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Personality assessment in nursing home residents with mental and physical multimorbidity: two informant perspectives
- Ankie F. Suntjens, Ruslan Leontjevas, Anne M. A. van den Brink, Richard C. Oude Voshaar, Raymond T. C. M. Koopmans, Debby L. Gerritsen
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- Journal:
- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 25 April 2024, pp. 1-13
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Objectives:
In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients’ relatives (HAP) with the present-time perspective of nursing staff (HAP-t).
Design:Cross-sectional.
Setting:Dutch gerontopsychiatric nursing home (GP-NH) units.
Participants:Totally, 142 GP-NH residents with MPM (excluding dementia).
Measurements:NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0–10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (−10–10).
Results:78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: “disorderly” (30.3%), “unpredictable/impulsive” (29.1%) and “vulnerable” (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6–2.9, p = 0.002). After RT correction, the traits “vulnerable”, “perfectionist” and “unpredictable/impulsive” behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6–1.7, p < 0.001; +2.1, 95% CI 1.3–2.8, p < 0.001; +0.6, 95% CI 0.1–1.1, p = 0.013), while “rigid” behavior scored lower (−0.7, 95% CI −1.3 to −0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58.
Conclusions:Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.
9 - The International Perspective on Tristram Shandy and the Argument
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- Anthem Press
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- 01 March 2024
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- 10 October 2023, pp 141-156
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Summary
We have discovered in Chapters 1 through 5 that in drawing his Shandean characters, Sterne's revision of dullness fuses benevolent intentions with self-defeating actions. We have found, too, that this paradoxical blend of self-sacrifice and self-inflation draws us within the Shandean world to admire their generosity and to laugh at their ineptness. Within the ambiguity of that world, we have also learned that while the benevolence of Yorick seems nearly unachievable, the life of utter dullness seems nearly unforgivable. Not surprisingly, as Mary-Celine Newbauld has thoroughly documented, such keen Sternean insights to the ambiguity of the human condition profoundly influenced other creative works in eighteenth-century Britain, including sentimental travel narratives, theater, and graphic arts.
The International Inf luence of Tristram Shandy and Sterne's International Inf luencers
In reading responses to Sterne's Tristram Shandy beyond England, we learn that Sterne's revision of dullness has been the primary cause of his work's popularity and influence. Lodwick Hartley writes, for instance, that Tristram Shandy enjoyed popularity with eighteenth-century American statesmen. While Thomas Jefferson admired Sterne's moral “emphasis on inward motive and intention,” Aaron Burr, thinking of forgivable, well-intended Shandean dullness, admitted that “if I had read Sterne more and Voltaire less, I should have known that the world was wide enough for Hamilton and me.” After outlining the many inept, eighteenth-century American imitations of Sterne's sentiment Hartley explains that twentieth-century Americans have appreciated Sterne for his Joycean treatment of “human isolation in a world where everybody is victimized by the limitations of language and by his own peculiar ‘association of ideas’ “ (Hartley 1971, 167). Yet American readers still value Sterne, says Hartley, as a “prophet of men of good will” (Hartley 1971, 168).
Sterne's revision of dullness has also strongly influenced non-English-speaking writers and readers. As A. O. Aldridge explains, Brazil's Machado de Assis reveals a “peevish pessimism” over worldly dullness that makes his tone more sardonic than Sterne’s. But Aldridge also notes that Machado de Assis revealed Sterne's influence by using the digressive technique to involve readers in the creative process of exposing hobbyhorsical dullness (Aldridge 1971, 170–75).
1 - Walter, Toby, Tristram, and the Reader: Sterne’s Revision of “Dullness”
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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Summary
Those who enjoy humor ranging from the sentimental to the ridiculous have long embraced Laurence Sterne's The Life and Opinions of Tristram Shandy, Gentleman, for such readers attest, as do Anne Bandry-Scubbi and Peter de Voogd (2013), that Sterne keeps his promise to arouse laughter that will help them to “fence against” ineluctable pain. As Madeleine Descargues- Grant and many other scholars attest, among the most memorable sources of laughter in Sterne's work stands Tristram's father Walter, the bungling philosopher of systems who stumbles in unbuttoned trousers to his son's christening, hoping to secure the infant's future with “Trismegistus,” a name, Walter asserts, that will guarantee the boy's greatness (4: 384; 1: 57). Equally entertaining, Tristram's Uncle Toby, the gentle ex-captain of artillery, plays boldly at war games but trembles in innocence before seductive Widow Wadman and tenderly refrains from hurting a bothersome fly (6: 556; 8: 715; 3:191). Most readers will also admit to chuckling heartily over Tristram's bawdy at the expense of an oversexed abbess (7: 606), and over Parson Yorick's hot-chestnut prank at the expense of the pompous old fornicator Phutatorius (4: 378); and such readers may laugh all the more freely with license granted by both Tristram and Sterne (1: Dedication to Pitt, 9; 8: 716).
