Healing relationships and the existential philosophy of Martin Buber

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core.     

Mediational Pathways Through Which Positive and Negative Emotionality Contribute to Anhedonic Symptoms of Depression: A Prospective Study of Adolescents

This study takes a developmental psychopathological approach to examine mechanisms through which baseline levels of positive emotionality (PE) and negative emotionality (NE) prospectively predict increases in anhedonic depressive symptoms in a community sample of 350 adolescents (6th–10th graders). Dependent stressors mediated the relationship between baseline levels of NE and anhedonic depressive symptoms after controlling for initial symptoms. Supportive relationships mediated the relationship between baseline levels of PE and anhedonic depressive symptoms, after controlling for baseline symptoms. In addition, NE X PE interacted to predict later anhedonic depressive symptoms, such that adolescents with low levels of PE and high levels of NE experienced the greatest increase in anhedonic depressive symptoms. Last, supportive relationships interacted with baseline PE to predict prospective changes in anhedonic depressive symptoms, such that adolescents with low PE and low supportive relationships experienced the greatest increase in anhedonic depressive symptoms. Results are discussed in terms of current theoretical models of the link between temperament and depression. This work was supported, in part, by NIMH grants R03-MH 066845 and 1R01HD054736-01A1 to Benjamin L. Hankin.     

Are Oppositional-Defiant and Hyperactive–Inattentive Symptoms Developmental Precursors to Conduct Problems in Late Childhood?: Genetic and Environmental Links

Inattentive–hyperactive and oppositional behavior have been hypothesized to be developmental precursors to conduct problems. We tested these hypotheses using a longitudinal sample of 6,466 offspring of women selected from nationally representative US households. Conduct problems across 8–13 years were robustly predicted by conduct problems at 4–7 years, but also were independently predicted to a small extent by both inattentive–hyperactive and oppositional behaviors at 4–7 years. Longitudinal multivariate behavior genetic analyses revealed that the genetic and environmental factors that influence conduct problems at both 4–7 and 8–13 years also influence the putative precursors at 4–7 years. After genetic and environmental influences on conduct problems at 4–7 years were taken into account, however, inattentive–hyperactive and oppositional behavior at 4–7 years shared causal influences with conduct problems 8–13 years to a negligible extent. These findings suggest that after early conduct problems are controlled, little is gained in terms of prediction or understanding genetic and environmental influences on later child conduct problems by treating early inattentive–hyperactive and oppositional behavior as developmental precursors to later conduct problems.     

Schematic knowledge changes what judgments of learning predict in a source memory task

Source monitoring can be influenced by information that is external to the study context, such as beliefs and general knowledge (Johnson, Hashtroudi, & Lindsay, 1993). We investigated the extent to which metamnemonic judgments predict memory for items and sources when schematic information about the sources is or is not provided at encoding. Participants made judgments of learning (JOLs) to statements presented by two speakers and were informed of the occupation of each speaker either before or after the encoding session. Replicating earlier work, prior knowledge decreased participants’ tendency to erroneously attribute statements to schematically consistent but episodically incorrect speakers. The origin of this effect can be understood by examining the relationship between JOLs and performance: JOLs were equally predictive of item and source memory in the absence of prior knowledge, but were exclusively predictive of source memory when participants knew of the relationship between speakers and statements during study. Background knowledge determines the information that people solicit in service of metamnemonic judgments, suggesting that these judgments reflect control processes during encoding that reduce schematic errors.     

Remembering words not presented in sentences: How study context changes patterns of false memories

People falsely endorse semantic associates and morpheme rearrangements of studied words at high rates in recognition testing. The coexistence of these results is paradoxical: Models of reading that presume automatic extraction of meaning cannot account for elevated false memory for foils that are related to studied stimuli only by their visual form; models without such a process cannot account for false memory for semantic foils. Here we show how sentence and list study contexts encourage different encoding modes and consequently lead to different patterns of memory errors. Participants studied compound words, such as tailspin and floodgate, as single words or embedded in sentences. We show that sentence contexts led subjects to be better able to discriminate conjunction lures (e.g., tailgate) from old words than did list contexts. Conversely, list contexts led to superior discrimination of semantic lures (e.g., nosedive) from old words than did sentence contexts.     

The ironic consequences of Obama’s election: Decreased support for social justice

Do Americans think that, because of Barack Obama’s election, affirmative action and other policies that address racial injustice are no longer necessary? In this study, we examined this question by assessing participants’ perceptions of racial progress and support for remedying racial injustice both prior to and after Barack Obama’s presidential victory. Following the election, participants increased their perception that racism is less of a problem in the US today than in times past. They also expressed less support for policies designed to address racial inequality. Given the continued prevalence of racial disparities in virtually all aspects of American society, these results raise important implications for the status of policies aimed at eliminating racial injustice.     

Negative Actions

Some philosophers have argued that refraining from performing an action consists in actively keeping oneself from performing that action or preventing one’s performing it. Since activities must be held to be positive actions, this implies that negative actions are a species of positive actions which is to say that all actions are positive actions. I defend the following claims: