Is This Relevant? Physician Perceptions,Clinical Relevance,and Religious Content in Clinical Interactions

Despite wide support among physicians for practicing patient‐centered care, clinical interactions are primarily driven by physicians’ perception of relevance. While some will perceive a connection between religion and patient health, this relevance will be less apparent for others. I argue that physician responses when religious/spiritual topics come up during clinical interactions will depend on their own religious/spiritual background. The more central religion is for the physician, the greater his or her perception of religion's impact on health outcomes and his or her inclusion of religion/spirituality within clinical interactions. Using a nationally representative sample of physicians in the United States and mediated path models, I estimate models for five different physician actions to evaluate these relationships. I find that a physician's religious background is strongly associated with whether or not he or she thinks religion impacts health outcomes, which is strongly predictive of inclusion. I also find that not all of the association between inclusion and physicians’ religious background is mediated by thinking religion impacts health outcomes. Issues of religion's relevance for medicine are important to the degree that religious beliefs are an important dimension of patients’ lives.     

Human Dignity and Assisted Dying

The United Nations' Universal Declaration of Human Rights, in its preamble, affirms ‘the inherent dignity and … the equal and inalienable rights of all members of the human family’ as ‘the foundation of freedom, justice and peace in the world’. However, advocates of assisted dying have proposed that human dignity is not inherent and that individuals should be able to determine their own dignity and quality of life. In response to this, it is suggested that persons who consider that their lives are no longer worth living, or believe that they have lost their ‘dignity’, are discriminating against themselves. Moreover, with assisted dying, as opposed to suicide, another person must also believe that it would be preferable for a person wishing to die not to continue living. In other words, assisted dying is a reflection of the unacceptable belief by a person that human dignity is not inherent and that another person can lose his or her dignity to such an extent that his or her life is no longer worth living and should be ended.     

Jerry

Jerry is a personal essay in which the author examines his relationship with a friend of the past 11 years. The author draws parallels between their outwardly very different lives and suggests how personal love and spiritual grace have unexpectedly crept in to influence both of them.     

Theorizing the Temporal Aspect of Ikigai or Life Worth Living among Japanese University Students: a Mixed-Methods Approach

Although cross-cultural and non-Western studies have advanced our knowledge on well-being, many studies have adopted English words including ‘happiness’ as their guiding concepts, which may have limited and biased their insight. The current study is part of a larger mixed-methods project that theorizes how Japanese university students pursue ikigai or a life worth living. The first qualitative study, based on 27 photo-elicitation interviews, generated a grounded theory of houkousei, or life directionality. Our qualitative findings suggested that when students formed explicit associations among the past, present, and future, they gained strong ikigai feelings. These associations were developed either cognitively by mentally associating existing present experiences with the past or future, or behaviourally by strategically choosing current experiences more pertinent to the past or future than alternatives. These actions resulted in two subjective states: life legacy and life momentum. Life legacy was the perception that one’s past had meaningfully contributed to his or her present experiences, life, and self. Life momentum meant the belief that one’s present experiences were helping him or her achieve the desired future. Lastly, having defining past experiences and setting clear goals both facilitated the associative actions. To further validate this theory, we collected online survey data from a national sample of 672 Japanese students. Our quantitative results, based on partial least squares structural equation modelling (PLS-SEM), largely supported our theoretical model. Our findings are discussed in light of the ikigai and eudaimonic well-being literatures.

     

‘Just Because I Can't Remember …’ Religiousness in Older People with Dementia

SUMMARY

This paper reports part of a pilot study that used spiritual reminiscence techniques to explore issues of religiosity, church attendance and meaning in life of a group of older people with dementia. The study used small groups, individual interviews and participant observation to examine the experience of dementia and the search for meaning used by people with dementia. There were 22 participants from three aged care facilities involved in the project. The majority of participants had been long-term church attendees and could describe how their religion and relationship with God had impacted on their lives. They had few fears for the future and derived considerable meaning in life from their relationships with family. Participants were able to describe early memories and also remember things happening recently in their aged care facility. This would seem to be the opposite of community expectations (and sometimes staff expectations) of older people with dementia.     

Postmodern Spirituality: Implications for Promoting Change

This article addresses selected effects of postmodernism on spirituality and contains a discussion of implications for promoting change in counseling. Because aspects of postmodern spirituality can prevent change, spiritual transformation may need to occur in the life of the client. Spiritual transformation is conceptualized as a process of helping the client develop resilient spirituality, which can enable the client to overcome his or her difficulties. Resilient spirituality involves finding meaning in adherence to a set of larger beliefs, the exercise of faith as a way of knowing, and an experience of connection with God and others.     

Spiritual coaching in cancer patients: treating the spirit as well as the disease

Interest in the exploration of spirituality in medical practice has been growing recently due to some studies suggesting its role in the improvement of patient well-being and quality of life. This project examined the feasibility of providing spiritual coaching with patients in an outpatient Radiation Oncology clinic setting. The purpose of spiritual coaching was to provide patients with opportunities to explore their current spiritual lives, increase their involvement in spiritually enhancing activities, and expand their spiritual opportunities. Quality-of-life measurements focused on feelings of hopefulness and distress were used in patients undergoing radiation treatment for cancer. This study suggests that there is a potential benefit for spiritual coaching in the care of cancer patients, and future studies will be done to further el ucidate the ationship of spirituality and quality of life in this population.     

