Of matters of fact and psychological discourse

Abstract

We build our theories in psychology with words, but words are slippery things. We can hold them to our own purpose only for a while, and even then, they can change shape within our hands. Both in science and in everyday life, we use words not just to understand the world around us, but to communicate and share this understanding with others. As a result, we acquire a consensual view of the world that guides our behaviour and so affects the very reality we attempt to understand.     

The role of the patient in the management of post surgical pain

Abstract

An experiment was conducted to test the idea that patients do not have the necessary knowledge about pain relief to contribute effectively to their own pain management through such strategies as being more assertive in requesting analgesia. When patients were provided with video-taped information about available pain control techniques, together with a rationale for the minimisation of pain and encouragement to request analgesia as required, they did not achieve significantly less pain than control groups. Since patients were well satisfied with pain levels substantially greater than zero, it is argued that the conventional wisdom that high pain scores indicate that post surgical pain is badly treated should be re-assessed.     

Suffering–At the Bedside of the Dying

SUMMARY

Care of people at the end of life is a challenge for the person with a life-limiting illness, their family and friends, and their professional carers. Clinicians, including pastoral care workers, nurses, doctors, and allied health professionals, find themselves at the bedside of the dying. At times, the professional's sense of self is challenged both by the suffering that they witness (physical, emotional, existential, social, sexual, or financial) and a sense of helplessness to relieve not only the patient's suffering but also that of the people to whom the dying person is close. What framework can help us to deal with the suffering that we cannot help but encounter? Ultimately people connecting in a real and meaningful way with other people is probably the only way that each of us can confront suffering and not have it destroy us. Creating an environment where people can begin to, or continue to connect with others at a level that is meaningful for all concerned is a pivotal starting point in dealing with suffering in any encounter with people at the bedside.     

Zen Buddhism and the intrinsic value of nature

Part IIt is a perennial theme in the literature on environmental ethics that the exploitation of the environment is the result of a blindness to (or perhaps a refusal to recognize) the intrinsic value of natural beings. The general story here is that Western traditions of thought have tended to accord natural beings value only to the extent that they prove useful to humans, that they have tended to see nature as only instrumentally valuable. By contrast, it is said that a new, environmentally friendly understanding of the world would value nature ‘for its own sake’, would conceive natural beings as having intrinsic value. In the light of such an understanding, the oak tree, for instance, would be seen not merely as a source of timber or shade or as a decoration for the front lawn, but as valuable ‘in itself’, as having an intrinsic value that ought to be respected (see further, O'Neill 1993, chapter 2).     

Babies Born Dying: Just Bad Karma? A Discussion Paper

The paper examines the notion of being born dying and karma. Karma is a belief upheld by Buddhists and non-Buddhists: That is, karma follows people from their previous lives into their current lives. This raises a difficult question: Does karma mean that a baby’s death is its own fault? While great peace can be found from a belief in karma, the notion of a baby’s karma returning in some sort of retributive, universal justice can be de-emphasized and is considered “un-Buddhist.” Having an understanding of karma is intrinsic to the spiritual care for the dying baby, not only from the perspective of parents and families who have these beliefs, but also for reconciling one’s own beliefs as a healthcare practitioner.     

Antinatalism,Asymmetry, and an Ethic of Prima Facie Duties1

Abstract

Benatar’s central argument for antinatalism develops an asymmetry between the pain and pleasure in a potential life. I am going to present an alternative route to the antinatalist conclusion. I argue that duties require victims and that as a result there is no duty to create the pleasures contained within a prospective life but a duty not to create any of its sufferings. My argument can supplement Benatar’s, but it also enjoys some advantages: it achieves a better fit with our intuitions; it does not require us to acknowledge that life is a harm, or that a world devoid of life is a good thing; and it is easy to see why it does not have any pro-mortalist implications.     

