A spirituality for the long haul: Response to chronic illness

This article outlines a spirituality appropriate for those whose lives are affected by chronic injury or illness. Spirituality may be defined simply as a sustained and lived-out vision of life. An emerging spirituality of the whole person in relation to self, others, society, the earth, and a divine presence that pervades all that is acknowledges: (1) the basic dignity of the person, and (2) the drive to growth, wholeness, and fullness in every person. It implies a respectful assistance toward whatever human growth is possible for the chronically ill, while summoning a caring presence that remains faithful despite limitations or impending death.     

Life insurance, living benefits, and physician-assisted death

One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.     

Rethinking covert stuttering

PurposeThe experience of passing as fluent, also called covert stuttering, has been uncritically framed as an inherently negative pursuit. Historically passing has been understood as a repression of one’s true, authentic self in response to either psychological distress or social discrimination. The authors of this paper seek a more nuanced understanding of passing. We ask, how must a person relate to herself in order to pass as fluent?MethodologyThis is a qualitative research study in which the authors utilized the ethical theories of philosopher Michel Foucault to contextualize data obtained from semi-structured interviews with nine participants who pass as fluent.ResultsRather than a repression of an authentic self our data suggests passing is more usefully understood as a form of resistance by people who stutter to a hostile society. Participants learned from experiences of delegitimization that their stuttering had ethical ramifications. Consequently, they used a variety of self-forming practices to pass and thereby achieve the privileges that come with perceived able-bodiedness.ConclusionPassing as fluent is not an inauthentic form of stuttering but a form of stuttering that is produced through the use of specific technologies of communication. These technologies of communication are constituted by the unique ethical relationship of the person who stutters with herself. Passing can be understood as an active form of resistance rather than a passive form of repression. By theorizing passing as fluent as an ethical relationship, we open up the possibility of changing the relationship and performing it differently.     

Performance-psychologic cross-sectional study of young schizophrenic patients with a subchronic and chronic disease course

According to ICD-9 and DSM-III-R-criteria 14 subchronic schizophrenic male patients (duration of illness less than 2 years) and 17 chronically ill male schizophrenics (duration of illness between 5 to 12 years) matched for sex, age, education, type of illness, and medication were with the aid of 4 tests investigated with respect to time characteristics of performance parameters. Whereas subchronic patients revealed performance scores within the normal range of reference scores, chronically ill patients showed dissociative variations in performance (high scores in reasoning, low scores in speed factor). This can be interpreted as instability of brain functioning which characterizes schizophrenics suffering from a long duration of illness. Correlations between prolonged reactions to "crossmodal" choices and subjective basic symptoms in subchronic patients are hints at well established introspection ability of self regarded complaints.     

The Teaching and Learning of Psychotherapy by Rudolf Ekstein and R. S. Wallerstein

The homogeneous group has been the most common form of group therapy for chronically physically ill children and adolescents. The goals of these groups have included the provision of peer support, adaptation to the realities of physical illness, and acceptance of and cooperation with the medical management of the disease. The refinement of the theory of developmental ego psychology suggests that the heterogeneous group has potential for aiding the emotional maturation of the chronically physically ill. This paper presents examples of groups of latency-age children, early adolescents, and middle adolescents that included chronically physically ill with physically healthy peers. The groups were planned under the assumption that despite external differences, children and adolescents of a similar age identify with peers in terms of normal age-specific developmental needs and conflicts.     

Mental Illness,Natural Death,and Non-Voluntary Passive Euthanasia

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not.     

Can I Be Ill and Happy?

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above.     

Awareness of Death Among Children: Does a Life-Threatening Illness Alter the Process of Discovery?

