‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

Social support in spouses of cancer patients: What do they get and to what end?

Using a retrospective design, the authors assessed several different aspects of social support (perceived, received, satisfaction with received, and support seeking) in 95 spouses of cancer survivors. The goals of the investigation were to (a) describe in detail the differences between husbands and wives on these support dimensions and (b) explore whether the relation between support and adjustment was different for husbands as compared to wives. While husbands and wives were generally similar-in their general perceptions of available support and in the amount of support they reported seeking, consistent with our hypothesis, compared to husbands of breast cancer victims, wives of prostate cancer victims reported receiving more support and being more satisfied with the support they received. Measures of social support predicted husbands’reports of marital satisfaction and adjustment, but not wives’reports. Partial correlation analyses indicated that sex differences in these support-adjustment links were not attributable to differences in age, or in the time between completing treatment and participating in the study. Sex differences observed in the present study are interpreted as highlighting the need for theory development to account for the complex mechanisms underlying links between supportive transactions and marital satisfaction and adjustment.     

‘Them’ and ‘us’: The experiences of women with metastatic disease in mixed-stage versus stage-specific breast cancer support groups

The objective of this study was to explore the experiences of women with metastatic breast cancer (MBC) in mixed-stage and stage-specific groups. Interpretative phenomenological analysis (IPA) was used to examine 15 interviews from eight women with MBC. The interviewees felt that their experiences were very much different from those of women with primary breast cancer (BC), because of their different prognoses. In mixed-stage groups, the interviewees described feeling silenced, marginalised and helpless. They did not receive support in these groups because survivors of primary BC are often afraid to face the idea of metastasis. In stage-specific MBC groups, on the other hand, women were able to talk openly and were understood by others with whom they identified. They became more informed about issues related to their illness. Seeing others living well despite MBC made them feel more hopeful. Although there are some disadvantages of participating in stage-specific groups, the findings suggest that, overall, stage-specific groups are more helpful to women with MBC than mixed-stage groups. These findings have implications for the provision of group support for this population.     

Repetition of ‘right’ and ‘wrong’ responses with a different number of response alternatives in study and test trial

The reinforcement values of ‘right’ and ‘wrong’ upon subsequent repetition of the response have been explained by the subject's independent memory for his previous response and its outcome ‘right’ or ‘wrong’. Detailed analyses on the data of recent experiments suggest that an increasing number of response alternatives for each stimulus makes the recall of the response and the outcome ‘right’ no longer independent. Therefore it was predicted that for a given number of response alternatives at the Test Trial, the likelihood that a subject will repeat a response called ‘right’ at the study Trial will be a function of the number of response alternatives at the Study Trial. The results were confirmatory. The explanation of these results was based on there being a larger informational value in the outcome ‘right’ with an increasing number of response alternatives.     

Experimental manipulation of emotion regulation changes mothers’ physiological and facial expressive responses to infant crying

This study examined whether instructing mothers to apply emotion regulation strategies can change mothers’ perception and reactivity to infant crying in an experimental within-subject design. Perception of crying, skin conductance level (SCL), facial expressivity, and intended caregiving responses to cry sounds were measured in mothers (N = 101, M = 30.88 years) who received suppression, reappraisal, and no emotion regulation instructions. Reappraisal resulted in lower SCL during exposure to crying and a less negative perception of crying compared to the suppression condition. In contrast, suppression resulted in increased facial expressions of sadness compared to the control condition. Thus, simple instructions on how to reframe thoughts about crying can change mothers’ perception of and reactivity to crying.     

“Why me?” – women’s use of spiritual causal attributions in making sense of breast cancer

Objective: This study addressed the role of positive (event is due to God’s Love or to God’s Will) and negative (event is due to God’s Anger) spiritual causal attributions in women’s adjustment to breast cancer.

Design: Ninety-three women diagnosed with breast cancer were assessed at six times from pre-diagnosis through two years post-surgery.

Main outcome measures: Women completed positive and negative measures of spiritual causal attributions (e.g. God’s Love), cognitive appraisals (e.g. threat), coping behaviour (e.g. avoidance) and well-being (e.g. distress).

Results: Positive spiritual attributions were consistently related to positive aspects of adjustment (e.g. positive appraisal, acceptance coping, and/or emotional well-being) while negative spiritual attribution was related to negative factors (e.g. appraisals of loss and uncontrollability, avoidance coping, and/or emotional distress). Path analyses revealed that the effects of positive and negative spiritual attributions on well-being were mediated by general cognitive appraisal and coping behaviour. Cross-lagged correlational analysis revealed a ‘downward spiral’ effect wherein the negative attribution of God’s Anger at pre-diagnosis predicted greater distress at 1 week pre-surgery which in turn predicted an increase in the negative attribution and so on across time.