Yet, as Richard A. Lanham explains, critics have long debated the meaning of Sterne's humor. In the ludicrous but short-lived clashes between the Shandys, all described in the following chapters, many mid-twentieth-century scholars see moral instruction, a reflection of the need for reasonable heads to join generous hearts in Christian living, an expression of faith in humanity's capacity for goodness in response to pain. Some critics from the late-twentieth and twenty-first centuries have echoed these moral themes. For instance, J. T. Parnell finds in Sterne's humor a commitment to Anglican values and an expression of “fideistic skepticism” in response to philosophical systems woven from pride, and Ryan Stark speaks of Sterne advancing “the Christian faith” in a “decidedly odd way” by exposing “gloomy religionists everywhere.”
4 - Isolation and Death: The Tragic Undertones of Shandean Benevolent Dullness
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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- 10 October 2023, pp 83-102
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Summary
Death, says Alvin Kernan, always emerges as the great symbol of tragedy. Isolation, therefore, as Northrop Frye explains, becomes the primary theme of the “tragic mode” in which the hero's exclusion from humanity often ends in exclusion from life. Though it seems at first strange to speak of tragedy in a satiric work devoted to laughter, the “underlying tonality” of Tristram Shandy modulates with tragic action, for the benevolent dullness of Sterne's comic heroes ends in either isolation or death.
Before progressing with his own life and opinions, Tristram relates the story of Yorick's death, which ends with the symbolic black page. I will therefore begin this chapter with a brief return to the tragic “fatality” that “attends the actions” of Yorick in his campaign against grave dullness (1: 24), focusing this time on Eugenius, who functions, to use Frye's terminology, as the “outspoken critic of the tragic action” and the witness of Yorick's cathartic death (Frye 1957, 218). Agreeing with Eugenius rather than with Helene Moglen, who finds Yorick an innocent victim of a dull community, I will show that Yorick, like most tragic protagonists in Frye's “high mimetic” mode, makes choices that cause his fate.
Eugenius’ Tragic Friend
We have already seen the type of Tristram's isolation in the penalty Yorick pays for his jesting campaign against dullness. We have also heard the warning of Yorick's friend Eugenius that the “fools” and “knaves” rebuked by Yorick's “sport” will challenge the parson with “war” (1: 32). As the “faithful friend,” whom Frye describes as “refusing, or at any rate resisting” that tragic hero's “movement toward catastrophe” (Frye 1957, 218), generous Eugenius spells out for the incorrigible parson-jester the “consequences” of such warfare with worldly dullness (1: 29). First, Yorick will suffer his “faith questioned,” his “works belied,” his “wit forgotten,” and his “learning trampled on” by the “malice” of “hired ruffians” (1: 32). Finally, in the “last scene” of his “tragedy,” the “helpless” parson will be “sacrificed” on the “fire” fueled by his jests in order to appease those who have felt the sting of his corrective wit (1:32).
8 - Parson Yorick in A Sentimental Journey and in A Continuation of Bramine’s Journal
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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Summary
I have argued in Chapters 1 through 5 that Sterne has consciously revised the traditional action of dullness in Tristram Shandy, that he has created benevolent Shandean characters who frustrate their good intentions with prideful, selfdefeating actions. Forwarding this same argument, Ronald Paulson asserts that Sterne also “modified the satiric process” in writing A Sentimental Journey. Though Yorick functions as a satirist in Tristram Shandy, writes Paulson, in A Sentimental Journey, the traveling parson becomes “both satiric object and observer” (264). To put Paulson's comment in the terminology used above, in A Sentimental Journey, Yorick displays, just like his friends in Tristram Shandy, benevolent dullness. Not surprisingly, in a close reading of Sterne's Continuation of Bramine's Journal, we find this same display of Shandean dullness found in A Sentimental Journey in Sterne's nonfiction account of Yorick-Sterne's passion for Eliza Draper and his anguish in England as she makes her own sentimental journey to India.
