CHAPTER 17 Belief Mark Cobb Introduction Humanity exists in a rich environment of beliefs that shapes the people we become, evokes and sustains the ways in which we see and experience the world, guides our behaviour and the actions we take, and directs our sense of purpose and meaning. We are all believers, or more specifically we all have a mixture of beliefs and lack of beliefs, and this purposeful human faculty is entangled in the mind as much as in the body, in our thoughts as much asin our actions, Consequently, in considering belief in relation to spiritu- ality and healthcare we have before us a vast field of subjects and disciplines making diligent enquiries into the nature and operation of beliefs. The following chapter aims to provide an overview of some of the waye in which we have come to understand belief and to provide some conceptual spans across discourses and disciplines that customarily do not intermingle. In particular, we will follow 1 path beginning with ideas about beliefs in general, and moving into the domain of religious and spizitual beliefs, From here we ‘will consider some of the scientific explanations of belief and look specifically at models that describe how beliefs operate in relation to health. This will bring us to one of the more creative and con- tentious intersections built around the idea of placebos, Finally, we will step behind the professional persona of healtheate profession- als, and consider how their sacred and secular beliefs may affect their clinical practice and decision making Beliefs in general Beliefs are part of our everyday lives and such is their ordinari- ness that they easily go unnoticed. We seldom identify our beliefs explicitly although we manifest them constantly in our thinking, perceiving, speaking, and acting, Beliefs figuze in the everyday ways ’n which we engage with the world: they shape our understand- ing of this experience and orientate our response. Beliefs therefore help us to navigate the world by functioning as irreducible guid- ing commitments. To believe something, in the general sense, is to have conviction in the proposition to which it refers: Alex believes that access to healthcare is a basic human right, Jean believes that meditation is good for our mental health, and Matti believes in socialism, It can be expected that thete beliefs are manifested in some ways in the lives of Alex, Jean, and Matti, and that even ifthe circumstances never arize in which their beliefs ean be observed they will make a difference to their thoughts and the ways they relate to these aspects of the world, A distinguishing feature of beliefs is that they relate to things wwe classify as either true or false, Beliefs carry an implied claim to ‘truth such that what we believe we consider true. When a person says that they believe the water is safe to drink we take it that the [person accepts the proposition to be true and will drinkit. A simple acknowledgement that something is true is insufliciently strong to be equated with belief. We may hold the idea that smoking causes cancer and continue smoking regardless ofthis thought, but if we believe this proposition then we are prepared to act as if it i true and quit smoking, This direct causal relationship between beliefs land bchaviour is lacking in the state of mind in which we hold ideas without regard to their veracity. Truth is therefore a regula- tor of beliefs, but itis sometimes a weak regulator, for example, in wishful thinking, This does not mean there are varieties of truth and therefore varieties of correct beliefs, but thatthe basi of some beliefs may not need to be as substantial because the interests we hhave in some belief propositions are less significant. For example, pregnant mother’s belief in the ability of her midwife is of critical interest compared with the belief she has in her partners ability to look after the house plants In order to hold a belief a person has to be capable of acquit ing relevant information about the object of belief, and therefore a belief is conditional upon what a person can learn or come to know-{1] The acquisition and formation of beliefs is not simply ‘a matter of intentionally inferring a true and warranted conclu sion from what we count as evidence. There may be factual, evi- dential and epistemic grounds for arriving at certain beliefs, but beliefs are also formed through processes of cultural transmission, social interactions and practices, and through other perceptual, ‘emotional, and non-reflective experiences through which we come to know aspects of reality with a high certainty of truth.(2, pp. 47-56] Human beings ate believers and do not need to put much cffort into developing beliefs, as Steglich-Petersen has commented “Many, in fact most, of people's beliefs are formed through sub- ‘conscious processes of perception and inference which are not in any interesting sense controlled by the intentions of the subjects ‘who have them.