The A Priori and the Empirical in Theories of Emotion: Smedslund's “Conceptual Analysis” of Emotion

Abstract

This paper examines the suggestion made by Smedslund that the empirical laws of emotion proposed by Frijda are a priori necessities, derivable from a definition of emotion Smedslund proposes. First, a distinction is drawn between a causal and non-causal reading of Smedslund's own definition of emotion. The suggestion is made that although on the causal reading the definition might provide sufficient conditions for being in an emotional state, causal regularities are empirical, so this reading would not meet his own criteria for an a priori definition. Moreover, showing that Frijda's laws are derivable from the definition thus understood would not undermine their empirical status. The non-causal reading is then examined and questions are raised about whether it can provide necessary and sufficient conditions for a state to be a state of emotion. Finally, the suggestion is made that the central issue in the question of whether or not a theory of emotion is wholly empirical turns not on whether it can be derived from a definition of emotion, but, rather, on the extent to which the explanations proposed of the regularities governing emotions must appeal to a priori rationality constraints.     

Oh death,where is thy sting? Reflections on dealing with dying patients

This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.     

The effect of self-referencing on memory for different kinds of source information

ABSTRACT

Self-referential processing has been proven to be effective in improving source memory. However, it is unclear whether different types of source information would be consistently enhanced when an item is self-referentially processed. In two experiments, the authors examined the influence of the self (compared with other-referencing and semantic processing) as well as learning intention (incidental/intentional learning) on memory for two types of source information (spatial location and colour) that differ in the amount of cognitive resources they require to be encoded in memory. Results show that self-referencing has enhanced memory for spatial location of words whatever this information is learned intentionally or incidentally, whereas it cannot facilitate memory for the colour of words under the intentional learning condition, nor can it under the incidental condition. These findings suggest that self-referential processing is beneficial in memory improvement but not all-powerful, a source self-reference effect is subject to source information type.     

Pain and athletes: Contact sport participation and performance in pain

ObjectivesThis study examined the effect of cold pressor pain on performance in high-contact athletes, low-contact athletes and non-athletes.DesignA three-group between-subjects experimental design was used.MethodSeventy-one participants completed a motor task and a cognitive task of different complexity (easy or hard) both in pain and not in pain. The motor task involved participants throwing a tennis ball at numbered targets in the correct order. In the cognitive task, participants were required to check off the numbers one to twenty-five in the correct order from a grid of randomly ordered numbers. Task difficulty was increased by adding dummy targets (motor task) or extra numbers (cognitive task).ResultsCold pressor pain was rated as less intense by high-contact athletes during both tasks compared to low-contact athletes and non-athletes. High-contact athletes’ performance was not hampered by pain on the motor task, whereas it was in low-contact athletes and non-athletes. However, pain did not hamper performance for any group during the cognitive task. Low-contact and non-athletes did not differ from each other in their pain reports or the degree to which their performance was hampered by pain in either task.ConclusionsThis study provides evidence that adaptation to pain through participation in high-contact sports can enhance both pain tolerance generally and motor performance specifically under increases in pain. The mechanisms behind these differences warrant further exploration.     

Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments

BackgroundPeople with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments.MethodsThirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores.FindingsDelayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores.InterpretationDelayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain.     

The mental pain of the psychoanalyst: A personal view

Abstract

Mental pain is a common concern of psychoanalysts in their professional life. Combining her clinical experience with previous contributions by others, the author presents a personal overview of the patient-triggered mental pain of the analyst. Countertransference is considered to be the major source of the analyst's work-derived mental pain. This type of mental pain is not to be avoided or discarded by the analyst. Rather, the analyst will benefit from tolerating and even welcoming professional mental pain: in most cases, mental pain will bring with it rich clinical material that, upon interpretation, will help him or her to offer previously intolerable contents back to the patient in a transformed version that now becomes acceptable. The analyst's mental pain may emerge in his dreams; clinical examples of this phenomenon are presented. It is suggested that there is an increased chance of the analyst undergoing mental pain when treating patients suffering from severe psychopathology, and a clinical case is reported to illustrate this assertion. The author proposes that a lifelong effort is to be expected from analysts in terms of enhancing their threshold of tolerance to professional mental pain. In situations of mental pain, analysts must be particularly aware of the need to modulate their interpretations before transmitting them to the patient. The capacity of analysts to transform their mental pain (Ta, according to Bion) will depend on the plasticity of their container functions, the quality of their transformation abilities and, in particular, their threshold of tolerance to mental pain.     

