Middlesex: A Pastoral Theological Reading

This article, written for the Group for New Directions in Pastoral Theology’s conference on the theme of “Emotion, Mood, and Temperament,” focuses on Middlesex, a Pulitzer Prize-winning novel by Jeffrey Eugenides, Professor of Creative Writing in the Lewis Center for the Arts at Princeton University. The novel, set in 20th century America and written as a fictional memoir, is a coming-of-age story of Cal/Calliope, a man with an intersex condition caused by 5-alpha-reductase deficiency. The mission statement of the Intersex Society of North America (ISNA) states that the organization is “devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.” This essay employs the resources of pastoral theology to assist in the project of ending shame regarding intersex conditions by offering a pastoral theological reading of Middlesex. As such, this essay is an example of the discipline of pastoral theology being employed in the field of medical humanities in particular and the field of clinical humanities more broadly, and it also serves as an example as to how one might offer a pastoral theological reading of a novel.     

New Directions for Clergy Experiencing Stress: Connecting Spirit and Body

This paper describes an online course on self care based on current research on clergy stress by Francis et al. (Pastoral Sciences/Sciences Pastorales 24(2):101–120, 2005), motivation by Miller and Rollnick (2012), self compassion by Barnard and Curry (Pastoral Psychology 61(2):149–163, 2012), will power by Baumeister and Tierney (2011), and habits by Duhigg (2012). This practical theological learning experience connects body and spirit by integrating an authentic spirituality into one’s daily experiences of coping with stress. Students shared Google document journals about implementing spiritual practices and a stress-relieving habit. Self reflection and peer support fostered a practical theological process of change in their lived theology of values, beliefs, and spiritual practices. Espoused values and beliefs were incorporated into spiritual and self care practices fostering compassion. This lived theology of compassion revealed and counteracted embedded values and beliefs, notably about God’s judgment.     

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.     

The effects of assertiveness training on the nontraditional role assumption of geriatric nurse practitioners

The Nurse Practitioner movement has been an important element in upgrading health care for the elderly, principally by reducing costs and increasing availability. One central concern in this movement is the ability of Nurse Practitioners [NPs] to break out of the restricted and repressed role of nurse. The teaching of assertive behavior has been an accepted method of assisting NPs in this role change. This study evaluates the effects of assertiveness training using a measure of role assumption in addition to the typical self-report attitude measures. Three cohorts of NP students (N=59) were evaluated with a pre-post administration of attitude measures of assertiveness and a six-month follow-up to measure role assumption. Although the training did have a significant impact on the attitude measures, the impact on nontraditional role assumption was minimal. Policy implications are discussed.     

Mandel'štam and Dante: TheDivine Comedy in Mandel'štam's poetry of the 1930s

Osip Mandel'?tam (1891–1938?) belongs among the greatest Russian poets of the twentieth century. During the thirties, when he led a tragic existence and felt a premonition of his inevitable violent death, Mandel'?tam saw in Dante not only the greatest poet, but also his own superior teacher, and his poems of that period contain a tormented meditation on the masterpiece of Dante's genius — theDivine Comedy. Epic poetry of Dante, Homer, Virgil and others was possible because the inner world of each poet was essentially at one with the ethos of the society in which he lived. Mandel'?tam's inner world was Judaeo-Christian, European, and rooted in classical and neo-Platonic philosophy, but his outer world, consisting of a new Marxist or pseudo-Marxist system, was totally at odds with it. Thus Mandel'?tam could not embody the epic impulse of the society he opposed. He was left with the tormented lyric impulse. The fundamental conflict between Mandel'?tam as a lyric poet and the society in which he had to live and work accounts for the fact that his vision of Stalinist society in a number of respects remarkably corresponds to Dante's vision of a perverted divine order in theInferno.     

Carrying the Burden: Perspectives of African American Pastors on Peer Support for People with Cancer

For African Americans facing advanced cancer, churches are trusted sources of support and ideal settings to improve access to supportive care. The Support Team model enhances community support for practical, emotional, and spiritual caregiving. We report on focus groups with pastors of 23 Black Churches and explore their perspective on the Support Team model for church members with cancer. Pastors describe the needs of church members facing cancer from a holistic perspective and recognize opportunities for synergistic faith–health collaboration. The results of this study indicate potential benefits of the Support Team model in Black Churches to reduce silent suffering among individuals facing cancer.     

Masochism and piety

A recent tract,The Whipping, is parallel in many ways to both Victorian flagellation pornography and medieval flagellation penance movements. The spirituality ofThe Whipping is seen to be basically masochistic. The same trend is easily seen inmuch standard pietistic literature. The question is raised whether the spiritual masochism does not represent a repressed and sublimated sexual masochism. If so, then Christians should ask themselves if they can consistently condemm sexual masochism while advocating its spritual counterpart, or vice versa.     