Conclusion: Although positive spiritual attributions may help women maintain an attitude of hope and acceptance in the face of cancer, results indicate that the effects of negative spiritual attribution can play a significant role in undermining their well-being.     

Defining ‘Dead’ in Terms of ‘Lives’ and ‘Dies’

What is it for a thing to be dead? Fred Feldman holds, correctly in my view, that a definition of ‘dead’ should leave open both (1) the possibility of things that go directly from being dead to being alive, and (2) the possibility of things that go directly from being alive to being neither alive nor dead, but merely in suspended animation. But if this is right, then surely such a definition should also leave open the possibility of things that go directly from being dead to being neither alive nor dead, but merely in suspended animation. I show that Feldman’s own definition of ‘dead’ (in terms of ‘lives’ and ‘dies’) does not leave this possibility open. I propose a new definition that does.     

‘What’ and ‘where’ in the human visual system: Two hierarchies of visual modules

In this paper we focus on the modularity of visual functions in the human visual cortex, that is, the specific problems that the visual system must solve in order to achieve recognition of objects and visual space. The computational theory of early visual functions is briefly reviewed and is then used as a basis for suggesting computational constraints on the higher-level visual computations. The remainder of the paper presents neurological evidence for the existence of two visual systems in man, one specialized for spatial vision and the other for object vision. We show further clinical evidence for the computational hypothesis that these two systems consist of several visual modules, some of which can be isolated on the basis of specific visual deficits which occur after lesions to selected areas in the visually responsive brain. We will provide examples of visual modules which solve information processing tasks that are mediated by specific anatomic areas. We will show that the clinical data from behavioral studies of monkeys (Ungerleider and Mishkin 1984) supports the distinction between two visual systems in monkeys, the what system, involved in object vision, and the where system, involved in spatial vision.I thank Carole Graybill for editorial help.     

Why Are Some Phenomenal Experiences ‘Vivid’ and Others ‘Faint’? Representationalism,Imagery, and Cognitive Phenomenology

One central brand of representationalism claims that the specific phenomenal character of an experience is fully determined by its content. A challenge for this view is that cognitive and perceptual experiences sometimes seem to have the same representational content while differing in phenomenal character. In particular, it might seem that one can have faint imagery experiences or conscious thoughts with the same contents as vivid perceptual experiences. This paper argues that such cases never arise, and that they are probably metaphysically impossible. I also suggest a fully representational account of differences in vividness between phenomenal experiences.     

What to Do with a Second Chance in Life? Long-Term Experiences of Non-carriers of Huntington’s Disease

Little is known about how people’s lives are influenced when going from a 50% risk status of Huntington’s disease (HD) to no risk after performing predictive testing. In this study, 20 interviews were conducted to explore the long-term (>?5 years) experiences after receiving predictive test results as a non-carrier of HD. The results showed a broad variety of both positive and negative reactions. The most prominent positive reaction reported was feelings of relief and gratitude, of not carrying the HD mutation for themselves and for their children. Also, the non-carrier status promoted in some individuals’ significant life changes such as a wishing to have (more) children, pursuing a career or breaking up from an unhappy relationship. However, negative reactions on their psychological well-being were also described. Some had experienced psychological pressure of needing to do something extraordinary in their lives; others expressed feelings of guilt towards affected or untested siblings, resulting in sadness or clinical depression. The new genetic risk status could generate a need of re-orientation, a process that for some persons took several years to accomplish. The results of the present study show the importance of offering long-term post-result counselling for non-carriers in order to deal with the psychological consequences that may follow predictive testing.     

Fear of ‘failure’ and ‘tissue damage’ in police recruits,constables, sergeants and senior officers

This study investigates the effects of occupational experiences on the pattern of fears among groups of British male police officers. Two categories of fears were studied: (1) fear of failure and negative evaluation; (2) fear of tissue damage and bodily harm. The former was expected to increase with police experience and seniority, whereas the latter should decrease due to greater exposure in vivo and limited opportunities for avoidance behaviour. The Ss comprised 72 police recruits, 62 constables, 30 sergeants and 93 senior officers. The hypotheses were confirmed, suggesting clear group differences among police officers in the pattern of fears which was related to police experience and seniority. The Fear scores were found to correlate significantly with neuroticism as measured by the EPQ.     

‘There and then’, ‘here and now’, ‘when and if’: The relationship of present,past and future in the consulting room

This paper revolves around the question of the patient’s inhabiting of time. Where is the main focus of the patient’s indwelling in time – the past, the present or the future – and what are the qualitative aspects of such indwelling? Of equal significance, is the patient able to move freely between past, present and future events and preoccupations and make links between them, or is he or she caught in a ‘time warp’? These questions are explored within a context of both psychodynamic and existential theory, drawing on the one hand on the work of Winnicott, Bick, Bion and Turp and on the other of Heidegger, Van den Berg, Merleau-Ponty, Kemp and Scheffler. The themes addressed are illustrated with clinical examples.     