Does sex moderate the relationship between anxiety and pain?

Objectives : Sex differences exist in the relationship between anxiety and pain, although findings are mixed. One reason could be because a number of anxiety measures have been used. Therefore, this study aimed to identify the core components within commonly used pain anxiety measures, and see whether these components are differentially related to sensation and pain thresholds in men and women.

Design, main outcome measures : One hundred and eighty-nine healthy adults (119 female) completed the Fear of Pain Questionnaire, Pain Catastrophising Scale, Pain Anxiety Symptoms Scale, Anxiety Sensitivity Index-3 and the Depression Anxiety Stress Scale. Thermal sensation and pain thresholds, mechanical sensation and pressure pain thresholds were also collected.

Results : A Principal Components Analysis of anxiety measures revealed three constructs: general distress, cognitive intrusion and fear of pain from injury/insult. Sex did not moderate the relationship between these anxiety constructs and sensation/pain thresholds. However, a significant main effect of sex was found to predict thermal pain thresholds.

Conclusion : Preliminary indications suggest that pain anxiety dimensions can be reduced to three core constructs, and used to examine pain sensation. However, sex did not moderate this relationship. Further research is required to establish the extent and strength of sex differences in the relationship between anxiety and pain.     

A test of the impact of pain on automatic motivational processes in people with knee osteoarthritis

ObjectivePeople with osteoarthritis are likely to be physically inactive and current socio-cognitive approaches to changing physical activity in this patient population are generally ineffective. We assessed prospective associations between physical activity and the automatic processes of habit automaticity, automatic evaluations, and automatic self-schema in people with knee osteoarthritis.DesignOne-week prospective.Method253 adults (aged 46–82 years, 72% female, 28% male) with knee osteoarthritis self-reported their physical activity behaviour of the past week, habit automaticity for physical activity and completed two implicit association tests to assess automatic evaluations of physical activity (relative to sedentary behaviour) and automatic self-schema for physical activity. One week later, participants self-reported physical activity and pain while walking over the prior week. Linear regression models assessed associations of each automatic process with subsequent physical activity and the moderation effect of pain and each automatic process on subsequent physical activity, controlling for covariates.ResultsWe did not find evidence of a statistical relationship between physical activity with automatic evaluations, automatic self-schema, or habit automaticity. The inclusion of pain while walking did not moderate the relationship between any automatic process and physical activity.ConclusionAlthough previous research on healthy, young adults suggests that automatic processes affect physical activity behaviour, we did not find evidence to confirm whether a similar relationship exists for older adults with knee osteoarthritis. Replication and extension work testing these research questions is needed to ensure the findings are not a result of measurement and design features of the study.     

Ethical Lessons from Heidegger’s Phenomenological Reading of Kant’s Practical Philosophy: Heideggerian Revision of Kant’s Justification of Morality*

ABSTRACT

In The Essence of Human Freedom, Heidegger suggests that Kant’s idea of pure will and Heidegger’s own idea of resoluteness are rooted in the same experience of demand from our own essence. This experience can unfold, I argue, through twofold self-understanding: first, the primordial self-understanding on the existentiell level that results in the indefiniteness of pure will (or resoluteness), as Heidegger’s phenomenological reading of Kant (or his own existential analysis) presents; and second, the practical self-understanding on the rational level that results in the principle of morality, as Kant’s Groundwork of the Metaphysics of Morals demonstrates. Based on this approach, if we accept Heidegger’s phenomenological interpretation of pure will but do not follow his rejection of the categorical imperative formulas, we can achieve a Heideggerian revision of Kant’s original justification of morality while avoiding Kant’s problematic assumption that the authentic self belongs to the intelligible realm.     

A portable defense of the Procreation Asymmetry

Abstract

The Procreation Asymmetry holds that we have strong moral reasons not to create miserable people for their own sakes, but no moral reasons to create happy people for their own sakes. To defend this conjunction against an argument that it leads to inconsistency, I show how recognizing ‘creation’ as a temporally extended process allows us to revise the conjuncts in a way that preserves their intuitive force. This defense of the Procreation Asymmetry is preferable to others because it does not require us to take on controversial metaphysical or metaethical commitments – in other words, it has the theoretical virtue of portability.     

