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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Intimate kissing is often viewed as a preliminary or ancillary behaviour in studies exploring sexual interactions. There is a lack of research that focuses on differentiating the types of intimate kisses, including the contexts in which they occur, and desirable and undesirable features. The current study was designed to assess memories of first, best, forbidden and worst kisses. Participants were 691 U.S. adults (mean age 32.27 years; 55% identified as male) who completed an online survey addressing kissing attitudes and experiences using both structured and open-ended survey tools. Four themes emerged through content analysis: physical components, connection to the partner, context, and emotions evoked; and these are discussed for all four types of kissing memories. Findings are discussed in terms of embodiment that intimate kisses capture, their role as a metric of one's attraction to a partner, and the means by which kissing experiences might solidify a sense of oneself as a sexual person.
Five siblings with autosomal dominant oculopharyngeal muscular dystrophy (OPMD) underwent P-31 Nuclear Magnetic Resonance Spectroscopy studies of forearm flexor muscles. Mean values of PCr/(PCr + Pi) in the patients were reduced (p = 0.01) and pH elevated (p = 0.02) in resting muscle when compared to controls. During exercise PCr/(PCr + Pi) fell quickly to values less than controls (p < 0.0001) despite submaximal exercise output and developed exercise-induced acidosis which exceeded that of controls (p = 0.05). Acidosis recovered slowly despite relatively normal recovery of PCr/(PCr + Pi) following exercise. Within the patient group, however, one member had normal resting, exercise and recovery values. The studies suggest that OPMD is a more widespread disorder of striated muscle than clinically appreciated. The pattern of findings observed in OPMD differs from those identified in denervation, disuse and mitochondrial myopathy.
In this important collection of essays Dennis Thompson argues for a more robust conception of responsibility in public life than prevails in contemporary democracies. He suggests that we should stop thinking so much about public ethics in terms of individual vices (such as selfishness or sexual misconduct) and start thinking about it more in terms of institutional vices (such as abuse of power and lack of accountability). Combining theory and practice with many concrete examples and proposals for reform, these essays could be used in courses in applied ethics or political theory and will be read by professionals and graduate students in schools of political science, public policy, law, public health, journalism and business.
Hospital ethics, familiar enough in practice but surprisingly neglected in the literature, deals with the ethical problems that arise distinctively or typically in hospitals. More precisely, it consists of the ethical principles that shouldgovern 1) the conduct of healthcare professionals and other staff in their capacities as members of the hospital as an institution, and 2) the conduct of the hospital itself as an institution. It is a species of institutional ethics, which focuses on the ethical problems created or significantly shaped by the institutional setting in which they occur.
If in a democracy the people have the authority to choose their representatives, then it would seem to follow that they should have the authority to choose the procedures by which they choose their representatives. Yet in nearly all democracies the procedures that govern elections have been established by officials or representatives themselves (Farrell 2001: 176–81; Pilon 2002: 6–13). Legislatures, courts, and commissions rather than popular initiatives or constitutional conventions created and continue to control the electoral process in most democracies. Until recently, attempts to make major changes in any electoral system were rare and rarely succeeded (Norris 2004: 4–6). But in the past decade, electoral reform has been gaining a place on the political agenda in many democracies. In the 1990s, many newly emerging democracies designed their own systems, and nine established democracies made far-reaching changes in their existing systems. Although many of these reforms have been carried out by elites, usually in reaction to contingent political circumstances rather than in the service of a plan to improve the system, citizens themselves have increasingly demanded, and in some cases won, a significant role in the process of reform.
The question of who should choose the electoral system – and more specifically the role citizens should play in that choice – is thus timely. Posing it also creates an opportunity to raise some issues in democratic theory and practice that have been often neglected.