[3] People hold intuitive beliefs that are grounded in perceptions or inferred from those of others, Mikko sees blood running from hisa SECTION coNcEPTS nose and concludes that he has a nose bleed, «belief that motivates hhim to seek frst aid from Eva. Mikko's perception of his epistaxis relies upon his basic senses, prior information about what blood indicates, and knowledge about the sources of blood. [4] We there- fore have the cognitive ability to form representations or models of the world without conscious effort, but we also have meta- sepresentational abity, Mikko arrives atthe warranted conclusion that he should seek Eva's help because he was informed that Eva frst aid, even though he has never met Eva, Mikko therefoze infers fom this meta-representation of Eva’s first-aid skills that she i likely to help him. Where people infer certainty or creedal attitudes from concepts beyond basic intuition, these are termed reflective beliefs, and these are typical of religions [5] is trained in Religious and spiritual beliefs “The primary characteristic of religious beliefs is their content or propositional objects relerring to non-physical agents, of which a belief in God is a common example. A belief in God refers to an ‘ultimate reality that transcends the natural world and is contingent upon a supernatural premise described variously as the sacred, the holy and their cognates. Some claim that there is substantial evi- dence that makes probable the existence of God, such as natural Jaws nd the millions of people who have experiences they attribute +0 God. [6] However, whilst a proposition about God may explain the evidence, a lack of evidence may not be a sufficient reason to disbelieve the existence of God. There are beliefs, such as free will, that cannot be conclusively demonstrated evidentially or through compelling argument alone, but which are not irrational to hold, Similarly, there is an epistemic warrant fora beliein God that does not rely exclusively or substantially upon evidence or argument.(7] A balief in the self does not depend on proof, but itis a necessary presupposition to think and act, and which provides meaning to life and enables individuals to make sense of the world, Its there- foze a basic belief that is the source of other beliefs and iti there- fore an absolute presupposition that we cannot get behind, test as 1 hypothesis or empirically verify. Similarly, a belief in the exist- ence of God is abasic or absolute presupposition from which other second-order beliefs are derived and made rational, such as miracles. ‘This is why miracles to an atheist ate irrational, but the arguments ‘used by an atheist are unlikely to convince the theist. [8] Religious belies can be informed by propositional knowledge, bbut more typically they relate to forms of practical knowledge (eg. gained through participation in rituals) and experiential knowledge (eg. of the presence of the divine). However, to hold ous belief requires a conviction beyond a level of ordinary acceptance that is more like a profound trust or allegiance to a ‘ruth. This capacity is referred to as faith and Bishop contends that faith involves more than the intentional deliberation of what the evidence shows to be tru: ‘faith involves beliefs which are held "by faith’, in the sense that holding them is an active venture which goes beyond—or even, perhaps, against—what can be established rationally on the basis of evidence and argument."9, pp. 471-2) Consequently, belels held by faith are never tentatively held or the simple endorsement of propositions, but they are commitments to irrevocable truths that orientate perceptions, thoughts and actions. (10) In his exploration of the psychology of religion William James considered that, ‘Were one asked to characterize the life of reli- gion in the broadest and most general terms possible, one might say that it consists of the belief that there is an unseen order, and that our supreme good les in harmoniously adjusting ourselves thereto. This belief and this adjustment are the religious ativude in the soul: (LL, p. Al] A belie in God therefore suggests a way of regarding the world that expresses something of how we intend to live in the world. [12] We can contrast the extent and impact of the religious life that James i referring to withthe life ofthe devoted golfer who holds golf to be the most important thing in her life and organizes her life around it zit were a religion. Golf impacts upon people's lives in terms of commitments, skill, and membership of a group, but itis difficult to see how the commit- ments required to play golf could extend into a way of regerding the world, or to its possiblity as a supreme good. Devoted golf players may risk hitting their ball into a bunker, but golf dacs not require a doxastc venture of faith about truth that give meaning and value to the whole of ite Taylor proposes that contemporary religious faith is defined by « double criterion: ‘the belief in anscendent reality, on one hhand, and the connected aspiration to a transformation which goes beyond ordinary human flourishing on the other. (13, p. 510} "Tis latter quest refers tothe spiritual if and it associated beliefs some of which tend towards immanent concerns. Whereas reli- tious beliefs can be referenced tothe offical creedalformlaries of 2 faith community and its institutions it isthe personal experience of the selF-authenticating subjetive life that often validates spi ‘tual beliefs. [1415] This illustrates something ofthe contemporary milieu and conditions for beliefs evident in many developed socie- tics that admit a plurality of forms, a wide gamut of content and secularity. In practical terms, this means that beliels do aot neces~ sarily determine a person’s religious, or spiritual ies tices. For example, a person may declare a Christan identity, not axtend church, practice meditation, and believe in reincarnation. [Nagel considers whether, leaving aside religious