The experience of spirituality in the psycho-social adaptation of cancer survivors

This article presents the results of a retrospective, phenomenological study of the experience of spirituality in the psychosocial adaptation of cancer survivors. The experience of illness for the participants in the study is one which promotes greater personal and spiritual growth. The study demonstrates that illness provokes personal growth and transformation in the individual. While making use of pre-existing coping resources, the person with cancer reevaluates and restructures her or his life, integrating new values, priorities, and perspectives which lead the patient to invest her or his life in something meaningful and beneficial to others.     

Using the Internet to investigate consumer choice spaces

Traditional investigations of consumer choice processes include a matrix of alternatives described by attributes. The researcher-createdmatrix presents a product option space for the participant. In this article, we propose an alternative methodological approach to consumer choice processes. Specifically, we investigate choice processes when a participant creates his/her own product space. We describe a Web-based program and methodology used to collect data for three customizable products. Empirical results indicate that consumers are willing and able to make choices from their own product space. This research provides a new avenue for exploring choice processes.     

Increasing therapeutic exercise participation by individuals with acquired brain injury using self‐recording and reinforcement

The purpose of this study was to evaluate the effects of self‐recording and contingent reinforcement on exercise participation by four adults with acquired brain injury. The results indicate that self‐recording and contingent reinforcement increased participation in stretching, aerobic, and weight‐lifting activities for each participant. The results also indicate that each participant was able to accurately self‐record his or her exercise participation. Possible operant conceptualizations for the observed behavior change, as well as limitations to the results, are briefly discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Biography becomes autobiography: distorting the subjective past

This work addresses whether creating a biographical sketch for a fictional adolescent can increase confidence that one personally experienced these details in adolescence (memory distortion) and whether susceptibility to such distortion (depends on whether adolescence is considered part of one's subjective past or subjective present. We divided the subjective past and present using the point at which a person experienced the last life event that changed his or her personality significantly. We operationalized the subjective past as events associated with the period before the last life-changing event and the subjective present as events associated with the period after that event. Participants' confidence in their own autobiographical memory increased after they wrote a brief story about a fictional character. This increase occurred only for those who considered adolescence to be part of their subjective past. These results indicate that subjective time (in addition to objective time) may be a valuable factor in determining who is susceptible to memory distortion. We discuss these findings in terms of familiarity attribution and source monitoring.     

Students’ Responses to Improve Environmental Sustainability Through Recycling: Quantitatively Improving Qualitative Model

This study attempts to contemplate the respondents’ behaviors regarding recycling, with the purpose of identifying the factors that influence their behaviors. The study is based on a survey that was conducted with 230 nationwide university students and guidelines borrowed from the Theory of Planned Behavior and The Theory of Reasoned action. The data collected was evaluated by applying the Structure Equation Modelling technique. The study concluded that peoples’ attitudes are largely subject to the moral values and general norms of their own society. Additionally, an individual’s response towards recycling is greatly determined by the extent of his/her awareness towards the environment, as well as his/her personal knowledge. Another conclusion was that an individual’s past experience towards recycling contributes to his/her attitude (willingness or apprehension about recycling) in the future. Furthermore, although the convenience and cost of recycling were found to be reasonably significant determinants about one’s recycling behavior, it was determined that time commitment is the most decisive factor that influences an individual’s willingness to or not to recycle. The study’s findings have not only established the authority of Theory of Planned Behaviour and Theory of Reasoned Action, but it has also presented propositions and recommendations for future research. The inferences were based on the study’s respondents, hence, so their validity can be applied to various scenarios involving local educational institutions or government structures. The goal of the study is to encourage people to engage in positive recycling behavior.     

Another conversion. Stanisław Brzozowski’s ‘diary’ as an early instance of the post-secular turn to religion

This essay is an attempt to analyze an important decision Brzozowski took at the end of his life, i.e. his late turn towards Catholicism, which, despite his own objections, we should nonetheless call a religious conversion. The main reason why Brzozowski resisted the traditional rhetoric of conversion lies in his often repeated conviction that faith cannot invalidate life, because “what is not biographical, does not exist at all.” Brzozowski, therefore, rejects conversion understood as a radical and abrupt revolution of the soul, which annuls everything that happened before, and turns to a model of religiosity (“Catholicism, undoubtedly”) which preserves his entire biographical past. In this manner, Brzozowski seeks his own formula of faith, more adequate to the “situation” of the modern man who lives in and through History. I argue that the model of “conversion without conversion” Brzozowski chose as representative of modern man is typically, though avant la lettre, post-secular: closer to the Jewish sources of past-oriented tschuva than to the mystical timelessness of traditionally Christian metanoia. The idea that redemption consists not in a liberation of a pure spirit but in a patient working-through of the universal history of creation is an implicit credo of the whole modern age, first fully articulated by Brzozowski and only later in the writings of Hermann Cohen, Franz Rosenzweig, and Walter Benjamin. Brzozowski emerges as a relatively early precursor of the future post-secular option whose advocates, like the author of The Diary, will not allow themselves to “lose a single moment,” either of their lives or the world’s history.     

