Functional focal retrograde amnesia: Lost access to abstract autobiographical knowledge?

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of “functional” memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.     

Circles of Solicitude and Concern

Abstract

Heidegger distinguishes between concern for things and solicitude for other Dasein. As Dasein is already being‐in‐the‐world and being‐with from the start, there is no need to define what another Dasein is to recognize it. In this paper it is argued that Dasein is thrown into circles of care, where the distinction between solicitude and concern is given. Although this undermines any attempts to regard a comatose patient as non‐Dasein, it raises questions about Dasein’s relations with animals. It is suggested that Dasein’s relations with animals could be captured by inserting another circle, for which the German word versorgen might be suitable.     

A Compelling Practice: Empowering Future Leaders in the Medical Humanities

Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP).     

Self-Coherence and Mutuality in the Analytic Dyad: Commentary on Michael Shoshani (Rosenbaum's) Dare to be Human

Michael Shoshani (Rosenbaum's) book Dare to be Human lays bare Michael's emotional relationship with his patient Daniel. Initially, Michael's early childhood relational behavioral patterns are evoked by Daniel's extreme emotional detachment and rejection of Michael as a person. Both analytic partners experienced extreme boundary violations as children in the form of violent beatings, Michael by his father and Daniel by his mother. Michael's mother was overbearing like Daniel's. Both, highly sensitized to intrusions and perceived slights by the other, remain locked in a doer/done to dynamic until Michael successfully breaks through the enactment by learning to stay with Daniel's distress, contain and regulate his own hurt feelings, and provide more space in the relationship by shifting to four times a week and moving Daniel to the couch. Through this process both analytic partners feel safer with each other, deepen their understanding of their own internal object world, and feel intimately engaged with each other. Daniel's life outside the analysis parallels his success in the analytic relationship.     

Understanding alexithymia in female adolescents: The role of attachment style

Adults with alexithymia retrospectively report emotional difficulties with caregivers during childhood. However, the association between attachment style and alexithymic traits may be evident at an earlier stage than adulthood, i.e. during adolescence. Sixty school-based healthy females aged 9–18 years (mean 14.08, SD 2.71 years) participated in an Attachment Style Interview (ASI) and completed the Toronto Alexithymia Scale (TAS-20). Greater levels of alexithymia were exhibited by both anxious and avoidant insecurely attached groups compared to securely attached participants. Fear of separation (characteristic of anxious attachment style) predicted both overall alexithymia scores and the specific alexithymic trait of ‘difficulty identifying feelings’ (DIF). Constraints on closeness (an avoidant attachment attitude) predicted ‘difficulty describing feelings’ (DDF). Low felt attachment to primary caregiver was a predictor of ‘externally oriented thinking’ (EOT). These findings indicate that features of anxious and avoidant insecure attachment styles are differentially related to the separate facets of alexithymia in female adolescents. Specifically, the findings concerning fear of separation may reflect the adolescent struggle for autonomy and the resulting effects on the affect regulation system. Our results also suggest that the normative differentiation of the emotional and cognitive aspects of alexithymia may occur on a developmental trajectory.     

Can positive affect induce self-focused attention? Methodological and measurement issues

Some studies find that positive affect can induce self-focused attention, but other studies find no effect. We suggest that the contrary findings result from how self-awareness was measured. One group of participants listened to happy or neutral music; another group imagined and described a happy or neutral event. Two measures of self-focus were then taken. The experiment replicated past findings: Positive affect increased self-focus on a pronoun selection task, but had no effect on a modified private self-consciousness scale. The results were slightly stronger when affect was induced using music. Implications for future research are discussed.     

Measuring the speed of recognising facially expressed emotions

Faces provide identity- and emotion-related information—basic cues for mastering social interactions. Traditional models of face recognition suggest that following a very first initial stage the processing streams for facial identity and expression depart. In the present study we extended our previous multivariate investigations of face identity processing abilities to the speed of recognising facially expressed emotions. Analyses are based on a sample of N=151 young adults. First, we established a measurement model with a higher order factor for the speed of recognising facially expressed emotions (SRE). This model has acceptable fit without specifying emotion-specific relations between indicators. Next, we assessed whether SRE can be reliably distinguished from the speed of recognising facial identity (SRI) and found latent factors for SRE and SRI to be perfectly correlated. In contrast, SRE and SRI were both only moderately related to a latent factor for the speed of recognising non-face stimuli (SRNF). We conclude that the processing of facial stimuli—and not the processing of facially expressed basic emotions—is the critical component of SRE. These findings are at variance with suggestions of separate routes for processing facial identity and emotional facial expressions and suggest much more communality between these streams as far as the aspect of processing speed is concerned.     

The effects of trait and state anxiety on attention to emotional images: An eye-tracking study

Attentional biases for threatening stimuli have been implicated in the development of anxiety disorders. However, little is known about the relative influences of trait and state anxiety on attentional biases. This study examined the effects of trait and state anxiety on attention to emotional images. Low, mid, and high trait anxious participants completed two trial blocks of an eye-tracking task. Participants viewed image pairs consisting of one emotional (threatening or positive) and one neutral image while their eye movements were recorded. Between trial blocks, participants underwent an anxiety induction. Primary analyses examined the effects of trait and state anxiety on the proportion of viewing time on emotional versus neutral images. State anxiety was associated with increased attention to threatening images for participants, regardless of trait anxiety. Furthermore, when in a state of anxiety, relative to a baseline condition, durations of initial gaze and average fixation were longer on threat versus neutral images. These findings were specific to the threatening images; no anxiety-related differences in attention were found with the positive images. The implications of these results for future research, models of anxiety-related information processing, and clinical interventions for anxiety are discussed.     

An Interactional Analysis of Clinical Interviewing

Clinical interviewing is viewed here as a social interactional pattern in order to examine the nature and limits of the technique as a means of scientific data acquisition. I defend the technique against criticisms that it is ecologically suspect and prone to systematic biases, mainly due to influence of the interviewer on the interviewee or to unnatural and biasing interactional patterns. The Central Hypothesis of this work is that at least some forms of clinical interviewing are derivative of naturally occurring patterns of activity and interaction. As such, they do not warrant unnecessary a priori suspicion. More importantly, this view leads to avenues of empirical examination that allow determination and checking of the character of the clinical interaction, which bears directly on how and when data extracted in clinical contexts are scientifically valid. Data from an extensive corpus involving a single subject are used to illustrate and substantiate claims.     

Division of Labor: Procedural Learning in Teacher-led Small Groups

This article presents an observational study of teacher-student interaction in fourth-grade small group sessions introducing an algorithm for solving remainder divisions. The groups are segregated by arithmetic achievement. Teacher and student input is analyzed with reference to a cognitive analysis of the task. A quantitative analysis compares amounts of teacher and student input at specific, cognitively significant points in procedures across groups. This analysis shows that there are qualitative differences both in solution strategies that evolve in the course of the lesson and in the extent to which the teacher-student interaction focuses on two "critical constraints" that are central to acquisition of this procedure. A subsequent analysis of transcribed protocols from the small group sessions discloses interactional mechanisms that can account for these differences. Much of the teacher's input is characterized as an unpacking of the necessary procedure by calling in subprocedures which take the students' responses as arguments and by specifying subprocedures lower down in the goal hierarchy when students failed to produce adequate responses. The interactive mechanisms combine with students' background knowledge to result in the group differences detected in the quantitative analysis.