or spiritual beliels, secular philosophy can provide a satisfactory response to ‘the questions of what itmeans to be human, how we make sense of our lives, and how we should live our lives within a larger frame- ‘work of existence and the univers. He zecognizes that, Existence is something tremendous, and day-to-day fe, however indispensa- ble, seems an insuificient response to it, ulure of consciousness (p. 8). Nagel suggests that one secular response is simply to declare that there is nothing missing, the universe is meaningless and the bigger picture is one adequately described by the sciences, Another respon he suggest is one of humanism: that we are part of a uni- versal humanity that collectively is the source of value and meaning beyond the individual. The third response tothe cosmic question he considers to be a form of Platonism in which we aze conscious of being part ofa larger cosmic process that is intelligible and pu poseful (though not designed). Nagel concludes tha che atheists position isan evasion of avery rel question and that humanism is ‘00 limited a response, which means tha ifthe Platonic alternative is ejected we are lft with a sense ofthe absurd [16 Scientific explanations of belief Explanations of beliefs exist in a wide range of scholarly disciplines including philosophy, theology, psychology, neurology, anthro- pology and sociology. More recently religious beliefs, experiences and expressions appear to have become a compelling subject for the cognitive sciences based upon developments in the theory of ‘mind [17] Cognitivism is biologically (brain) based and a standardview claims that beliefs are cognitive states that play certain emo- tional and inferential roles that help guide and explain actions.(18] Neurobiological explanations are partial and, therefore, need inte- grating with more lived concepts of cognition including the social and cultural dimensions. Baker, for example, rejects the empiri cal conjecture of neuroscience and the reductive claims of the physicalists arguing instead for an explanation of belieis derived from how they operate in practice and the effect they have. Beliefs are disclosed in the actions, thoughts, and words of people, which for Baker means that, ‘Persons have beliefs; brains have neural states. Having certain neural states is, presumably, necessary for people to have beliefs; but it does not follow that for a perzon to have a particular belief, there isa neural state that constitutes that Delief?[19, p. 154 Peychologists propose that beliefs arise from mental processes that give rise to assumptions held to be true about the world we experience and are generative of thoughts and behaviours.(20, p. 110] Similarly religious beliefs are an inevitable result of our ordinary cognitive processes, which is why they are so common. Barrett argues that beliefs in god-concepts and similar religious {ideas can be distinguished from other forms of reflective beliefs by a number of distinct characteristics that are supported by the ways our minds make sense of the world: 1. They have a small number of counterintuitive but plausible atures which violate the category of the object we have deter- mined by our senses or a property that the object is expected to have. For example a belief in the Virgin Mary is a belief in a person who does not live on earth. 2. They are identified as having agency and altsibuted with inten- tionality or motivation, for example people pray to a divinity for help. 3. They possess strategic personal information, for example, moral and social information, which relates typically to survival or reproduction, for example, the parents of a stll-born child may ask what they had done wrong for God to let this happen 4. They are capable of acting in the world (such as on objects oF events) in detectable ways, for example through miracles 5. They motivate personal and corporate behaviours that reinforce belies, for example, regular congregational prayers in a mosque provide an explicit demonstration of belief and promote resil- fence (o sceptical scrutiny [21, 22] Psychological explanations that aim to demonstrate the inevita- bility of religious beliefs rely upon an understanding of the cog- nitive Functions of human beings. Some take this further and suggest the beliefs are simply and nothing more than manifesta- tions of our cognitive functions. Alper, pursuing this argument tunder the influence of neo-Darsnian theory, concludes that God isan evolutionary adaptation, in other words God is... not divine ‘butan organic phenomenon, 23, p. 227] Similavy, Bering follows an evolutionary argument to explain that human beings have a cognitive predisposition to believing in God, but this is no more than a convincing ilusion and adaptive trait implying that in real- ity the existence of God is improbable [24] This appears to dismiss the importance and necessity of iusions, symbols, and metaphors as an intermediate psychological space through which we interpret and relate toa reality that we can only partially know and exp ence [25] Despite the particular focus on the neural correlates of| CHAPTER 7 BELIEF spirituality the cognitive science of religion isa broader church and has the potential o develop a necessary interdisciplinarity between the natural sciences and other diseiplines,(17] However, convinc- ing scientific explanations may come to be, they will always be cor rigible and confined by their own methodological and conceptual