Response to Erich Loewy: commentary

The capacity to suffer, the vulnerability with respect to suffering, confers on all animals with that capacity (not just human beings) a prima facie right not to be caused suffering. Nurturing in order to stave off such suffering is the first act of the community toward the individual, primarily in infancy. Hence for Loewy, autonomy, the gradual growth of self-determination in individuals, is grounded in a broader moral commitment of the community, that of beneficence. This is the critical point in his argument, for it represents a wholesale critique of modern libertarianism. Libertarians, in contrast to Loewy's argument, seem to ground the nature of the community in the prima facie right of autonomy. For Loewy, the community not only has an obligation to refrain from harming individuals (nonmaleficence), but it also has an active duty to ameliorate and prevent, as far as possible, the suffering of its members. Thus, if there is a social contract, it is one of nurturing one another to overcome the vulnerability of suffering, not primarily one of protecting autonomy. This is most significant for clinical ethics as well. Once the primary obligation to ameliorate suffering is no longer necessary, when the individual loses or does not have the primary moral worth prompted by the capacity to suffer, then secondary and symbolic obligations emerge. Loewy is thereby able to suggest a "calculus" of moral worth, wherein our obligations to individuals in a permanent vegetative state or to anencephalics (almost always the individual will have lost the capacity to suffer through some cerebral event) must be weighed against other primary obligations. Although Loewy admits that grounding clinical ethics in the capacity to suffer might be "thin," it nevertheless prompts serious discussion about the nature of the "good" in good clinical ethics decisions.     

Disclosing Extra-Dyadic Involvement (EDI): Understanding Attitudes, Subjective Norms, and Perceived Behavioral Control

Extra-dyadic involvement (EDI) is a complex issue that affects many individuals, couples, and families. One important, relatively unexplored issue concerns the disclosure of EDI. Despite some scholarly discourse on whether disclosure should be facilitated in a therapeutic context (e.g., Butler et al. in J Marital Fam Ther 35:125–143, 2009; Butler et al. in Am J Fam Ther 36:265–283, 2008), empirical research has not studied the intrapersonal or interpersonal processes related to disclosure. In this study, we explored potential factors involved in the decision to disclose EDI by looking at the relationships among attitudes towards EDI (in terms of perceived justifications and costs), subjective norms (obligation to disclose), and perceived behavioral control (difficulty) associated with EDI disclosure. Our sample included 337 individuals enrolled in at least one university course at one of three geographically distinct universities. Findings indicate that more permissive attitudes towards EDI are not significantly associated to the perceived difficulty in disclosing EDI or the obligation associated with disclosing EDI involving sexual intercourse. However, more permissive attitudes are related to lower felt obligation to disclose EDI that does not involve direct sexual intercourse. Conversely, more restrictive attitudes towards EDI (perceived severity, degree of perceived upset, and how detrimental it is perceived to be to the relationship) predicted greater difficulty but also greater obligation in disclosing all forms of EDI. Specific implications of these findings, including potential implications for therapy, are discussed. Overall, this study provides preliminary information regarding potentially useful factors to consider in understanding the EDI disclosure process that may also be useful in developing intervention points in therapy.     

Harm in the Wild: Facing Non-Human Suffering in Nature

The paper is concerned with whether the reductio of the natural-harm-argument can be avoided by disvaluing non-human suffering and death. According to the natural-harm-argument, alleviating the suffering of non-human animals is not a moral obligation for human beings because such an obligation would also morally prescribe human intervention in nature for the protection of non-human animal interests which, it claims, is absurd. It is possible to avoid the reductio by formulating the moral obligation to alleviate non-human suffering and death with two constraints: The first concerns the practicability of intervention and establishes a moral obligation to intervene only in cases where this is humanly possible. The other constraint acknowledges that lack of competence in humans can risk producing more harm than good by intervening. A third way of avoiding the problematic version of the natural-harm-argument considers whether human and non-human suffering and death are sufficiently different to allow different types of responses. I argue that the attempt to avoid the reductio of the natural-harm-argument by disvaluing non-human death can only work with an anthropocentric bias, which accords to non-human suffering and death a fundamentally different value and that it fails to dismiss the moral obligation created by the harm that non-human animals face in the wild.     

