The practice of empathy as a prerequisite for informed consent

The patient-physician relationship, as formulated in the traditional biomedical model of medicine, is inherently flawed. In entering this relationship, most patients seek simply to be delivered from illness back to normal psychosocial functioning. The physician, however, almost invariably responds with a purely biologic approach to diagnosis and treatment that often does not effectively address the patient's needs. This precludes the opportunity for a consensus between them, and may in fact lead to the physician manipulating the patient's decisions about the course of therapy. The relationship should be reshaped within a new scientific model of patient care that combines the biomedical analysis of disease with an empathic understanding of the patient's illness experience. Truly informed consent is viewed as a natural outcome of the application of this more comprehensive framework.     

An Auto‐Ethnographic Study of “Open Dialogue”: The Illumination of Snow

This auto‐ethnographic study describes the changes in the author's thinking and clinical work connected to her first‐hand experience of Open Dialogue, which is an innovative, psychosocial approach to severe psychiatric crises developed in Tornio, Finland. In charting this trajectory, there is an emphasis on three interrelated themes: the micropolitics of U.S. managed mental health care; the practice of “dialogicality” in Open Dialogue; and the historical, cultural, and scientific shifts that are encouraging the adaptation of Open Dialogue in the United States. The work of Gregory Bateson provides a conceptual framework that makes sense of the author's experience and the larger trends. The study portrays and underscores how family and network practices are essential to responding to psychiatric crises and should not be abandoned in favor of a reductionist, biomedical model.     

Autonomy,Subject-relativity,and Subjective and Objective Theories of Well-being in Bioethics

Among the different approaches to questions of biomedical ethics, there is a view that stresses the importance of a patient’s right to make her own decisions in evaluative questions concerning her own well-being. This approach, the autonomy-based approach to biomedical ethics, has usually led to the adoption of a subjective theory of well-being on the basis of its commitment to the value of autonomy and to the view that well-being is always relative to a subject. In this article, it is argued that these two commitments need not lead to subjectivism concerning the nature of well-being. This revised version was published online in June 2006 with corrections to the Cover Date.     

Group life shapes the psychology and biology of health: The case for a sociopsychobio model

Engel presented a compelling case for a biopsychosocial model of health. This challenged a biomedical model that he saw as reductionistic, physicalistic, and exclusionist. Yet despite its laudable goals and popularity, the biopsychosocial model can be faulted for being incremental, imprecise, and individualistic. Ultimately, this means it is no less reductionist than the biomedical model which it sought to supplant. In this paper, we present a reformulation of this model that foregrounds the capacity for social groups—and the social contexts in which those groups are embedded—to structure psychology and, through this, biology and health. This sociopsychobio model argues that the three elements of Engel's framework are not fixed and immutable but rather dynamic and interdependent. The model is consistent with a range of recent approaches to health that have focused on the important role that social class, social inequality, social structure, and social networks play in shaping health outcomes. In this paper, though, the concrete value of this reformulation is illustrated through a discussion of recent research that focuses on the role of group memberships and associated social identities in shaping the psychology and biology of stress. This review underlines two key points that are central to the general case for a sociopsychobio model of health. First, that groups are a force in the world that shape the psychology and biology of their members (as well as members of other groups) in ways that cannot be reduced to those group members' functioning as individuals. Second, that groups provide their members with a basis for seeking to change the world rather than simply accepting it. In this, group life is not merely an appendage to psychology and biology but is instead a basis for collective experiences that have the potential to unleash new expressions of both.     

Hospice Care and a Theology for Patients at the End of Life

In Richard Kearney's text Anatheism, he claims that one can respond to the call of the stranger in two ways, with hospitality or with hostility. However, because the stranger possibly bears the presence of the divine, he urges one to risk responding to the stranger's call with hospitality rather than hostility, opening oneself up to encountering the sacred in the form of the stranger. In the present analysis, I claim that hospitality toward the stranger is modeled in the hospice philosophy of care for dying patients. I note the distinctions between the biomedical model of health care and the biopsychosoical model of care, and draw on Kearney's framework and Dorothee Soelle's text Suffering to suggest that, with regard to how to interpret pain, the act of hosting can be an option more viable than that of demonstrating hospitality.     

Infertility, “Experientially Oriented” Couples Therapy and Subsequent Pregnancy

SUMMARY

Four couples who had been diagnosed as clinically infertile were seen in experientially oriented couples therapy. Each couple conceived a baby shortly after a particularly powerful session. These ' sessions are described. The commonality across these sessions involved opening up the clients' inner experiencing and enabling these clients to actualize and integrate whatever was deeper within. The conventional biomedical and psychoanalytic approaches to infertility are described. The experiential model provides an alternative way to understand the timing of pregnancy or lack thereof. It also offers a holistic approach to working with infertile couples.     