Child age, parent and child gender, and domain differences in parents’ attributions and responses to children’s outcomes

The influence of children’s age, and parents’ and children’s gender on parents’ attributions and emotional and behavioral responses to their children’s successful and unsuccessful social and academic outcomes, was investigated. Seventy-six dual-parent families (mothers and fathers) of fifth (n=28), eighth (n=23), and eleventh grade (n=25) children participated. The results of this study suggest that from fifth grade on, at least, the ways parents explain the causes of and respond to their children’s social behavior and academic outcomes involves a complex interaction of children’s age, children’s gender, parents’ gender, domain, and outcome. Results are discussed in terms of children’s socialization. This paper is based in part on a master’s thesis at Clark University by the first author. An earlier version of this paper was presented at the annual meeting of the Eastern Psychological Association, Providence, RI, April 1994. The authors would like to thank the parents, teachers, and school administrators of Holden and Auburn, Massachusetts, who participated in this project. We would also like to thank Kristen Rotis and Leslie Edwards for their tireless help in revising and preparing the questionnaires, and for entering data for this project.     

What’s the object of object working memory in infancy? Unraveling ‘what’ and ‘how many’

Infants have a bandwidth-limited object working memory (WM) that can both individuate and identify objects in a scene, (answering ‘how many?’ or ‘what?’, respectively). Studies of infants’ WM for objects have typically looked for limits on either ‘how many’ or ‘what’, yielding different estimates of infant capacity. Infants can keep track of about three individuals (regardless of identity), but appear to be much more limited in the number of specific identities they can recall. Why are the limits on ‘how many’ and ‘what’ different? Are the limits entirely separate, do they interact, or are they simply two different aspects of the same underlying limit?We sought to unravel these limits in a series of experiments which tested 9- and 12-month-olds’ WM for object identities under varying degrees of difficulty. In a violation-of-expectation looking-time task, we hid objects one at a time behind separate screens, and then probed infants’ WM for the shape identity of the penultimate object in the sequence. We manipulated the difficulty of the task by varying both the number of objects in hiding locations and the number of means by which infants could detect a shape change to the probed object. We found that 9-month-olds’ WM for identities was limited by the number of hiding locations: when the probed object was one of two objects hidden (one in each of two locations), 9-month-olds succeeded, and they did so even though they were given only one means to detect the change. However, when the probed object was one of three objects hidden (one in each of three locations), they failed, even when they were given two means to detect the shape change. Twelve-month-olds, by contrast, succeeded at the most difficult task level.Results show that WM for ‘how many’ and for ‘what’ are not entirely separate. Individuated objects are tracked relatively cheaply. Maintaining bindings between indexed objects and identifying featural information incurs a greater attentional/memory cost. This cost reduces with development. We conclude that infant WM supports a small number of featureless object representations that index the current locations of objects. These can have featural information bound to them, but only at substantial cost.     

‘My Husband is My Key to Paradise.’ Attitudes of Muslims in Indonesia and Norway to Spousal Roles and Wife-Beating

This article explores the influence of religious factors and values held by local societies, when Muslims develop their personal attitudes and perceived religious norms regarding spousal roles and wife-beating. It is based on qualitative interviews with 59 Muslims in Indonesia (N?=?35) and Norway (N?=?24). In addition, relevant Indonesian and Norwegian Muslim literature and web pages are examined. According to most Indonesian respondents, Islamic norms prescribe male leadership and allow the husband to beat a disobedient wife. This was regarded as crucial for the wife’s destiny after death. According to most Norwegian respondents, Islamic norms promote gender equality and oppose wife-beating. The sharp contrast between the perceived religious norms of Indonesian and Norwegian respondents may be caused by dissimilar cultural values in the two countries – values that influenced personal attitudes and thus the horizon of understanding where religion and authoritative text were interpreted. The reasoning of the respondents also sheds light on the importance of specific sacred texts when religious norms were developed individually. From a psychological point of view, the implementation of the egalitarian attitudes represented by numerous respondents may have positive effects for Muslim women living in patriarchal societies.     

Are changes in blood pressure and total cholesterol related to changes in mood? An 18-month study of men and women.

The authors investigated the within-person association of reported mood with blood pressure and total cholesterol (TC) levels, each assessed 4 times over an 18-month period in 128 men and 154 women. Change over time in tense arousal was significantly positively associated with changes over time in systolic blood pressure (SBP) and diastolic blood pressure (DBP) but not TC. A change in hedonic tone was significantly associated with SBP (an increase in negative affect was associated with an increase in SBP) but not with DBP or TC. There were no sex differences in associations of mood with SBP or TC. However, increases in tense arousal and negative affect were significantly associated with an increase in DBP for women but not men.