When do victim group members feel a moral obligation to help suffering others?

In four experiments, we assessed when the salience of ingroup historical victimization will encourage a sense of moral obligation to reduce the suffering of others. Historically victimized groups (Jews and women; Experiments 1 and 3) who considered the lessons of the past for their ingroup felt heightened moral obligation to help other non‐adversary victimized groups. However, when the suffering outgroup was an adversary, Jews (Experiment 2) and women (Experiment 4) who focused on the lesson of historical victimization for their ingroup reported lower moral obligation to reduce others' suffering. The lesson focus effect on moral obligation was mediated by benefit finding as well as perceived similarity to the outgroup. Means to facilitate moral obligation, as well as limiting factors, among victimized group members are discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

Dual Identification and the (De‐)Politicization of Migrants: Longitudinal and Comparative Evidence

The article examines the role of dual identification with both the ethnocultural ingroup and the society of residence in the politicization of migrants. The researchers employed a longitudinal and comparative research design with members of the two largest, but sociologically very different, migrant groups in Germany as research participants (i.e. Turkish migrants and Russian migrants). In line with prior work that has shown that, among members of aggrieved groups, dual identity functions as a politicized collective identity, we found that dual identification fostered political engagement among Turkish migrants. In contrast, Russian migrants reported no substantial grievances, and dual identification negatively affected their subsequent political engagement. The contributions of these findings to an articulation of research on politicization with research on intergroup conflict and a more comprehensive understanding of political phenomena driven by dual identification are discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

A course in hypnosis for chaplains

Understanding the mental processes involved in suffering has always been the best basis for communication between patients and caretakers. In this paper we are concerned first with acknowledgment of the existence, generally unknown, and the effects, generally unrecognized, of the hypnotic processes that occur in many forms of suffering, and second with developing our thesis that the understanding and use of hypnotic principles can greatly enrich the chaplain's capacity to alleviate suffering. In this brief presentation we will confine our discussion to the teaching of hypnosis as a virtual necessity in modern clinical training for chaplains. Comments and considerations will precede and follow an outline of the course presently offered at Lenox Hill Hospital [but we cannot here attempt to discuss or explain the fundamentals of hypnotic process or any other aspects of the course content itself]. A basic bibliography is appended for those who wish to know more about hypnosis itself.     

Self-sacrifice in Heidegger

Heidegger’s treatment of self-sacrifice has suffered neglect. In this paper, it is critically analysed and found wanting, and it is argued that for a proper understanding its historical location must be taken into account. The way he treats self-sacrifice presents a particular instance of many recurrent features in his thinking. Some of these can be better understood by reference to the kinship with certain forms of religious thought. In particular, the absence of a moral dimension has a counterpart in certain familiar forms of religiosity.     

Military service and moral obligation∗

The author investigates the view that there is a moral obligation to serve in the armed forces of the nation State of which one is a citizen resident (with special reference to young American men at the present time). It is conceded that under current law in this country there may be such a legal obligation, that many men may be obliged to render such service, and that under certain circumstances even a moral obligation to serve may also exist. What is denied is that any of the familiar theories of moral obligation is adequate in existing circumstances to establish this thesis in general. The result is either that a new theory of moral obligation must be developed to fit the current facts, or the present assessment of those facts must be fundamentally revised, or we must concede that draftees and men generally have no such moral obligation of service at all.     

Can research influence clinical practice?1

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.     

Counting on Whiteness: Religion,race, ethnicity,and the politics of Jewish demography

American Jews have long been an anomaly for scholars concerned with understanding how they fit into extant social scientific or historical categories. Sometimes they seem best described as an ethnic group, other times as a religious one. This ambiguity has also vexed Jewish communal leaders whose desire to comprehend their communities has largely been underwritten by their intention to protect it. This intersection of sociological methods and schema and Jewish communal concerns has resulted in decisive omissions regarding how best to account for the racial and ethnic diversity of American Jews. An analysis of survey instruments used in 175 American Jewish population studies and community portraits conducted since 1970 reveals a focus on questions of religious practice and an avoidance of those about race and ethnicity, resulting in a “religio-racial formation” of American Jews as White. This approach to studying American Jewish life has marginalized or excluded non-White Jews while ensuring ongoing Jewish communal access to Whiteness without having to claim it explicitly.     