Psychological Tests Don't Think: An Appreciation of Schafer's Psychoanalytic Interpretation In Rorschach Testing

Roy Schafer 's Psychoanalytic Interpretation in Rorschach Testing has, for nearly 40 years, represented a hallmark of psychodynamically informed psychological assessment. In this article, Schafer's contribution is reviewed in light of recent contributions to the Rorschach literature. Following a summary of the main sections of the work, Schafer's approach to the Rorschach is critically re-examined from the perspective of modem assessment practice. Differences between the epistemological bases of psychoanalytic and empirical methods of Rorschach interpretation are highlighted, and the prospects for an integration of these two approaches are considered. It is concluded that Schafer's contribution remains as fresh today as when written 40 years ago.     

On the Madness in His Method: R. B. Cattell's Contributions to Structural Equation Modeling

In the space available for this essay I can provide only a cursory review of the many methodological contributions of R. B. Cattell. I have chosen to look at these from the vantage point of contemporary issues in structural equation modeling. Cattell's factor analytic approach is compared With current modeling practices. A critical evaluation is offered which finds much of Cattell's work still innovative, still technically advanced, and still of great value to contemporary model builders.     

Critique and resistance: Ethical,social‐theoretical,political? On Fabian Freyenhagen's Adorno's Practical Philosophy

Fabian Freyenhagen's impressive reconstruction of Adorno's ‘practical philosophy’ provides a convincing defence of the possibility of making normative claims about the social world we live in without justifying these claims in terms of the right, the good, or human nature. More specifically, and more controversially, Freyenhagen argues that the normative resources Adorno's critique relies on are provided by a negative Aristotelianism. In this paper, I argue that this approach underestimates the extent to which Adorno follows the model of immanent critique, I highlight the socio‐theoretical underpinnings of what Freyenhagen calls Adorno's ‘ethics of resistance’, and I discuss the risk of overstating the danger of co‐optation that collective political action faces.     

The Defiant Power of the Human Spirit: Mental Health in Later Life

SUMMARY

This paper sets forth a wholistic perspective on the aging process, that clearly acknowledges the struggles and tensions between both the positive and decremental aspects of aging encountered in this journey. It speaks eloquently of the overarching tapestry of our lives balanced against the precariousness and brevity of life's experience. It speaks of challenges of later life that are experienced as physical decrements progress. Against these are balanced the need for rituals and transcendent symbols to enable the person to move into the spiritual and find meaning in the journey. In presenting this picture of aging, Kimble moves beyond the biomedical paradigm and applying Frankl's material he clearly demonstrates the defiant power and potential of the human spirit in adjusting to and moving through and beyond suffering.     

THE LOST LEGACY OF ANSELM'S ARGUMENT: RE‐THINKING THE PURPOSE OF PROOFS FOR THE EXISTENCE OF GOD

In his Proslogion, Anselm presents a proof for God's existence which has attracted a tremendous amount of scholarly attention. In spite of all that has been said about this proof and proofs for God's existence more generally, scholarly consensus seems to dissipate when it comes to determining whether theistic proofs are persuasive and sound. In this article, I will argue that there is a way to provide compelling proof for the existence of God. To substantiate this claim, I will not attempt to prove that God exists apart from His revelation in any of the ways that have been advocated by various philosophers of religion. Rather, I will endeavor to explain that Anselm's approach to offering evidence for God's existence is quite different from the approach that modern philosophers tend to attribute to him and to elaborate on what that approach involves by reading Anselm's argument in the context of Augustine's De Trinitate and the whole of the Proslogion.     

Nesselroade and Molenaar's Measurement Concerns and Proposals: An Introduction

In this special section Nesselroade and Molenaar (N & M) propose a provocative new approach to measurement invariance. When measures are collected repeatedly over time (e.g., daily diary studies), a potentially unique measurement model relating the items to the underlying construct can be created for each individual. If hypothesized causal paths specified between constructs (e.g., frustration → aggression) can be constrained to be equal across the individuals, a model with idiographic measurement of the constructs, but with nomothetic structural relationships can be specified. Three commentaries react to N & M's proposal. Revelle and Wilt challenge the priority given by N & M to unique individual measurement structures, arguing that between subjects differences in structural relationships are empirically important and meaningful. Markus's uses David Hume's framework to raise philosophy of science challenges for N & M's approach. Maydeu-Olivares challenges the incremental validity of N & M's approach, arguing that N & M's approach is unlikely to improve the prediction of between subjects criteria. Finally, N & M present a rejoinder to the three commentaries.     