A Sentimental Journey
Yorick begins his journey basking in the warmth of his benevolent urge to share his prosperity, but his prejudice toward mendicants quickly exposes his self-righteous dullness. Sounding more like Tristram, who blames all his problems on fortune (1: 8), Yorick claims that he was “predetermined” to put his purse away when the “mild, pale” monk approaches, as the hard-working clergyman, now idle, cannot abide those who get through life in “sloth and ignorance, for the love of God.” Though Yorick later grants charity, in the form of a snuff box, to the monk (1: 26), his sudden, generous reversal, as John Stedmond points out, results from his desire to impress the melancholy beauty he has met. Yet the legitimate warmth of Yorick's heart radiates first from the guilt he suffers for his cruelty to the monk, guilt he feels before he meets the woman (1: 11); later, Yorick will cry over the monk's grave with only the reader there to note his feelings (1: 27).
Yorick's Sentimentality
Yorick's tears, however, do not always flow from deep feeling, as Stedmond argues in discussing the famous caged-starling scenes. Though Yorick sighs apostrophes to the abstraction “Liberty” and laments the “miseries of confinement” suffered in the bird cage and in the Bastille (2: 96, 97), the dull parson, observes Stedmond, forgets to release the bird in his anxiety over his own need for a passport to preserve his freedom (Stedmond 1967, 155; 2: 92).
Contents
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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6 - Laurence Sterne’s Letters
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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Summary
In a letter written in 1767, one year before his death, Laurence Sterne describes himself as a “sentimental being” but assures his anonymous aristocratic friend that he counts himself as no ineffectual, scatter-brained Shandy. “The world has imagined,” Sterne explains to the earl, that “because I wrote Tristram Shandy I was myself more Shandean than I really was.”
We must acknowledge Sterne's disclaimer here when we contrast his sales to those of Tristram, who laments the “ten cart loads” of unsold volumes (8: 663) and receives no recognition in Paris (7: 599). In contrast to such failure and anonymity, in a 1762 letter to the famous actor David Garrick, Sterne writes of the “unexpected honours” he received in France, boasting that he has, unlike Tristram, converted many French readers “unto Shandeism” (Letter 81: 224; Letter 84: 242). Indeed, in his 1765 letter to Robert Foley, Sterne admits receiving, unlike Tristram, a “considerable sum” from sales of Tristram Shandy (Letter 147: 409), and Sterne's letter to Thomas Becket in the same year describes gratifying sales (Letter 89: 261).
Yet despite this contrast between the author's success and the surrogate's failure as well as Sterne's denial of Shandean kinship, Sterne shares Tristram's authorial experiences and motives. We have already seen in Tristram Shandy itself that Sterne and Tristram have accepted the inevitable persecution that comes to wit and the inevitable death that comes to humanity, and that, their tragic resignation notwithstanding, both authors have committed themselves to writing for friendship and against dullness. Sterne's letters reflect this same Shandean resignation and commitment.
Sterne's Epistolary Rebukes of Moralistic Dullness
Even though Tristram Shandy became immediately fashionable, Sterne, like Tristram, received numerous rebukes from the “grave” moralists. In a 1760 letter to Garrick, Sterne speaks of the “wound” he received from the rumor that he intended to lampoon William Warburton as Tristram's tutor. Such a report, says Sterne, mirrors the kind of “malice” that “brought poor Yorick to his grave” (Letter 46: 123). In that same year, Sterne confesses in a post-script to a letter addressed to Warburton that “the scribblers’ use me ill” (Letter 59: 152); Sterne was also accused of slandering Dr. Mead in his portrait of the pompous Dr. Kunastrokius (Letter 45: 125). Reiterating
Frontmatter
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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2 - The Yorick Standard, Walter’s Benevolent Dullness, and Tristram’s Friends: The Plot of Satire in Tristram Shandy
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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Summary
In analyzing the plot of satire in Tristram Shandy, I will first join Melvyn New and others in affirming that Sterne has set up good-natured Parson Yorick as his model of the humble but active life of benevolence, his Christian satiric standard, which exposes by contrast the self-defeating folly of dullness. But I will depart from New and John Stedmond by demonstrating the paradoxical blend of dullness and benevolence in the Shandean world. Focusing primarily on Tristram's father, Walter, I will show that Shandean self-deceptions flow from generosity as well as from self-importance. I will argue, too, that Sterne created this ambiguous but laughter-provoking fictional world not to make dullness seem harmless but to draw readers into “friendship” with those—the Shandys—who lack the brutal brand of dullness that buried Yorick, thereby luring readers toward the standard of humble benevolence that most will never fully attain. To emphasize the elusive challenge of Yorick's life, I will finally illustrate how Sterne uses Tristram to mock the dullness in readers that he fails to see in himself.
