Helen Flanders Dunbar,John Dewey,and clinical pragmatism: reflections on method in psychosomatic medicine and bioethics

This article outlines the method utilized by physicians and major figures in the founding of Clinical Pastoral Education, Helen Flanders Dunbar, in her work of 1943, Psychosomatic Diagnosis, and relates it to the currently evolving approach in bioethics known as clinical pragmatism. It assesses Dewey's influence on both Dunbar in psychosomatic medicine and clinical pragmatism in bioethics, and illustrates the breadth of influence of the school of philosophical thought known as pragmatism with which Dewey's name and those of William James and Charles Sanders Pierce are most often identified.     

The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

Changes in limb stiffness under conditions of mental stress

In 2 experiments, the effects of mental stress on limb stiffness were investigated. The relative contribution to arm stiffness of individual muscle activity, co-contraction, muscle reflexes, and postural adjustments were examined. In each experiment, participants (N = 24, Experiment 1; N = 16, Experiment 2) held their supinated hand under a tray that they were required to return to horizontal after it had been suddenly released. Electromyographic activity in the biceps and triceps muscles was recorded, as were elbow and wrist angles and tray displacement. In Experiment 1, mental arithmetic stress was shown to lead to decreased tray displacement (i.e., increased resistance) compared with displacements under the control, unstressed condition, as well as to increased elbow flexion before tray release. In Experiment 2, the increased resistance to perturbation caused by mental stress was found to be independent of initial elbow angle, but to vary as a function of the amount of upward force exerted before tray release. The authors conclude that stress-induced increases in limb stiffness result from changes in the initial position of the elbow, specified by its angle, together with the initial force exerted by participants to counteract the mechanical perturbations.     

Industrial buyers' perception of effective selling'

The most fundamental aspect of commerce is interaction between buyers and sellers. Accordingly, the psychological study of selling techniques can be considered as old as trade. This study investigated two categories of selling techniques composed of 17 objection-addressing and 13 sale-dosing strategies. Reported are survey responses from 242 industrial buyers, frequent targets of selling techniques, who were asked to identify which technique from each category they associated with salespersons' effective selling behavior.     

Pastoral Care and Medical Education

This essay describes how contemporary medical education and pastoral care share historical roots, confront similar pressures and objectives in the formation of future professionals, and address common concerns in the area of bioethics. The essay concludes with a summary of ideas regarding the present and future relationship between medical education and pastoral care. The essay is dedicated to the memory of David P. Rogers, M.D., whose vision of medical education and medical practice embodied a rare passion for justice.     

No Right to Resist? Elise Reimarus's Freedom as a Kantian Response to the Problem of Violent Revolt

One of the greatest woman intellectuals of eighteenth‐century Germany is Elise Reimarus, whose contribution to Enlightenment political theory is rarely acknowledged today. Unlike other social contract theorists, Reimarus rejects a people's right to violent resistance or revolution in her philosophical dialogue Freedom (1791). Exploring the arguments in Freedom, this paper observes a number of similarities in the political thought of Elise Reimarus and Immanuel Kant. Both, I suggest, reject violence as an illegitimate response to perceived political injustice in a way that opposes Locke's strong voluntarism and the absolutism of Hobbes. First, they emphasize the need to maintain the legal state as a precondition for the possibility of external right. Second, they share an optimistic view of the inherently “just” nature of the tripartite republican state. And finally, Reimarus and Kant both outline an alternative, nonviolent response to political injustice that consists in the freedom of public expression and a discourse on the moral enlightenment of man.     

In perfect harmony: synchronizing the self to activated social categories

The self-concept is one of the main organizing constructs in the behavioral sciences because it influences how people interpret their environment, the choices they make, whether and how they initiate action, and the pursuit of specific goals. Because belonging to social groups and feeling interconnected is critical to human survival, the authors propose that people spontaneously change their working self-concept so that they are more similar to salient social categories. Specifically, 4 studies investigated whether activating a variety of social categories (i.e., jocks, hippies, the overweight, Blacks, and Asians) increased associations between the self and the target category. Whereas Studies 1 and 2 focused on associations between stereotypic traits and the self, Studies 3 and 4 examined self-perceptions and self-categorizations, respectively. The results provide consistent evidence that following social category priming, people synchronized the self to the activated category. Furthermore, the findings indicate that factors that influence category activation, such as social goals, and factors that induce a focus on the interconnectedness of the self, such as an interdependent vs. independent self-construal, can impact this process. The implications of changes to the working self-concept for intergroup relations are discussed.     

A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.