to participate in research during the pandemic. Safeguards to protect research participants include ethical guidelines [e.g. Declaration of Helsinki and good clinical practice (GCP)], legislation to protect participants’ privacy, research ethics committees (RECs) and informed consent. The International Committee of Medical Journal Editors (ICMJE) advises researchers to document compliance with these safeguards. Adherence to publication guidelines has been suboptimal in other specialty fields. The aim of this rapid review was to determine whether COVID-19 (...) human research publications report compliance with these ethical safeguards.MethodsA rapid systematic literature review was conducted in MEDLINE using the search term ‘COVID-19’. The search was performed in April 2020 with no start date and repeated to include articles published in November 2020. Filters were ‘Full free text available’ and ‘English Language’. Two reviewers assessed article title, abstracts and full texts. Non-COVID-19 articles and non-clinical studies were excluded. Independent reviewers conducted a second assessment of a random 20% of articles. The outcomes included reporting of compliance with the Declaration of Helsinki and GCP, REC approval, informed consent and participant privacy.ResultsThe searches yielded 1275 and 1942 articles of which 247 and 717 were deemed eligible, from the April search and November respectively. The majority of journals had editorial policies which purported to comply with ICMJE ethical standards. Reporting of compliance with ethical guidelines was low across all study types but was higher in the November search for case series and observational studies. Reporting of informed consent for case studies and observational studies was higher in the November search, but similar for case series. Overall, participant confidentiality was maintained but some case studies included a combination of details which would have enabled participant identification. Reporting of REC approval was higher in the November search for observational studies.ConclusionsWhile the majority of journal’s editorial policies purported to support the ethical safeguards, many COVID-19 clinical research publications identified in this rapid review lacked documentation of these important safeguards for research participants. In order to promote public trust, ethical declarations should be included consistently. (shrink)

Recognition theory attempts to conceptualize interpersonal relationships and their normative political implications. British social philosopher Gillian Rose developed her own version of recognition rooted in the work of Georg Hegel. This article applies Rose's theory of recognition to care, arguing that its emphasis on lack of identity, the dynamic process of recognition and the existential risks involved accurately describes the relationship between nurse and patient. Rose's version is compared to both contemporary notions of the interpersonal in healthcare literature, other forms (...) of recognition theory and Emmanuel Levinas's vision of intersubjective relationships, a traditional philosophical basis for nursing care. In each case, I will argue that Rosean recognition is a fuller, more complex and ultimately more satisfying view of the relationships involved. (shrink)

Volume 20, Issue 10, October 2020, Page 67-69.

Guidelines for revisions to Diagnostic and Statistical Manual of Mental Disorders, 5th edition asked those proposing certain types of revision to consider potential harms to patients. Specifically, those proposing new diagnoses were to consider whether ‘the harm that arises from the adoption of the proposed diagnosis exceed[s] the benefit that would accrue to affected individuals’, and potential for harm was cited as a possible reason for keeping a diagnosis in the appendix rather than promoting it to the main classification. The (...) ‘do no harm’ criterion was referred to in... (shrink)

The period between 1780 and 1840 has long been regarded as a crucial one in the development of geology. In 1780, relatively little was known about the structures and processes of the earth in spite of the efforts of individual mining engineers and bureaucrats, mineralogists, fossil collectors and cosmogonists. By 1840, the sequence of the European rocks was well on the way to being sorted out. This laid the groundwork for the reconstruction of the history of the earth and also (...) of life on the earth. Sophisticated theories of geological causes, consistent with contemporary physics, were in hand. The appropriate methodologies for both historical and causal investigation had been much debated, and a coherent and self-conscious body of men devoted themselves almost exclusively to geology. (shrink)

Egypt of the Hellenistic and Roman periods remains the most thoroughly documented multilingual society in the ancient world, because of the wealth of texts preserved on papyrus in Egyptian, Greek, Latin and other languages. This makes the scarcity of interpreters in the papyrological record all the more curious. This study reviews all instances in the papyri of individuals referred to as hermēneus in Greek, or references to the process of translation/interpreting. It discusses the terminological ambiguity of hermēneus, which can also (...) mean a commercial mediator; the position of language mediators in legal cases in Egyptian, Greek and Latin; the role of gender in language mediation; and concludes with a survey of interpreting in Egyptian monastic communities in Late Antiquity. (shrink)

Hellenistic and Roman acrostich inscriptions are usually full of verbal and visual clues, which point the reader in the direction of the ‘hidden message’ contained in the vertical lines of the text. The authors of such inscriptions want their audiences to appreciate the skill that has gone into their composition. There are several complementary ways in which the presence of an acrostich might be signalled to the reader or viewer and their attention directed towards it. These include direct verbal statements, (...) or more subtle allusions, within the text of the inscription. But, even without having read its text, the viewer of an inscription containing a ‘hidden message’ is often immediately aware that some kind of wordplay is at work. Acrostichs, palindromes and various kinds of word square are all graphically striking, or their appearance may be enhanced to make them more so. Regular spacing, the repetition of the acrostich in a separate column and the use of painted or incised grids are all ways in which the layout of the text on the stone can invite the viewer to play a word game. In some cases, as I will argue in this paper, acrostich makers envisaged—even intended—the participants in this game to include the illiterate as well as the literate. (shrink)