Dullness and Distortion of Reality
The plot of satire, says Alvin Kernan, relates events in no causal, linear sequence. Rather, the ironic, apparently disjunctive plot relates the actions of the self-deceived in conflict with the actions of the real world. Motivated by pride, by the conviction that they may exceed limitations that define mortals, the dull ignore “what is and is not possible for man” and, therefore, secure perpetual self-defeat and “build,” ultimately, a world without form, a wasteland swarmed by a mindless mob (Kernan 1965, 102, 14). Such a plot, notes Kernan, illustrates Northrop Frye's description of the “mythos of winter,” one of the four “mythoi or generic plots,” the mythos that portrays the energetic “creation” of chaos, of a “world that desire rejects” (Kernan 1965, 183, 14).
This triumph of chaos results, Kernan writes, from a “multitude of smaller movements” of dullness, which he categorizes as confusing reality, magnifying reality, and diminishing reality. When dull people use language, explains Kernan, they produce confusion rather than clarity because they intend to display their verbal wit, not to share their observations on reality (Kernan 1965, 30).
Preface
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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Summary
Reflecting the turn toward cultural studies, the rich site for exploring issues of race, gender, and social injustices, the twenty-first century has seen many university presses publishing books focusing on multiple works and disparate authors. Most scholars have celebrated the value and timeliness of such publications, but I would argue that the time has come for a fresh reading of Sterne's greatest novel. In perusing the criticism on Sterne's work, we find Tristram Shandy frequently cited as a “novel on novel-writing,” a novel well “grounded” in “eighteenth-century fiction” yet a precursor to Joycean streamof- consciousness narration and to “postmodern” thought (Keymer 20, 27); we also find descriptions of Sterne's novel as equally grounded in satire on “Enlightenment system-building,” satire reminiscent of Burton's reflections on the sources of melancholy, Swift's allegories on madness, Cervantes’ anti-romances, and the “learned wit” of Rabelais and Monteyne (Keymer 20, 21, 24). Reflecting these diverse descriptions of Sterne's most famous novel, book-length studies of Sterne's Tristram Shandy appeared frequently in the 1950s, 1960s, and 1970s; since then, Sterne studies have multiplied and prospered, primarily in academic journals, but also in specialized books.
I offer this book, then, to demonstrate that, beyond the traditional objects of satire found in Sterne's Tristram Shandy, Sterne has revised the satiric plot in developing what I call the “benevolent dullness” of Walter, Toby, and Tristram; I borrow this term “dullness,” of course, from Alexander Pope's great satire “The Dunciad,” published in 1743, two decades before Sterne began publishing the first volumes of his novel.
The Shandys’ self-defeats derive, as this book will show, from generous instincts and from deliberate “moral characters” as well as from arrogant selfdeceptions that typify traditional objects of satire, such as leaders in government, the military, the sciences, the arts, and literature—the intelligent but sinisterly self-absorbed dunces that populate Pope's nightmarish poem and threaten collectively to “bury all” in a culture of “darkness.”
Additionally, the book will show that this paradoxical blend of dullness and benevolence in Sterne's characters generates an ambiguous moral condition that evokes both praise and blame in Sterne's readers.
3 - “True Shandeism”: The Unhappy Comic Action in Tristram Shandy
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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Summary
The action of Shandean dullness, as we have seen, unfolds as radically satiric: arrogant self-deceptions produce social conflict and self-defeat. Witness once again the family “harmony” disrupted by Walter's self-indulgent research on Slawkenbergius, which secures neither the nose nor the future of Tristram (3: 277). We have also seen, however, that Shandean self-deceptions derive as well from self-preserving yet generous instincts fused with conscious benevolence in efforts for social union. Note once more Tristram's efforts on behalf of “friends,” partially described in the previous chapter. All comic characters, says Alvin Kernan, possess this vitality to preserve and give the self, and these efforts to reconstruct dull society on a benevolent foundation, explains Northrop Frye, define the goal of comic action. Because comic characters seek survival and freedom renewed in social union, they have the will to triumph over the “blocking forces” of dullness and the absurd mischances that together challenge their efforts to order human existence.