The parliamentary career of John Stuart Mill offers a unique opportunity to observe the tension between theory and practice in the public life of a philosopher-politician. Mill is one of the few political philosophers in modern times to have held national political office, and the only one to have won a legislative seat after publishing theoretical works that proposed practical reforms. The aim of this chapter is to see what can be learned from that career about the challenges a philosopher who goes into politics faces, and more generally about the challenges a politician of principle confronts in turning theoretical commitment into legislative action. The inquiry is partly interpretive: to what extent did Mill modify his principles for political benefit? It is also normative: to what extent should Mill have modified his principles? The answers to the normative question, suitably generalized, suggest some criteria for assessing the compromises that principled legislators make in any democratic polity.
Mill is an apt subject for such an inquiry not only because he was a major theorist, but also because he was known as, and took pride in being known as, an independent thinker who promoted progressive reform. He espoused unpopular positions – some far ahead of his time, such as women's suffrage, and some opposed even by his own allies, such as the recognition of land claims of Irish tenants. He did not aspire to be a politician and won his seat in Parliament without conducting a conventional campaign.
No criticism of politicians in liberal democracies is more common than the charge of hypocrisy. If true, the charge would seem to constitute a serious wrong. Hypocrisy, after all, is a species of deception, and no vice is more dangerous to democracy than deceit. As both politicians and philosophers have long emphasized, veracity is a precondition of democracy. To hold their leaders accountable for any decision or policy, citizens must have truthful information about what leaders and their opponents have done and intend to do.
No theorist insisted more consistently or eloquently on the need for accountability in moral and political life than did Judith Shklar. From her criticism of theorists of historical inevitability for their political evasions to her castigation of public officials for their indifference to passive injustice, she expressed nothing but contempt for people who exercise power without responsibility. Nor did Shklar, in her own writing or speaking, personally or professionally, hesitate to speak openly and candidly. “Facing up to” whatever problem was at issue (as in “Facing up to Intellectual Pluralism”) was her consistent counsel.
It is therefore surprising to find her, in Ordinary Vices, singing the praises of hypocrisy. In the most penetrating theoretical discussion of the subject since He gel's critique of the “age of hypocrisy,” Shklar vigorously defends hypocrites against their critics. She argues that “hypocrisy is one of the few vices that bolsters liberal democracy” (248). Her “liberalism of fear” not only accommodates hypocrisy but welcomes it.
Sunshine laws, the Freedom of Information Act, investigative journalism, and a robust First Amendment ensure that U.S. citizens have access to more information about public officials and public agencies than ever before in history. Yet even in what may be the most open national government in the world, secrecy persists. According to the Information Security Oversight Office, which keeps watch over the U.S. government's secrets, more than three and a half million new secrets are created each year. That works out to almost ten thousand new secrets a day. No doubt many more secrets were not even recorded. Until recently, even the rules and criteria for classifying and declassifying secret information were themselves secret. There are now two million officials in government and another one million in private industry with the authority to classify documents. Many of these are what are called derivative classifiers, who without signing their own names can declare their own document classified just because it quotes from another, originally classified, document.
Government secrecy certainly has not been ignored. Many scholars and reformers have examined it critically, and government bodies have investigated the problem. A bipartisan national Commission on Government Secrecy headed by Senator Daniel Patrick Moynihan concluded that a massive “culture of secrecy” has spread with little oversight throughout the government during the past eighty years, and has now seriously eroded our democratic process. Nevertheless, most of the literature on government secrecy neglects the fundamental democratic values underlying the problem and focuses instead on the laws and policies that regulate secrecy, patterns of abuses by individual officials, or particular practices such as executive privilege and national security.
If the we lf are state is to be democratic, the legislators who make its policies must be responsible to the citizens who are affected by them. Responsibility requires that legislators explain their actions to the citizens they represent. Giving reasons is part of what being responsible means, and part of what being reelected requires.1 But the nature of welfare itself poses a dilemma for democratic responsibility. To justify decisions about welfare, representatives must consider the preferences of citizens. But those preferences at any particular time are not adequate grounds for a justification of welfare policy. Orthodox theories of representation provide no way to cope with this problem; a satisfactory theory must take a different approach. Instead of looking for justifications solely in the preferences of citizens at a particular time, we should look at the legislative process in which the justifications are made.