The role of randomised controlled trials in developing an evidence‐base for counselling and psychotherapy

Background: Representatives of counselling and person‐centred organisations indicate many of their members feel their profession and orientation is under threat, with counselling services being decommissioned in NHS settings. Aims: To understand the views of key figures in the psychological therapies field (policy makers, researchers and representatives of the counselling community) towards randomised controlled trials (RCTs), and their present and future role in developing the evidence‐base for counselling and psychotherapy. Method: Interviews (phone, Skype or face‐to‐face) were conducted with 24 authorities in the field. Relevant practitioner and academic networks were also contacted and key documents in the field were reviewed. Results: Key figures believe that RCTs will continue to play a decisive role in determining which psychological interventions are recommended and commissioned within the NHS for the foreseeable future. Other methods are seen as having some validity, but are generally considered supplementary to RCTs and not a replacement for them. Discussion: Although many members of the counselling community are critical of RCTs, they are likely to remain the mainstay of commissioning policy for some years to come. This means, in the coming years, members of the counselling community may face difficult choices in how to promote their work, while maintaining their core principles and values.     

Paying for medical care: a Jewish view

According to Jewish law, there is a clear obligation to try to heal, and this duty devolves upon both the physician and the society. Jewish sources make it clear that health care is not only an individual and familial responsibility, but also a communal one. This social aspect of health care manifests itself in Jewish law in two ways: first, no community is complete until it has the personnel (and, one assumes, the facilities) to provide health care; second, the community must pay for the health care of those who cannot afford it as part of its provision for the poor. The community, in turn, must use its resources wisely, which is the moral basis within the Jewish tradition for some system of managed care. The community must balance its commitment to provide health care with the provision of other services.     

Ability,Responsibility, and Global Justice

Many have argued that we have a moral obligation to assist others in need, but given the scope of global suffering, how far does this obligation extend? According to one traditional philosophical view, the obligation to help others is limited by our ability to help them, or by the principle that “ought implies can.” This view is primarily defended on the grounds that it is a core principle of commonsense moral psychology. This paper reviews findings from experimental philosophy in cognitive science demonstrating that “ought implies can” is rejected by moral psychology. Researchers find that moral obligations are ascribed to agents who cannot fulfill them, suggesting that moral requirements do sometimes extend beyond what we are able to do. This research furthers our understanding of moral obligation, identifies an important need for further cross-cultural work in moral psychology, and demonstrates a way in which scientific experimentation can be applied to improve upon the conceptual analysis of important philosophical concepts in normative ethics.

     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Pain as purgation: The role of pathologizing in the life of the mystic

Since Descartes, man has been defined in terms of body and spirit only. Yet there is a third term that is of crucial importance for the founding of a psychology of suffering. The realm of psyche, or soul, is a middle ground between the spirit and the body in which the psychological forces of one's life find expression. A psychological approach to the anguish of the suffering soul can be found within the writings of the early desert fathers as well as in the paintings of Hieronymus Bosch. The penitent must learn patience in the face of his suffering, before he can experience the joy of spiritual maturity.A famous anchorite came to take counsel on high things with the abbot Pastor, but the old man turned away his head, and the anchorite went away aggrieved. His disciple asked Pastor why he had refused to talk with a man so great and of such reputation in his own country, and the old man said that his visitor could speak of heavenly things, but that he himself was of earth. If he had spoken to me of the passions of the soul I could have answered him: but of the things of the spirit I am ignorant.Mr. Fischer is a member of the Psychology Department, University of Dallas, Irving, Texas 75060.     

Trauma and Gender

The meaning of trauma within psychology has for a long time been viewed mostly from a ‘pathologising’ standpoint. Viewed as pathology, people's trauma may become understood using a singular lens thereby leaving out broader contextual (social, environmental, political, historical, economical etc.) aspects that have been shown to play a role in the subjective experience of various forms of suffering. Psychology has for a long time been quick to diagnose victims of traumatic experiences from an individualistic perspective, almost always positioning the ‘problem’ within the person. As a result of the Vietnam War, World Wars I and II and the Holocaust, the rise in the diagnosing of PTSD gave way to the labelling of trauma. Within psychology, post‐traumatic stress disorder has become the way to operationalise suffering, and I would like to argue that this occludes how suffering lives in a family, a community and in gendered bodies. The gendering of trauma continues to be a silenced space. There is a need to highlight and acknowledge the gendered nature of suffering which begs for trauma to be understood in context and not as an isolated act or occurrence affecting the individual. Women have remained, and in many ways continue to remain, silenced with minimal opportunities to name the world for themselves. This paper seeks to provide a critical analysis of the notion of trauma (and its intersection with gender) that arises from conflict and post‐conflict situations.     