Writing his life and opinions for the sake of friendship defines Tristram's comic will to preserve himself and to unite others, a will, says William V. Holtz, that Tristram shares with his creator. The degree to which Sterne's art depicts the “comic triumph of life” over dullness will be the primary concern of this chapter (Kernan 1965, 187). To define the comic view of human limitations, I will first return to Tristram's story of Yorick, the parson whom Tristram endorses, before and beyond the black pages, for what Kernan calls his comic spirit, his warmth, and his wit. I will then follow John Stedmond in using Yorick to measure the dullness of Tristram's world; departing from Stedmond, however, I will show that Tristram purposely resurrects Yorick the jester not only to help him win friends through laughter but also to sharpen the contrast between Walter's educational follies and the learning abused by the worldly dull.
I will turn then to Tristram's self-assertive comic struggle against what Kernan calls the “ludicrous minutiae” that fill his family's past and prevent the telling of all. In Kernan's view, Tristram deprives his autobiography of the “dignity” he would give it when he insists on recounting past “trivialities” such as the ridiculousness of his naming and circumcision ceremonies (Kernan 1965, 96).
7 - The Shandean Sermons of Parson Sterne
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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Summary
In his scholarly Notes to the Sermons, the fifth volume of The Florida Edition of the Works of Laurence Sterne, Melvyn New rightly challenges the “notion” that “we can find a mirror in Sterne's Sermons of the popular conception of the Shandean author” (17), for Sterne wrote and preached as an Anglican clergyman aiming to convey a Christian message, not to reveal his own life (21). Yet, this autobiographical disclaimer notwithstanding, we have found in our analysis of Tristram Shandy Sterne's standard of humble benevolence in Parson Yorick; we have found self-inflating and self-defeating dullness in characters like Phutatorius; we have found the paradox of benevolent dullness in the Shandys; and throughout we have found Tristram and Sterne's intent to draw readers toward Yorick by drawing them first into the laughing world of the Shandys. These same discoveries of character and authorial intent, if not authorial identity, can be made in Sterne's sermons.
Sermons on “Kindred Virtues” and the Folly of Dullness
In the preface to Marjorie David's edition of The Sermons of Mr. Yorick,2 for instance, Sterne underlines Yorick's call for charity guided by religion, a call found in the “Abuses of Conscience” sermon delivered by Trim in Tristram Shandy (2: 139–67).3 His sermons, writes Sterne (Preface: 2), will illustrate “philanthropy, and those kindred virtues to it, upon which hang all the laws of the prophets.” In his sermon titled “Inquiry After Happiness,” Sterne expands on Psalm IV, 5–6, in a Johnsonian manner, surveying vain searches for happiness in pomp and sensuality to conclude that all such “experiments” lead to disappointment and the “perplexed state” of dullness (1: 5). One can escape this defeated state, writes Sterne, only through “the joy and satisfaction of living in the true faith and fear of Thee” (1: 5). Such faith, explains Sterne in “The Case of Hezekiah and the Messenger,” demands that a human being live, as we have found that Yorick lives in Tristram Shandy, with “open and generous integrity”; one must say “the thing he thinks” and do “the thing he pretends,” not like wealthy Hezekiah, who takes credit for the gifts of God (17: 164).
References
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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Satire, Comedy and Tragedy
- Sterne's 'Handles' to Tristram Shandy
- Richard C. Raymond
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The first four chapters of the book provide a close reading of the satiric, comic, and tragic action of Laurence Sterne's novel in the context of criticism from the twentieth and twenty-first centuries. Chapter 5 provides a summary of Chapters 1-4, focusing on Sterne's purpose in revising satiric plot structures and in blurring the lines between fiction and autobiography. Chapters 6-8 then examine Sterne's themes from Tristram Shandy that inform his letters, sermons, and other fiction; Chapter 9 discusses the international reception of Tristram Shandy and argues for using writing-to-learn strategies to teach Sterne's greatest novel to undergraduate and graduate students.
Index
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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5 - Benevolent Dullness, Ambiguity, and the Reader: Modal Complexity and the Plots of Tristram Shandy
- Richard C. Raymond, Mississippi State University
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- Satire, Comedy and Tragedy
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- 01 March 2024
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Summary
Having analyzed the satiric, comic, and tragic actions that form the plots of Tristram Shandy, we might adopt the posture of Shakespeare's Polonius, who would only have to decide whether Sterne's work should be labeled tragicomic satire or satiric tragicomedy. Indeed, one might legitimately question the usefulness of the definitions of satire, comedy, and tragedy borrowed here from the work of Alvin Kernan and Northrop Frye, as none of these definitions, by itself, lets us describe the complex action of Tristram Shandy.
