Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

Idiographic network analysis of discrete mood states prior to treatment

Idiographic network models based on time‐series data have received recent attention for their ability to model relationships among symptoms and behaviours as they unfold in time within a single individual (cf. Epskamp, Borsboom, & Fried, 2018; Fisher, Medaglia, & Jeronimus, 2018). Rather than examine the correlational relationships between variables in a sample of individuals, an idiographic network examines correlations within a single person, averaged over many time points. Because the approach averages over time, the data must be stationary (i.e. relatively consistent over time). If individuals experience varying states over time—different mixtures of symptoms and behaviours in one moment or another—then averaging over categorically different moments may undermine model accuracy. Fisher and Bosley (2019) address these concerns via the application of Gaussian finite mixture modelling to identify latent classes of time points in intraindividual time‐series data from a sample of adults with major depressive disorder and/or generalised anxiety disorder (n = 45). The present paper outlines an extension of this work, wherein network analysis is used to model within‐class covariation of symptoms. To illustrate this approach, network models were constructed for each intraindividual class identified by Fisher and Bosley (137 networks across the 45 participants, mean classes/person = ~3, range = 2–4 classes/person). We examine the relative consistency in symptom organisation between each individual's multiple mood state networks and assess emergent group‐level patterns. We highlight opportunities for enhanced treatment personalisation and review nomothetic patterns relevant to transdiagnostic conceptualisations of psychopathology. We address opportunities for integrating this approach into clinical practice and outline potential shortcomings.     

Roles and Representations of Women in Early Chinese Philosophy: A Survey

An understanding of the roles and representations of women in classical Chinese philosophy is here derived from central texts such as the Analects, the Lienü Zhuan, and the I Ching. We argue that the roles of women during the classical period of Chinese philosophy tended to be as part of the “inner,” working domestically as a housewife and mother. This will be shown from three passages from the Analects. Women were represented as submissive and passive, as with the qualities ascribed to yin energy, and therefore as rightfully subordinate to men. However, despite representations of women in philosophy being thus at this time, there were exceptions, specific women who could take a male “outer” political role. The story of Jing Jiang from the Lienü Zhuan suggests that although women being involved in “outer” affairs were looked down on, there were still women who would be and who would occasionally get praised for doing so. This shows that it was realized, explicitly or otherwise, that women were capable of taking those roles, but also that they were not allowed to take such roles at that time.     

The Objectivity of Values: Invariance without Explanation

This paper develops and motivates minimalism about the objectivity of values: the objectivity of values is no more, and no less, than invariance with respect to possible differences in attitudes. Thus the relation of invariance need not have any particular explanation, or, indeed, any explanation at all, for values to count as fully objective. Values need not be metaphysically real, simply in order to be objective, as according to traditional realist views. But we should not suppose, as some recent writers do, that there is no special issue of objectivity to consider: the issue of objectivity is the issue whether or how values vary with our attitudes.     

Assessment of dysfunctional beliefs in borderline personality disorder

This study had two aims: to test the hypothesis that borderline personality disorder (BPD) patients hold numerous dysfunctional beliefs associated with a variety of Axis II disorders, and to construct a BPD belief scale which captures these beliefs. Beliefs were measured using the Personality Belief Questionnaire (PBQ) which is designed to assess beliefs associated with various personality disorders, although not specifically BPD. Eighty-four BPD patients and 204 patients with other personality disorders (OPD) were randomly split into two study samples. Fourteen PBQ items were found to discriminate BPD from OPD patients in both samples. These items came from the PBQ Dependent, Paranoid, Avoidant, and Histrionic scales and reflect themes of dependency, helplessness, distrust, fears of rejection/abandonment/losing emotional control, and extreme attention-seeking behavior. A BPD beliefs scale constructed from these items showed good internal consistency and diagnostic validity among the 288 study patients. The scale may be used to assist in diagnosis and cognitive therapy of BPD.     

Concurrent validity of the Personality Assessment Inventory Alcohol Problems (ALC) Scale in a college student sample

The concurrent validity of the Alcohol Problems scale (ALC) was investigated in a college student sample (N = 200). The relationships between the ALC and associated features of alcohol problems (e.g., consumption patterns, expectancies, maladaptive coping, and stress) were examined. The validity of the ALC for identifying clinically significant alcohol problems (assessed with the Structured Clinical Interview for the fourth edition ofthe Diagnostic and Statistical Manual of Mental Disorders) was also examined. The ALC was related to the associated features and was a valid indicator of alcohol problems. T scores of 80, 85, and 90 had superior hit rates for alcohol abuse; and scores of 80, 85, and 90 had superior hit rates for alcohol dependence.     

The neurodynamics of emotion: delineating typical and atypical emotional processes during adolescence

The study of development is, in and of itself, the study of change over time, but emotions, particularly emotional reactivity and emotional regulation, also unfold over time, albeit over briefer time‐scales. Adolescence is a period of development characterized by marked changes in emotional processes and rewiring of the underlying neural circuitry, making this time of life formative. Yet this period is also a time of increased risk for anxiety and mood disorders. Changes in the temporal dynamics of emotional processes (e.g. magnitude, time‐to‐peak and duration) occur during this developmental period and have been associated with risk for mood and anxiety disorders. In this article, we describe how the temporal dynamics of emotions change during adolescence and how they may increase risk for these psychopathologies. We highlight studies that illustrate how formalizing temporal neurodynamics of emotion may enhance links among levels of analyses from neurobiological to real‐world, moment‐to‐moment experiences.     

The Application of Family Systems Theory to Organizational Consultation: A Content Analysis

A content analysis was performed on 43 articles published between 1970 and 1998 discerned as relating family systems theory (FST) frameworks and constructs to organizational consultation. Frameworks and constructs were coded and then investigated in relation to four independent variables: type of organization, decade of article publication, gender, and educational training of author. Results indicate that the use of FST frameworks and constructs vary depending upon the characteristics of the organization, time period, and consultant. Results highlight specific FST frameworks and constructs most common in organizational consultation.     

Comparison of the efficacy of two name-learning techniques: expanding rehearsal and name-face imagery

Two name-learning techniques were compared: expanding rehearsal and name-face imagery. Participants studied name-face associations and were given a cued recall test in which they were presented with a face and were to recall the name. They were presented with either an expanding rehearsal schedule (expanding condition), a distinctive facial feature coupled with a word phonologically similar to the last name and an interactive image linking the name and facial feature (name-face imagery condition), or a no memory (control) strategy. The expanding rehearsal schedule led to superior name learning relative to the name-face imagery and control conditions after a 15-min (Experiment 1) or 48-hr (Experiment 2) retention interval. In Experiment 3, the retrieval practice explanation was tested but not supported; we argue that an encoding variability interpretation is consistent with the overall pattern of results. Applied implications are also discussed.