Parents’ moral intentions towards antisocial parent behaviour: An identity approach in youth sport

ObjectivesGrounded in personal and social identity theory, the purpose of this study was to examine whether parents’ personal and social identity perceptions influence their moral intentions towards antisocial parent behaviour in a youth sport setting.DesignParents of competitive youth ice hockey players (N = 437) read a vignette that either described a parent from the participant’s own team (i.e., ingroup), or a parent from an opposing team (i.e., outgroup) acting antisocially towards an athlete from the participant’s own team, an opposing athlete, or their own child. Parents were asked whether they would respond to the antisocial behaviour in the form of direct or indirect criticism or report the behaviour to the coach or to the league.ResultsParents were more likely to directly criticize ingroup parents than outgroup parents and they were more likely to indirectly criticize outgroup parents than ingroup parents. Further, parents with stronger social identities reported higher intentions to indirectly criticize an outgroup parent. There were no main effects for reporting behaviour (to coach or league), and personal identity did not moderate relationships with moral intentions towards antisocial behaviour.ConclusionBy providing parents with a situation that includes antisocial parent behaviour in the immediate youth sport environment, novel insight was gathered with regard to what contextual elements might drive parents’ intention to criticize, but not report antisocial behaviour.     

Strengthening Couples from a Single-Parent Household Using Relational Cultural Therapy

ABSTRACT

Individuals initially learn about intimate relationships from observing others, such as their parents or caregivers’ relationship, which may positively or negatively affect their own romantic relationship. This article focuses on the application of Relational-Cultural Therapy (RCT) concepts to establish resilience among couples with at least one partner from a single-parent household. Some individuals from single-parent households may not have witnessed romantic relationships to confidently engage in adult romantic relationships. Additionally, clinicians may not consider family background as a source of contention for a couple’s presenting concerns. Thus, this article provides creative interventions and implications to assist counselors in working with couples.     

Pain intensity and pain unpleasantness in triathletes: A study examining their associations with pain catastrophizing and pain expectations

ObjectiveTriathletes represent a growing and unique population of individuals willing to endure significant mental and physical stress to practice the sport they love. However, little is known about the pain experienced while training for and competing in a triathlon and how psychological factors influence this experience. This study will assess pain experienced by triathletes in training and competition, and investigate the association between pain catastrophizing and pain expectations with triathlon pain intensity and pain unpleasantness.DesignIn this observational study, a sample of 261 triathletes completed two online surveys before and after participating in a triathlon.ResultsModerate levels of pain intensity and pain unpleasantness were reported during training and competition. Pain catastrophizing was positively associated with expected and actual triathlon pain unpleasantness, but not with pain intensity. Expected pain intensity was also significantly associated with pain intensity experienced while competing, whereas expected pain unpleasantness was significantly related to both triathlon pain intensity and unpleasantness. Finally, regression analysis revealed pain catastrophizing and pain expectations to be unique predictors of triathlon pain intensity and pain unpleasantness.ConclusionThis study highlights the important role of psychological factors in triathletes' experience of pain and could eventually help tailor interventions aimed at improving the practice of triathlon.     

What really matters

What really matters fundamentally in survival? That question—the one on which I focus—is not about what should matter or about metaphysics. Rather, it is a factual question the answer to which can be determined, if at all, only empirically. I argue that the answer to it is that in the case of many people it is not one’s own persistence, but continuing in ways that may involve one’s own cessation that really matters fundamentally in survival. Call this the surprising result. What are we to make of it? According to several philosophers, not much. I argue that these philosophers are wrong. What best explains the surprising result is that in the case of many people one’s special concern for oneself in the future is not fundamental, but derived. I explain what this means. Finally I explain why the task of explaining empirically what matters fundamentally in survival is in some ways more like a meditative quest than a traditional inquiry in western philosophy or social science and, as such, is best answered not by psychologists, but by philosophers.