Frye himself would have answered this question, I believe, by pointing out that modal complexity represents the hallmark of great literature. The tragic action of Tristram Shandy, as we have seen in Chapter 4, can be partly categorized under Frye's “high mimetic” mode, in which protagonists Yorick and Tristram stand strong in their bold criticisms of grave, reputable dullness. Yet ironically, as Yorick and Tristram come to recognize, their strong moralrhetorical stances leave them weak, vulnerable to the swarms of the dull who come together long enough to slander and destroy.
We have also seen the tragic action of Tristram Shandy blend with comic action as it falls to what Frye would call the “low mimetic” stories of Walter and Toby, stories inseparable from Tristram’s. In telling the stories of his precursors, Tristram illustrates the benevolent “moral character” he would place at the center of a new comic Shandean society, which he would populate with his “hearty, laughing” friends (2: 132; 4: 402). But as we have discovered, within the fictional world created by Sterne, neither Tristram nor his forebearers succeed in drawing friends, in renewing life on the foundation of society's ruins. Tristram, Walter, and Toby may all be fairly counted among the protagonists of “low mimetic” tragedy, for they find themselves excluded from the society they would regenerate (Frye 1957, 39). But this bimodal action, we have found, does not resolve tragically, as Tristram resurrects Yorick regularly and ends his cock-and-bull story with a joke, not with a catastrophe. Neither does the action resolve comically, for despite the joking at the end, we find no harmony, no regeneration, and no shared vision—only Toby's embarrassment, Mrs. Shandy's confusion, and Walter's rhetorical nonsense (9: 803–9).
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
- Print publication:
- December 2021
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Background
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
ResultsEarlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
ConclusionsAAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Cardiac responses in paediatric Pompe disease in the ADVANCE patient cohort
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- Barry J. Byrne, Steven D. Colan, Priya S. Kishnani, Meredith C. Foster, Susan E. Sparks, James B. Gibson, Kristina An Haack, David W. Stockton, Loren D. M. Peña, Si Houn Hahn, Judith Johnson, Pranoot X. Tanpaiboon, Nancy D. Leslie, David Kronn, Richard E. Hillman, Raymond Y. Wang
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 3 / March 2022
- Published online by Cambridge University Press:
- 23 August 2021, pp. 364-373
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Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Trial registry: ClinicalTrials.gov Identifier: NCT01526785 https://clinicaltrials.gov/ct2/show/NCT01526785.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
Characteristics and health conditions of a group of nursing home patients with mental–physical multimorbidity – the MAPPING study
- Anne M.A. van den Brink, Debby L. Gerritsen, Miranda M.H. de Valk, Richard C. Oude Voshaar, Raymond T.C.M. Koopmans
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- International Psychogeriatrics / Volume 29 / Issue 6 / June 2017
- Published online by Cambridge University Press:
- 06 March 2017, pp. 1037-1047
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Background:
Long-term care facilities have partly taken over the traditional asylum function of psychiatric hospitals and house an increasing group of patients with mental–physical multimorbidity (MPM). Little is known about the characteristics, behavior, and care dependency of these patients. This paper aims to describe these aspects.
Methods:Explorative, descriptive study among patients with MPM without dementia (n = 142), living in 17 geronto-psychiatric nursing home (NH) units across the Netherlands, stratified by those referred from mental healthcare services (MHS) and other healthcare services (OHS). Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. Patients referred from MHS (n = 58) and from OHS (n = 84) were compared by descriptive statistics.
Results:Despite exclusion of patients with dementia, the majority of participants had cognitive impairment. Prevalence and severity of frontal impairment were high, as well as the number of patients with clinically relevant neuropsychiatric symptoms. MHS patients were younger, had more chronic psychiatric disorders, and more often used antipsychotics. Neuropsychiatric symptoms, domains of care dependency, physical conditions and concomitant medication use differed not significantly between the subgroups.
Conclusions:Both groups of patients with MPM showed heterogeneity in various aspects but differed not significantly regarding the consequences of their multimorbidity. In a variety of characteristics, this group seems to be different from other NH patient groups, which requires extra knowledge and skills of the staff. To uncover which knowledge and skills are necessary, the next step should be to investigate the specific care needs of NH patients with MPM without dementia.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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