Estimation of Group Priorities and Value of Information

In this paper, we present a Bayesian approach to model uncertainty about a group's priorities in a multicriteria evaluation problem and develop a methodology to quantify amount of information provided by a sample of priorities. In so doing, we discuss how the quantification of the information content can be used to decide to elicit additional priorities from the group. We illustrate the implementation of our approach and discuss additional insights that it provides using real‐life data from an academic department's priority analysis. Copyright © 2013 John Wiley & Sons, Ltd.     

Inferring Learners' Knowledge From Their Actions

Watching another person take actions to complete a goal and making inferences about that person's knowledge is a relatively natural task for people. This ability can be especially important in educational settings, where the inferences can be used for assessment, diagnosing misconceptions, and providing informative feedback. In this paper, we develop a general framework for automatically making such inferences based on observed actions; this framework is particularly relevant for inferring student knowledge in educational games and other interactive virtual environments. Our approach relies on modeling action planning: We formalize the problem as a Markov decision process in which one must choose what actions to take to complete a goal, where choices will be dependent on one's beliefs about how actions affect the environment. We use a variation of inverse reinforcement learning to infer these beliefs. Through two lab experiments, we show that this model can recover people's beliefs in a simple environment, with accuracy comparable to that of human observers. We then demonstrate that the model can be used to provide real‐time feedback and to model data from an existing educational game.     

Exploring the Effects of Creativity Training on Creative Performance and Creative Self‐Efficacy: Evidence from a Longitudinal Study

In organizations and educational institutions, creativity trainings are the preferred approach to enhancing individual creative abilities. However, three issues regarding these trainings still remain largely unsolved. First, the question of how long‐lasting creativity training effects are has not been sufficiently answered so far. Second, the question arises whether all participants benefit from such trainings equally in terms of their creative performance (CP). Third, an increasing number of studies have shown that creativity trainings may also be able to increase participants' creative self‐efficacy (CSE), that is, the confidence in one's own creativity. Other studies, however, did not find evidence for this effect. Therefore, this article aims to address these issues by analyzing data from three measurement waves. Results reveal that participants' CP increased during the training and decreased only slightly 4 weeks after the training. Additionally, we found an effect of diminishing training returns in that the higher a participant's CP before the training the lower the training effect was. In contrast to most prior literature, we found no support for an effect of creativity training on participants' CSE. We discuss these findings and offer implications for both theory and practice. Finally, we state this study's limitations and derive avenues for further research.     

Putting the mind back into the body a successor scientific medical model

This paper examines today's received scientific medical model with respect to its ability to satisfy two conditions: (1) its explanatory adequacy relative to the full range of findings in the medical literature, including those indicating a correlation between psychosocial variables and disease susceptibility; and (2) the fit between its physicalist patient and disease concepts and what today's basic sciences, so-called sciences of complexity, tell us about the way matter, notably complex systems (e.g. patients), behave and the nature of scientific explanation. I conclude that the received (biomedical) model falls short on both counts and to satisfy these conditions is to articulate a formal successor model. This successor must be guided by premises consistent with the findings and methods of today's basic sciences on which an applied science like medicine depends for its validity. Additionally, the successor model must be able to explain (and predict) the full range of clinical findings, both those that its predecessors explains and at least some of those that it does not. The aim of the paper is to identify such a model.     

Books Received

In Questioning Technology, Feenberg accuses Heidegger of an untenable 'technological essentialism'. Feenberg's criticisms are addressed not to technological essentialism as such, but rather to three particular kinds of technological essentialism: ahistoricism, substantivism, and one-dimensionalism. After these three forms of technological essentialism are explicated and Feenberg's reasons for finding them objectionable explained, the question whether Heidegger in fact subscribes to any of them is investigated. The conclusions are, first, that Heidegger's technological essentialism is not at all ahistoricist, but the opposite, an historical conception of the essence of technology which serves as the model for Feenberg's own view. Second, that while Heidegger does indeed advocate a substantivist technological essentialism, he offers a plausible, indirect response to Feenberg's voluntaristic, Marcusean objection. Third, that Heidegger's one-dimensional technological essentialism is of a non-objectionable variety, since it does not force Heidegger to reject technological devices in toto. These conclusions help vindicate Heidegger's ground-breaking ontological approach to the philosophy of technology.