Welfare policy, more than most other kinds, is grounded in the preferences of citizens. The reasons that representatives give for other kinds of policies, such as civil rights or cultural development, should not follow preferences so closely. When justifying these policies, representatives might not count some preferences as reasons at all (those based on racial prejudice, for example), and might regard other reasons as decisive (those based on individual rights or ideals of excellence). But when welfare is in question, what citizens say should count for more. Citizens may be mistaken about their own welfare, but at some point they must be taken as competent judges of it.
Ethics scandals have proliferated in the worlds of government, business, medicine, and on the sites of many other professions, even the clergy. In the United States more members of Congress have been investigated and sanctioned for misconduct in recent decades than in all of its previous 200-year history. Some 500 officials in the executive branch have been charged with misconduct since 1970. The top executives of Enron, once the world's seventh largest corporation, perpetrated fraudulent schemes that brought about the company's collapse in 2001. The ensuing inquiries exposed ethical failures in other corporations and in the institutions that are supposed to oversee them. Accountants, lawyers, bankers, security analysts, and brokers were implicated. The Catholic Church in the United States has yet to recover from the most devastating scandal in its modern history – the failure to deal early and properly with the hundreds of priests who abused young children. Less dramatic but no less significant lapses occurred in the healthcare system, philanthropic organizations, universities, the legal profession, and the media.
Are public officials, corporate executives, and other leaders becoming more corrupt? Are we in the midst of a “corruption crisis” as some have declared? There is no good reason to believe that our leaders in general are more corrupt than they used to be. In some respects, they may be less corrupt. Conduct that was widely ignored in previous eras (petty graft, nepotism, payola, drunkenness, and physical violence in Congress) would be grounds for prosecution today.
The questions asked in practical ethics most often take this form: What is the right thing to do? But equally important is a question that is less often asked: What is the right thing to do when others do not do what they ought to do? The ethics of oversight addresses this question. It focuses on the moral responsibility for seeing that other people act rightly and, when they do not, the responsibility for acting to correct the problem.
Overseers now play a more important role than ever, and so, therefore, should the ethics of oversight. In modern society, particularly in organizations, we have to trust the decision makers to act rightly because we cannot monitor everything they do. We trust them in part because we trust the people charged with overseeing them. When both the decision makers and their overseers betray our trust, the violation is more than just a double failure of individual responsibility. It points to a systematic problem of institutional responsibility.
the scandals: the failure of oversight
We have seen some striking failures of this kind of responsibility in recent years. I concentrate on three cases from the United States – involving a corporation, a church and a government agency – but their general features, especially the responses to the failures, are relevant to organizations in many other countries. What is striking is how similar the responses are, even though the organizations and the wrongs are quite different.
Democracy does not suffer bureaucracy gladly. Many of the values we associate with democracy – equality, participation and individuality – stand sharply opposed to the hierarchy, specialization, and impersonality we ascribe to modern bureaucracy. Yet for a long time political theorists did not see bureaucracy as a threat to democracy, and democratic theorists still have not formulated a satisfactory response to the challenge bureaucratic power poses to democratic government. One response to this challenge denies bureaucracy any place at all in a genuine democracy. Theorists who take this approach usually realize that they must show that bureaucracy does not inevitably appear in every modern society, but only in those societies they consider non democratic. Thus, nineteenth-century British writers often referred to bureaucracy as the “Continental nuisance,” from which their democracy was immune. Marx and other socialist writers agreed that France and Germany had the most highly developed bureaucracies, but they insisted that, as merely one manifestation of the bourgeois state, bureaucracy would disappear with the capitalism that gave rise to that state. Yet socialist societies (admittedly not yet the democracies Marx had in mind) turned out to be more bureaucratic than the governments they replaced. Similarly, the belief that bureaucracy inheres in only socialist government could hardly be sustained once capitalist societies created the administrative structures necessary to maintain their large welfare states.
Still, from time to time, voices on both the left and the right revive the hope that bureaucracy might be abolished. Many have called for decentralization to eradicate bureaucracy. But smaller political