The authors review studies on death awareness among children who are healthy, chronically ill, and terminally ill. The review suggests that children with life-threatening diseases demonstrate increased understanding of death compared with children who are either healthy or chronically ill. In particular, children with terminal illness, especially during the end stage of their disease, show an advanced understanding of the death concepts of irreversibility and finality. In contrast, healthy and chronically ill children appear to require certain age, cognitive developmental level, or intelligence thresholds to understand these concepts. Possible explanations for the findings in this literature are discussed. The implications of death awareness research for counselors are used as a base for suggesting counseling strategies.     

Imaginal Dialogues in the Self:Theory and Method

ABSTRACT The story a person tells about his or her life is viewed as a polyphonic novel. This metaphor implies that the self is multivoiced; that is, there is no single "I" as an agent of self-organization but several, relatively independent "I" positions that complement and contradict each other in dialogical relationships. From this perspective the role ofimaginal figures in the organization of the self is analyzed. A theory and method are presented allowing us to study both the content and the organization of multivoiced self-narratives. The method is illustrated with two idiographic studies, where people tell their life story not only from the perspective of the familiar "I" but also from the perspective of an imaginal figure with whom they have had a long-lasting relationship. Finally, it is argued that the metaphor of a polyphonic novel is particularly useful because it allows us to decentralize the Western concept of the self.     

The Concept of Death: A Religio-philosophical Analysis

In an age in which vast progress has been made in organ transplant technology, it is imperative to determine the point at which a human being is considered dead, for transplantation cannot occur until after death. Traditional religious views imply that a human being is dead upon the departure of the soul from the body. Taking the biological death of the body as a conclusive sign of the soul's departure is not an option. Biological death refers to decomposition, and this cannot equate to the death of the person as such, for this would make the concept and practice of transplantation absurd, for transplantable parts of a biologically dead—i.e. decomposing—body could not be used. On the other hand, if parts of the human body are themselves still biologically alive, could it not be said that taking such parts would amount to murder?

Two conclusions follow from this predicament. First, death as a ‘normative’ concept stands in sharp distinction from a purely biological concept. Second, a normative concept of death is entangled with a normative concept of personhood. That is to say, from the moment that a human being is not considered a person as such, parts of the body could be removed for transplantation or, indeed, for any other justified medical purpose. In this regard, various theories of the person are put forward. Which of these theories is compatible with a workable concept of death? In this paper two principal theories of the person will be discussed and it will be argued that a brain-based theory of death is conducive to a normative concept of death, thus allowing for organ transplantation.     

The Effects of Time Pressure on Controlling Reactions to Persons With Mental Illness

Population surveys suggest that the general public stigmatizes persons with mental illness less than in the past. However, implicit attitude measures find that immediate reactions to mentally ill persons are still negative among both the general public and people diagnosed with mental illness. Time-course data suggest that these reactions may be dynamic, with immediate negative reactions becoming less prejudicial over time. We manipulated time pressures imposed upon social judgments about a mentally ill person. Participants perceived a mentally ill person as dangerous when forced to respond quickly; participants given ample time to respond were less likely to have this perception.     

Well-being and Need for Support of Adolescents with a Chronically Ill Family Member

This study investigates whether there are differences in the well-being, need for help and use of support services between adolescents with and without a chronically ill or disabled family member. It also examines the role played by the type of illness, the relationship to the family member and the nature and intensity of the help provided by the adolescent. A Dutch sample of 1581 adolescents (average age 14.6?years) completed a questionnaire in 2010 about mental health problems, pro-social behavior, need for and use of support and the illness of family members and any care tasks performed by the respondent. Young people with a sick family member had more mental health problems than their counterparts without a chronically ill family member. They also reported a greater need for and use of help and support. Performing domestic tasks was found to be a predictor for overall mental health problems. The intensity of the help given was related to the need for help by the adolescent. It is concluded that growing up with a chronically ill family member and spending a lot time performing (domestic) tasks are risk factors for adolescent mental health problems and adolescents’ need for help. Special attention is warranted for those who need support but who do not translate that need into reality by seeking help.     