horizons. Ruthless scepticism or a sense of the absurd in not an inevitable conclusion to the powerful explanatory descriptions of beliefs: ‘But the mere fact that a belief cheers us up, or even that it could have helped with survival, does not show that belief is groundless. An alternative possiblity is always that it just happens to be true’[26, p. 113) Health beliefs Beliefs about what sustains health, causes illness and brings about healing are part of our beliefs library, and come into play with- ‘out deliberation or introspection in our thoughts, decisions, and actions when we are making sense of illness experiences, responé- ing to treatment decisions, following advice and seeking help. Health beliefs are commonly used to explain why people do not follow health-maintaining advice and behaviours, vary in their response to symptoms, and adapt or abandon treatment regimens. ‘One of the most prominent theories to explain and prediet health- related behaviours is the Health Beliefs Model, « psychosocial ‘model developed from psychological and behavioural theory. The Health Beliefs Model has been used in research into the variance in individual behaviours relating to health prevention and protec tion behaviours, symptom denial, and treatment compliance. The ‘model includes the following beliefs as contributors to determin- ing health-related behaviour + Vulnerability or susceptibility to contracting a condition (includ- ing belief in a diagnosis) + Severity ofthe illness and its clinical and social consequences + Benefits or effectiveness of the available action to treat the disease ‘+ Negative consequences of a health action such as side effects, «ost, or inconvenience. (27) ‘The predictive power of these beliefs have been criticize: they are inadequate on their own in explaining health-related behaviours and targeting only beliefs without addressing other determinants is unlikely to provide the basis for an effective intervention strategy. [28] Self-regulation theory is another prominent model accounting, {for how particular beliefs contribute to the personal representation ‘or mode! of an illness that, in turn, determines how the individual responds to the threat of an illness.[29] For example, in studies of people with diabetes, beliels about the seriousness of their condi- tion, complications, and impact on their lives, and beliefs about the effectiveness of the different components of diabetic control ‘were consistent predictors of diabetes self-management [50] Shared beliefs ate a feature of social groups and may contsibute to differences in such things as the ulilization of healthcare, the adoption of preventative health behaviours and responses to symp- toms of ill-health. A study comparing the beliefs about medicines between undergraduate students from Asian and European back grounds found that differences were specifically related to beliefs in the capacity of medicines to cause harm and benefit with Asian students having more negative belief about medicine-(31] Shared belief are also a feature ofthe groupings of healthcare professionalsus SECTION CONCEPTS who ate socialized into particular beliefs, values, and behaviours through their training and acceptance as members ofa peer group. In clinical practice learnt propositional knowledge, beliefs, experi= ential knowledge, reasoning, and routines blend as the healtheare professional interacts with the messy world of patient care requit~ ing decisions and actions.[32] Consequently, clinicians do not always practice according to the letter of clinical guidelines, which ‘means that the clinicians’ beliefs influence their management of patients which in turn effect the patients’ outcomes and the beliefs that patients acquire from their clinicians [33] Religious communities promote shared belief systems within lived traditions of practice that address matter? of human sulfering and wellbeing. They therefore provide people who ate ill sources of meaning, practice, experiential knowledge and social support Teler suggests that one of the pathways connecting religiousness and spirituality to health outcomes is through beliefs ‘Belief in a benevolent God and an afterlife may be key to a generalized expec tation of positive outcomes. Moreover, religious beliefs offer indi- viduals cognitive resources beyond these relatively simple or naive beliefs in good outcomes.'[34] A study conducted in a region of the southeastern United States (known for its high levels of religios- ity) found that most people (809) believed that God acted through doctors to cure illness and that God's wil is a more important fac- tor than the skill of the doctor in people’s recovery from illness. [35] Religious or spiritual beliefs can also mediate illness experi- ence: another study found that, ‘Core beliefs were sources that grounded and maintained an interpretative structure through which participants viewed their life events and positively framed their experiences. [36) These beliclt may contribute to the ways in which people cope with their illness and therefore affect their outcomes, wellbeing and quality of life [37-39] More specifically health benefits may derive from religious beliefs and practices through the placebo effect. (40) ‘There is evidence that spiritual and religious beliefs may be a positive factor in health and wellbeing, and as such aze tolerated within orthodox healthcare. Spiritual and religious traditions may also challenge biomedical values and beliefs, and promote alter native practices. However, spiritual and religious beliefs may also contribute to problematic ways of coping and maladaptation to the challenges of an illness. For example, a person with a belief in a caring God who suffers from chronic pain may feel abandoned by God or be angry with God if they have no relief from unremitting pain.