The Structure and Function of Near-Death Experiences: An Algorithmic Reincarnation Hypothesis

Hypothesizes that a near-death experience (NDE) is the subjective experience of having the state of consciousness in which a person experiences the last moment of his or her life being turned, in stages, into the state of consciousness experienced as the point of no return. The life review this, as is interpreted as a review of the states of consciousness experienced during our lives. Our responses to reviewing our own behaviors while in specific states reinforces and classifies them into those to repeat in future lives and those to avoid. We examine a modification of the traditional doctrine of reincarnation that takes into account biological and cultural evolution. This allows an understanding of how the attributes of NDEs could have undergone selection even though all opportunities for mating have already passed at the time of death.     

Shame in Sexual Minorities: Stigma,Internal Cognitions,and Counseling Considerations

Theorists, clinicians, and researchers have suggested that shame is a central concern in the lives of sexual minority individuals. Cognitive theorists believe that shame occurs when a person fails to achieve his or her standards, which are often based on social, cultural, and spiritual values. Although it is asserted that stigma causes shame among members of a sexual minority, the empirical evidence suggests that negative internal cognitions are partly responsible. By targeting negative beliefs, counselors can help sexual minorities reduce their sense of shame, particularly around issues related to sexual identity. The authors offer counseling strategies for reducing shame in sexual minority clients.     

At Death's Door: Therapists and Patients as Agents

This paper explores the interrelationship between patients' exercise of will to make advances in an analysis and their readiness to forgive their analysts for their human limitations. There is a thin line between idealization of the analyst, probably a necessary component of the process, and resentment of the analyst for his or her privileged position in the world and in the analytic situation itself. The patient's “progress” emerges as a kind of reparative gift, one that implicitly overcomes the patient's tendency to withhold such change out a sense of chronic, malignant envy. Particularly poignant in terms of its potential to elicit the patient's reparative concern is the situation in which the analyst is struggling with his or her mortality because of aging or life-threatening illness. In this essay two clinical vignettes are presented to illustrate some of the issues that this situation poses. One begins with an elderly patient appearing at the door of the analyst's (the author's) home the day of his return from the hospital after coronary bypass surgery. The other begins with an analyst who is terminally ill appearing at the door of a patient who is threatening suicide. The two stories are compared in terms of their implications for human agency, the exercise of will, and the coconstruction of meaning in the face of mortality in the analytic process.     

Spiritual Psychotherapy for Antisocial and Psychopathic Personalities: Some Theoretical Building Blocks

Until now a profound theoretical model for spiritual psychotherapy, which is constructed specifically for nonreligious antisocial and psychopathic patients who have spiritual and philosophical interests, is missing. In this paper some important theoretical issues with respect to spiritual psychotherapy for antisocial and psychopathic patients will be discussed such as the links between spirituality on one hand and authenticity, vanity; emotional, moral, and social capacity; reality testing; creativity; and faith in life on the other. Furthermore, the spiritual psychotherapist's attitude towards his or her patients will be explored.     

Creative Change: The Life and Work of Four Novelists: Jane Austen, E. M. Forster, Barbara Pym, and Henry Roth

Robert Kastenbaum has argued that we need to take a life-span approach to the lives of artists in order to determine what factors affected their creativity. To that end, I briefly review the lives of four writers, Jane Austen, E. M. Forster, Barbara Pym, and Henry Roth. Each followed a different pattern: Austen wrote productively until her early death; Forster ceased to write novels after his midlife success; Barbara Pym continued to write until her death from cancer; and Henry Roth restarted his moribund career in his seventies. These differences suggest that creativity is closely connected to life events and the artist's psychological state of mind.     

Issues of ethics and identity in diagnosis of late life depression

Depression is often diagnosed in patients nearing the end of their lives and medication or psychotherapy is prescribed. In many cases this is appropriate. However, it is widely agreed that a health care professional should treat sick persons so as to improve their condition as they define improvement. This raises questions about the contexts in which treatment of depression in late life is appropriate. This article reviews a problematic case concerning the appropriateness of treatment in light of the literature in bioethics. Specific attention is paid to the concept of authenticity and the role of suffering. Suffering is often the result of a situation in which one's self is damaged. In some circumstances, this suffering should not be seen as a symptom of illness, but as a reflection, in a difficult life context, of the individual's authentic nature. Assessment of depression in the elderly must go beyond a symptom list and must consider both the context of the individual's situation and his or her authentic self. When the symptoms reflect the individual's assessment of the situation in the context of the authentic self, they may be "appropriate." However, even when the symptoms are appropriate, if they interfere with life assessment and adjustment, treatment should be considered.