Can humans think their way to increased freedom?

In response to Auger's article, “Are Human Beings Free?” several points are made in favor of humans' having at least some degree of free choice or free will: (1) Although partly dependent on biological and social influences for their tastes, people may sometimes actually train themselves to change these tastes and desires. (2) Although logically people may never be totally responsible for their acts, unless we pragmatically hold them responsible for their antisocial behavior we vitiate all moral rules of the social groups in which theychoose to reside. (3) RET can hold people responsible for their wrongdoing and help them to act less wrongfully in the future by teaching them how to condemn theirdeeds andacts but not themselves as humans.     

Congestive Heart Failure and Quality of Life

Our study aimed to assess the quality of life (QoL) of patients with congestive heart failure (CHF) and to correlate the different aspects of QoL with relevant socio-demographic variables, CHF severity, somatic comorbidities, other clinical variables and depressive symptomatology. In a cross-sectional study design, a community sample of 103 adult patients with CHF (mean age 68 years, 73 % male) was recruited from an outpatient cardiology practice. CHF severity was assessed with physician ratings of the New York Heart Association (NYHA) functional class and measurement of brain natriuretic peptide (BNP) levels. The psychometric evaluation of quality of life was made using the Medical Outcomes Study Short Form-36 (SF-36) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The Beck Depression Inventory Second Edition (BDI-II) assessed depressive symptoms. Using multiple linear regression, predictors of poorer QoL included being a female, being older, living alone, NYHA functional class ≥ II, higher levels of BNP comorbidity (such as renal insufficiency and cerebrovascular disease), fluid retention, depressive symptomatology (assessed by BDI-II) and treatment with anti-dyslipidemics, diuretics and β-blockers. Among these correlates, psychological distress was the most strongly related to QoL. Also, functional status measured by NYHA demonstrated a high impact on QoL. Our findings suggest the need to address such factors in developing effective care to improve psychological and functional status in order to enhance QoL in these patients.     

Near-Death Experiences and Spiritual Well-Being

People who have near-death experiences often report a subsequently increased sense of spirituality and a connection with their inner self and the world around them. In this study, we examined spiritual well-being, using Paloutzian and Ellison’s Spiritual Well-Being Scale, among 224 persons who had come close to death. Participants who reported having near-death experiences reported greater spiritual well-being than those who did not, and depth of spiritual well-being was positively correlated with depth of near-death experience. We discussed the implications of these findings in light of other reported aftereffects of near-death experiences and of spiritual well-being among other populations.     

Ethics,AIDS, and community responsibility

In the discussion of the responsibilities of society to the HIV infected and uninfected, a serious question seems to have been left out of the picture: To what extent are people who are not infected, have no special relationship to the infected and have no professional responsibilities for the care of AIDS patients under an obligation to come to the aid of people with the HIV? In this paper, I shall examine our responsibilities, as members of society, for the welfare of others to whom we may or may not have a special relationship. I shall argue that those responsibilities flow from the conditions that structure our transactions with others; conditions that make such transactions possible.     

The hospice: Humane care for the dying

The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly “Hillhaven”) Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in the legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.     

A rule-based expert system for music perception

We describe an expert system written in Pascal to simulate part of Lerdahl and Jackendoff’s (1983) theory of music perception. This program, a production system based on a Hearsay II architecture (Nii, 1986), illustrates a number of techniques, including program modularity, complex data structures, and simulated parallelism using operating system concepts.     

Emotional Impulsivity in Children with ADHD Associated with Comorbid—Not ADHD—Symptomatology

Children with ADHD often demonstrate sudden and intense shifts in both positive and negative affect. This study examined the role of diagnostic status on emotional impulsivity in children utilizing ecological momentary assessment (EMA). Parents of 64 8–12 year old children (15 ADHD-only; 27 ADHD-comorbid; 22 control) completed a diagnostic structured interview and then an EMA protocol, rating the child’s affect thrice daily for 28 days. Analysis of covariance (ANCOVA) suggested that children with ADHD and a comorbid disorder demonstrated significantly more EMA-derived emotional impulsivity than children with ADHD only and control children. No difference was found between children with ADHD only and control children. This study suggested that children with ADHD demonstrate significantly higher levels of emotional impulsivity than control children only in the presence of a comorbid disorder.     

Understanding Middle School Students’ Physical Activity and Health-Related Quality of Life: An Expectancy-Value Perspective

Assessing and promoting physical activity and health-related quality of life (HRQOL) have become major public health issues, but little is known regarding HRQOL and its relation with physical activity in adolescents. This study attempted to examine relationships among middle school students’ motivation, physical activity, and HRQOL by using the expectancy-value model as a theoretical framework. Participants were 282 middle school students who responded to a previously validated inventory assessing their motivation, physical activity, and HRQOL. Correlation analyses revealed that expectancy-related beliefs and task values were positively related to physical activity and HRQOL. Physical activity was positively associated with physical, emotional, and social functioning of HRQOL. Regression analyses showed a significant relationship between increasing expectancy-related beliefs and increasing degrees of HRQOL. This research line is promising in that it can provide useful information regarding the translation of theory to practice in influencing adolescents’ physical activity and HRQOL.     