Eternal Recurrence and the Categorical Imperative

The question has been raised whether Nietzsche intends eternal recurrence to be like a categorical imperative. The obvious objection to understanding eternal recurrence as like a categorical imperative is that for a categorical imperative to make any sense, for moral obligation to make any sense, it must be possible for individuals to change themselves. And Nietzsche denies that individuals can change themselves. Magnus thinks the determinism “implicit in the doctine of the eternal recurrence of the same renders any imperative impotent…. How can one will what must happen in any case?” At the other end of the spectrum, those who do hold that eternal recurrence is like a categorical imperative, for their part, tend to ignore or deny the determinism involved in eternal recurrence. This article explores the extent to which it can be claimed that eternal recurrence is like a categorical imperative without downplaying Nietzsche's dterminism.     

Facilitating Performance with Cued Wording: An Examination of Reasoning in the Tax Context

Researchers have consistently found increased accuracy for reasoning tasks that involve permission and obligation situations; however, little is known about the task characteristics that aid the reasoning processes in these situations. This study investigates the ability of cued wording (i.e., ‘is permitted’ or ‘is required’) to increase the accuracy of subjects' reasoning. Specifically, two experiments were conducted using versions of the Wason selection task to present tax rules involving permission and obligation situations. Results of both experiments generally support the use of cued wording to increase reasoning accuracy, especially for those subjects with no experience with the rule. These results have implications for rule-driven fields like taxation, where taxpayers must comply with numerous provisions containing permission and obligation situations. © 1997 John Wiley & Sons, Ltd.     

Collaboration and Social Inquiry: Multiple Meanings of a Construct and Its Role in Creating Useful and Valid Knowledge

The concept of collaboration in community research and intervention, although not new, has grown tremendously in importance in the past 20 years. Yet, it is both a contested concept in terms of its intent and a still evolving idea in terms of its meaning and implications. The purpose of this monograph is to begin to "unpack" the collaboration construct in terms of its many meanings, rationales, goals, models, dynamics, and accomplishments. Although models of collaboration are often well articulated there is "partial paradigm acquisition" (E. J. Trickett, 1984) in terms of understanding their behavioral and ethical implications. There is more theology than conclusion. The promise of collaboration, although considerable, is still in need of multiple and varied empirical examples of how collaboration contributes to both the process and goals of community research and intervention, however defined. The monograph closes with a brief overview of what we have learned from reviewing this literature, an articulation of the kinds of questions that need to be addressed, and a series of recommendations for how to increase our understanding of the collaboration construct in community research and intervention.     

(Emotion-centered) problem-solving therapy: An update

Problem-solving therapy (PST) is a psychosocial intervention, typically considered to be a member of the cognitive and behaviour therapies family, and is based on a biopsychosocial, diathesis-stress model of psychopathology. The overarching goal of this approach is to promote the successful adoption of adaptive problem-solving attitudes and the effective implementation of certain behaviours as a means of coping with life stressors in order to attenuate the negative effects of such events on physical and mental well-being. Over the past several decades, in addition to accumulating strong support for its efficacy as a clinical intervention, similar to many other forms of psychotherapy, PST has undergone various evolutionary changes. Developed primarily as a more cognitive-based approach, due to the large body of literature in the field of affective neuroscience that underscores the importance of the impact of affect on problem solving, PST has evolved into emotion-centered problem-solving therapy (EC-PST). This article provides for a brief excursion into the historical roots of PST and why it has evolved into EC-PST, as well as providing support for its characterisation as a transdiagnostic approach. In addition, several meta-analyses that underscore its efficacy are described, as well as the most recent clinical guidelines that comprise EC-PST.