Combating the mental health stigma with nostalgia

We report research implicating nostalgia as an intrapersonal means of warding off the stigmatization of persons with mental illness. We hypothesized and found that nostalgia about an encounter with a person with mental illness improves attitudes toward the mentally ill. In Experiment 1, undergraduates who recalled an encounter with a mentally ill person while focusing on central (vs. peripheral) features of the nostalgia prototype reported a more positive outgroup attitude. This beneficial effect of nostalgia was mediated by greater inclusion of the outgroup in the self (IOGS). In Experiment 2, undergraduates who recalled a nostalgic (vs. ordinary) interaction with a mentally ill person subsequently showed a more positive outgroup attitude. Results supported a serial mediation model whereby nostalgia increased social connectedness, which predicted greater IOGS and outgroup trust. IOGS and outgroup trust, in turn, predicted more positive outgroup attitudes. We ruled out alternative explanations for the results (i.e., mood, perceived positivity, and typicality of the recalled outgroup member). The findings speak to the intricate psychological processes underlying the prejudice‐reduction function of nostalgia and their interventional potential. Copyright © 2013 John Wiley & Sons, Ltd.     

Children’s first and second-order false-belief reasoning in a verbal and a low-verbal task

We can understand and act upon the beliefs of other people, even when these conflict with our own beliefs. Children’s development of this ability, known as Theory of Mind, typically happens around age 4. Research using a looking-time paradigm, however, established that toddlers at the age of 15 months old pass a non-verbal false-belief task (Onishi and Baillargeon in Science 308:255–258, 2005). This is well before the age at which children pass any of the verbal false-belief tasks. In this study we present a more complex case of false-belief reasoning with older children. We tested second-order reasoning, probing children’s ability to handle the belief of one person about the belief of another person. We find just the opposite: 7-year-olds pass a verbal false-belief reasoning task, but fail on an equally complex low-verbal task. This finding suggests that language supports explicit reasoning about beliefs, perhaps by facilitating the cognitive system to keep track of beliefs attributed by people to other people.     

The Process of Group Treatment with the Chronically Mentally Ill

Group treatment has been used with inpatient psychiatric clients for numerous years. Only since the advent of deinstitutionalization have outpatient services begun to utilize this format. Over the ears, mental health professionals have realized that traditional talk therapy approaches do not adequately address the multiple, pressing needs resented by the person with chronic mental illness. A multi-modalry approach that utilizes case management, medication, family support, and group therapy has evolved. Specifically, activity focused group therapy has been recognized as an integral treatment modality. The author presents a model of group treatment and process which underscores the value of Occupational Therapy's contribution to the treatment of the chronically mentally ill.     

Inferences about the authentic self: when do actions say more than mental states?

Three studies involving 478 undergraduates examined the perceived importance of observable actions versus mental states in revealing the "true self"-the authentic and fundamental nature of a target person. Results suggest that when people have only limited information about a target, they believe that an action is more diagnostic of the individual's true self than the accompanying mental state. When participants have knowledge concerning chronic dispositional tendencies of the target, however, they judge that a chronic mental state is more diagnostic of the true self than a chronic action tendency. Considered together, the findings suggest that people conceptualize the true self as a relatively private entity but nevertheless believe that an action of a little-known person may be particularly informative about that individual. Perceived diagnosticity of the true self was partially mediated by inferences concerning the relative stability of actions versus states but not by inferences of volition.     

Anger expression in the Picture-Frustration study under stressful conditions

In order to study anger expression in health and illness, the Rosenzweig Picture-Frustration study was administered to hospitalized depressives, parents of seriously ill children, and healthy controls. A follow-up study then compared responses of acutely and chronically ill adults. Externally directed aggression was lower in people experiencing more severe stress, and was negatively correlated with external locus of control and with depression. It is suggested that within limits outer-direction of blame for frustration may characterize unstressed, well-adjusted people, and that further research with the Rosenzweig in relation to assertion training would be valuable.