(41] Religious or spiritual beliefs may therefore be a source of distress or conflict, and cause people to opt for solutions that exacerbate the challenge of the illness. The beliefs a person has in God that were acquired in childhood may, for example, have functioned perfectly well until faced with an illness criss. In this, instance, there is potential for a dissonance between the real-life experience, and the undeveloped beliefs that can lead co negative feelings of despair and abandonment. Similarly, people's beliefs may be poorly integrated with their lives or be rigid, which may be inadequate when a person faces major life challenges or existential suncertainty,(42] Finally, the beliefs that people hold about health and sources of healing not only have personal implications, but they also have ‘moral, social, and legal consequences. This is most starkly illustrat ced in people whose beliefs in God's power are absolute and unme- diated, such that they turn to their fith and disregard healthcare when they, or those they care for, are a risk ofillnes or are unwell ‘This raises philosophical questions about what constitutes reliable ‘ways of knowing and the rationality of belief, but the critical issue here is that religiously motivated health beliefs may have epistemic grounds and yet be inconsistent with morally o: legally permissible conduct. In America, there are reported cases where parents of ill children rely upon prayer as treatment and reject medical care on the grounds of their religious belifs.(43] The suffering and death of children through faith-based medical neglect alerts us to the need to question the ethics of beliefs. An ethical position in relation ‘to health behaviours suggests that legitimate choices resulting from religious beliefs should only be considered preferential where there are no other evidentally decidable options. Placebos ‘The relationship between beliefs, healthcare practice and health out- comes have a particular convergence in the use of placebos and the study of the placebo effect. Placebos are substances or techniques that have no active component or known direct therapeutic benefit bbut are administered with intention of pleasing or bringing comfort ‘to a patient.[44] Placebos ate therefore commonly used in trials of drugs where, for example, a control group receives an inert saline injection asa placebo and they are compared with a treatment group ‘that receives an injection of the active drug being studied, More generally, a patient’ confidence in a treatment (whether or not it intentionally involves a placebo component) and in the practitioner administering the treatment may give rise to a placebo response. In other words, a fraction ofthe therapeutic effect may arise from con- textual, social, and cognitive factors associated with the treatment and more specifically the development of beliefs in the anticipated benefit of the treatment [45] Whilst a positive therapeutic eflect is referred to asa placebo, anegative effet may result oma disbeliefin the treatment oF an anticipated worse outcome, known asthe nocebo effect. For example, ina study of a new intervention, patients report ed more symptoms related to possible side effects mentioned on the consent form they had read and signed compared to patients who used a consent form that had not mentioned these side effets. [46] ‘That beliefs can result in physiological, behavioural, and subjec- tive effets is not new, however the advent of improved experimental ‘methods and neuroimaging have enabled a better understanding of ‘the mechanisms and mediators of placebo. In the field of pain, for example, researchers have studied how treatments with no direct pharmacological or physical effects (such as meditation) engage ‘Physiological, neurobiological, and psychological mechanisms that can moderate pain through analgesic and hyperanalgesic respons- «8, Placebo analgesia involves the release of endogenous opioids ‘that provide pain relief, whereas nocebo analgesia involves a neu- rohormone, increased brainstem activity and increased anxiety resulting in incteased pain. [47] However, whilst there is a general acceptance of psychosomatic effects there is considerable caution, and debate about what can of should be attributed to placebos and their purported therapeutic power-(48] In a Cochrane Review of 202 randomized clinical trials that covered a wide range of clinical conditions comparing a placebo group and a no-treatment group the authors. did not find that placebo interventions have impor~ tant clinical effects in general. However in certain setings placebo srventions may influence patient-reported outcomes, especially ppain and nausea, though itis difficult to distinguish patient-reported efets of placebo from response bias, [49]Despite the uncertainties about the placebo response and what may cause it there are clinicians who seem willing to some extent to use certain placebo interventions and treatments in the care of patients although the empirical data on this i limited, The inter ventions in these cases are typically routine therapeutic