Afterword: Elaborating Health and Medicine’s Publics

This essay argues that medical and health humanists interested in the rhetorical work of publics can extend their research by attending to embodiment and infrastructure. In addition to discussing how such strategies are illustrated in the essays appearing in this special issue, I relate them to the rhetorical study of personal health records (PHRs) as described in consumer-directed arguments. I conclude by posing two questions to health and medical humanists: “How do discursive constructions of publics and more specific instantiations of embodied experiences mutually shape each other?” and “What do the infrastructures of health and medical users look like and involve in their enactment?”     

Parent Training Outcomes Among Young Children with Callous–Unemotional Conduct Problems with or at Risk for Developmental Delay

School-aged children with conduct problems and high levels of callous–unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP + CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to conduct problem (CP) outcomes. To date, little is known about treatment response among young children with CP + CU, particularly those with or at risk for developmental delay. Components of parent–child interaction therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP + CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP + CU are discussed.     

Identification With Video Game Characters as Automatic Shift of Self-Perceptions

Two experiments tested the prediction that video game players identify with the character or role they are assigned, which leads to automatic shifts in implicit self-perceptions. Video game identification, thus, is considered as a kind of altered self-experience. In Study 1 (N = 61), participants either played a first-person shooter game or a racing game. Subsequently, they performed an Implicit Association Test (IAT) designed to detect cognitive associations between character-related concepts and players' self. Findings indicate a stronger automatic association of military-related concepts to shooter players' self and a stronger association of racing-related concepts to racing game players' self. Study 2 (N = 48) replicated the IAT result from Study 1 and demonstrated the stability of the identification pattern. Implications for identification as an element of the video game experience and future research directions are discussed.     

Extending the expanded model of organizational identification to occupations

We extend Kreiner and Ashforth's (2004) research on the expanded model of organizational identification to the occupational level of self. A survey of 251 customer service representatives from an Indian call center indicates that occupational identification, occupational disidentification, ambivalent occupational identification, and neutral occupational identification are empirically differentiable. Further, each form of identification in the expanded model was related to certain predictors from a set of ten situational and individual difference variables, and to certain outcomes from a set of five adjustment variables. The differing patterns of antecedents and outcomes for each form of occupational identification suggest that each form constitutes a relatively unique phenomenon.     

Seeking support: An interpretative phenomenological analysis of an Internet message board for people with Complex Regional Pain Syndrome

In this article, we report on the findings of a qualitative inquiry into how an online message board for people who have Complex Regional Pain Syndrome (CRPS) was used by its members. All messages (and responses) posted on the CRPS message board over a 4-month period were collected retrospectively. The data were analysed using the method of Interpretative Phenomenological Analysis. Members used the message board to seek (and provide) support to those with CRPS, and also to express their emotions, feelings and experiences linked to their condition. The message board provided an important source of support for a patient group that can otherwise become isolated as a result of their mobility problems. Furthermore, the analysis revealed the unrealistic hopes that patients can hold concerning the anticipated outcomes of their treatment. This is an important issue for healthcare professionals to explicitly address when interacting with the patient group.     

Clinical Commentary

Abstract

This paper is the narrative of a first-time father with a son born seven weeks early by Caesarean section. Against the anxiety and trauma of his infant's birth and his wife's illness, another inner darker drama is being relived. Michael shows all the wounds of a battered child. He asks two awesome questions - Will I be to my son as my father was to me? Will my son be to me as I was to my father? Fearful and at first unvoiced questions, the developing interviews gave them a voice. We respected Michael's sharing of the early and fearful days and nights when his infant first came home. We sometimes found it hard to empathize with his running away to hide in work, until we understood what he was hiding from. Most poignant was his struggle with his anger and hurt with his father and his desire to understand, ‘Why?’, so that he would not be like this to his son. We saw a sensitive revelation of life being born inside him anew, as he made contact with his real infant and his psychic infant within. Of particular interest was the therapeutic use of the research interview space and the interviewer.     

Childhood anxiety associated with low BMI in women with Anorexia Nervosa

Objective

Extremely low body mass index (BMI) values are associated with increased risk for death and poor long-term prognosis in individuals with anorexia nervosa (AN). The present study explores childhood personality characteristics that could be associated with the ability to attain an extremely low BMI.

Methods

Participants were 326 women from the Genetics of Anorexia Nervosa (GAN) Study who completed the Structured Interview for Anorexia Nervosa and Bulimic Syndromes and whose mother completed the Child Behavioral Checklist and/or Revised Dimensions of Temperament Survey.

Results

Children who were described as having greater fear or anxiety by their mothers attained lower BMIs during AN (p < 0.02). Path analysis in the GAN and a validation sample, Price Foundation Anorexia Nervosa Trios Study, confirmed the relation between early childhood anxiety, caloric restriction, qualitative food item restriction, excessive exercise, and low BMI. Path analysis also confirmed a relation between childhood anxiety and caloric restriction, which mediated the relation between childhood anxiety and low BMI in the GAN sample only.

Conclusion

Fearful or anxious behavior as a child was associated with the attainment of low BMI in AN and childhood anxiety was associated with caloric restriction. Measures of anxiety and factors associated with anxiety-proneness in childhood may index children at risk for restrictive behaviors and extremely low BMIs in AN.