Synergy between Positive Psychology and Indian Psychology? Reflections on Barriers and Pathways

There are points of convergences between Positive Psychology and Indian Psychology. But we do have to cross many barriers and travel some distance on converging pathways for the potential synergies between these fields to manifest. There are indicators in the global literature that Positive Psychology is maturing as an approach but this is yet to become very evident in the Indian research on Positive Psychology. Systematic efforts at discovering convergences between Indian Psychology and Positive Psychology can go a long way in enriching our understanding of well being.     

The history of a catatonic dog

This article is a condensed life-history of a dog (“V3”) born and reared in the Pavlovian Laboratory and studied until his death in 1961. A detailed study was made of his pathologic development, his relations to people, and the effects of drugs. Measurements recorded were heart rate, blood pressure, respiration, 24-hour activity, sexual reflexes, general behavior. Although early experiments were done chiefly for recording and were not considered noxious or traumatic, this dog’s general development and symptoms seem to have been “constitutionally” rather than environmentally determined. His external behavior was strikingly similar to that of a catatonic patient-flexibilitas cerea, general immobility. Of particular interest was the “Effect of Person”: in the presence of all humans who confronted him he showed catatonic postures, cardiovascular disorders (tachycardia up to 200 beats/min., bradycardia to 12 beats/min., drop of blood pressure from 150 to 75 mm Hg, arrest of heart-beat for as long as 8 seconds), moribund poses. His response to drugs illustrated the specificity to a definite “constitutional type”: sexual activity markedly increased by alcohol and rarely present except after administration of alcohol; no improvement after administration of tranquilizers, except alcohol and meprobamate, which made him act like a normal dog in behavior and in relations to people. His symptoms and reactions to both people and drugs were generally opposite to those of another dog, “Nick”, studied over his life span: Nick showed excessive activity in physiologic systems; hyperactivity (running); generally, improvement through “Effect of Person”; sexual inhibition with alcohol. Observations of the two dogs suggest that symptoms as well as reactions to drugs are the result of the “type” rather than the procedure used, that perhaps psychopathologic symptoms are due more to inborn constitution than to “conflict” (“collision”) between excitation and inhibition, and that neurotic or psychotic symptoms may not interfere with longevity-Nick lived to be 14 years old and died fighting; V3, who also spent most of his life in the laboratory, died at the age of 14.     

Cognitive-Behavioural Therapy Targeting Fear of Progression in an Interdisciplinary Care Program: A Case Study in Systemic Sclerosis

People living with chronic illness often report uncertainty about the future, fear of disease progression, fear of becoming physically disabled, and a reduced life expectancy as important sources of stress. However, little is known about psychological interventions targeting these concerns. The aim of this study is to illustrate an intervention to reduce emotional distress and concerns about the future in a patient with systemic sclerosis (SSc), a rare chronic rheumatic disease with serious consequences for most patients, and to present a preliminary report on its effectiveness using a single-case study design. Because of the complexity of symptoms and complaints due to SSc, the psychological intervention was embedded in an interdisciplinary care program also consisting of physical therapy, occupational therapy, and specialized nurse care.     

A Cross-Sectional and Longitudinal Investigation of the External Correlates of Sluggish Cognitive Tempo and ADHD-Inattention Symptoms Dimensions

The objective was to determine if the external correlates of sluggish cognitive tempo (SCT) and ADHD-inattention (IN) dimensions were the same in cross-sectional and longitudinal analyses. Teachers and aides rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), and depression along with academic impairment in 758 Spanish children (55 % boys) on three occasions (twice at the end of the first grade year [6-week separation] and then again 12-months later at the end of the second grade year). Three of eight SCT symptoms showed substantial loadings on the SCT factor and substantially higher loadings on the SCT factor than the ADHD-IN factor for teachers and aides at each assessment (seems drowsy, thinking is slow, and slow moving). Cross-sectional and longitudinal analyses yielded similar results with SCT and ADHD-IN factors having different and unique external correlates (higher scores on SCT predicted lower scores on ADHD-HI and ODD while higher scores on ADHD-IN predicted higher scores on ADHD-HI and ODD with SCT and ADHD-IN both uniquely predicting academic impairment and depression). Developmental and methodological reasons are discussed for the failure to find an inconsistent alertness SCT factor (daydreams, alertness fluctuates, absent-minded, loses train of though, and confused).