treatments but which are known to he ineffective in relation to the condition being treated, for example, prescribing antibiotics for a viral infec- tion, or vitamins against fatigue [50] Promoting positive expecta- tions in patients through the use of placebos whilst not deceiving them has potential ethical and dlinical consequences. The Scientifi Advisory Board to the German Medical Association considers that doctors should receive training in the use of placebos and supports their us, ‘... only when no approved drug is available, the patient has a minor illness or condition, placebo treatment does not raise the risk of harm to the patient, and placebo treatment seem likely to succeed.51] The beliefs of healthcare practitioners ‘The role of beliefs in healthcare isnot just a matter for patients, but for healthcare practitioners, Theze is often a disregard of personal beliefs as they are deemed a private matter and irrelevant to clinical practice with the limited exception of the conscientious objection in which itis accepted that particular religious beliefs may conflict ‘with certain practices, such as termination of pregnancy. There is & general probibition of clinicians proselytizing as this is considered to contradict the primary concerns of the patient and the fiduci- ary relationship of care. In the UK the General Medical Council goes as far as recognizing that, ‘Personal belieft and values, and cultural and religious practices are central to the lives of doctors and patients [52] However, it cautions against discussing persone beliefs with patients, Belicls are therefore typically addressed in relation to ethical values and individual rights leaving the subject in something of a lacuna that is seldom explored or discussed, Empirical data is beginning to surface about the influence of religious beliefs on practice, In one example, 116 American pae- diatricians completed a survey about their spiritual and religious identity, beliefs, and practices, and compared their results with a sample of the American public. The paediatricians had weaker reli- gious identities than the public, but similar spiritual profile. More ‘han half ofthe paediatricians reported that ther beliefs influenced their interactions with patients and colleagues to some extent.(53] Ina survey of UK doctors (including general practitioners, neurol- ogists, palliative medicine, and care ofthe elderly specialists) com- parisons were made with the general population and, whilst there was a general similarity in strength of religious faith, there were “underlying variations associated with the ethnicity ofthe doctor. In addition ifthe respondents reported having atlended a patient who had died in the past year they were asked questions about the care of this patient, Variations in reported clinical decisions with the intention of hastening the end of life were associated with religious beliefs—xeligious doctors were less likely to take such decisions and had lower rates of continuous deep sedation instead [54] ‘Variations in clinical practice associated with beliefs (religious or secular) are not widely understood, and there is tle evidence that this is addressed in education and supervision. Clinicians must be presumed therefore to be working this out on their own within the ‘minimal guidelines that exist, This isa disservice to the clinicians Who hold sincere beliefs, act with integrity and practice ethically, CHAPTER 7 BELIEF 117 but who are inhibited in exploring and expressing their vocational motivations, Similarly, clinicians may sometimes adopt mela- dlaptive coping strategies with the potential of harmful sequelae, ‘Neutrality in these matters avoids potentially contentious issues, but the beliefs vacuum does not exist. A more open and respect fal recognition of the nature and role of belies, and those who hhold them may enrich the humanity of dlinicians, promote more ‘open discussions about the grounds of clinical values and ethical decisions, and minimize the potentially negative effects that may result from incongruence with an idealized ‘neutral’ professional persona Conclusion Beliefs are central to health and spirituality and are basic to the ‘ways in which people understand and respond to their experienc cs of the sacred and the human, In considering beliefs in relation to healtheare we should ask questions about the truths by which people navigate their lives, how these beliefs mediate and inter pret experiences of being wel or ill, and the relationship between particular beliefs and practices of healing. Questions about beliefs ‘exceed traditional biomedical models and remind us ofthe need to maintain wider perspectives when attempting to understand and cate for suffering people, What contributes to a person’s health and brings about healing docs not simply involve pharmacologi- cal agents or clinical interventions but convictions made manifest in the humanity of care and our faith in that which gives our lives meaning and purpose, References 1 rete, FI. (1985). The epistemology of belie. Syhere $5(1), 5-18, 2 Wiliams, B.A. (2006). Moore AW. Philosophy ara uomanisie lscplne Princeton: Oxford: Princeton University Pret. 4 Stepich-Petersen, A (2006). No Norm Needed: on the Aim of Beli The Philosophical Quarterly. $6(225):499-S16 4 Feith, CD. (2007). Making up the Mind: How th Brain Creates our ‘Mental Word, Oxford: Blacoell 5 Sperber, DAN, (1997). 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