Is the cerebellum a smith predictor?

The motor system may use internal predictive models of the motor apparatus to achieve better control than would be possible by negative feedback. Several theories have proposed that the cerebellum may form these predictive representations. In this article, we review these theories and try to unify them by reference to an engineering control model known as a Smith Predictor. We suggest that the cerebellum forms two types of internal model. One model is a forward predictive model of the motor apparatus (e.g., limb and muscle), providing a rapid prediction of the sensory consequences of each movement. The second model is of the time delays in the control loop (due to receptor and effector delays, axonal conductances, and cognitive processing delays). This model delays a copy of the rapid prediction so that it can be compared in temporal register with actual sensory feedback from the movement. The result of this comparison is used both to correct for errors in performance and as a training signal to learn the first model. We discuss evidence that the cerebellum could form both of these models and suggest that the cerebellum may hold at least two separate Smith Predictors. One, in the lateral cerebellum, would predict the movement outcome in visual, egocentric, or peripersonal coordinates. Another, in the intermediate cerebellum, would predict the consequences in motor coordinates. Generalization of the Smith Predictor theory is discussed in light of cerebellar involvement in nonmotor control systems, including autonomic functions and cognition.     

The rationing of health care: A doctor's dilemma

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital—Cornell Medical Center in March 1991.The Rev. Curtis W. Hart, M.Div. is Director of Pastoral Care and Education at the New York Hospital—Cornell Medical Center.The Rev. Paul Conner, O.P., is Associate Professor and Director of the Master's Program in Public Health Care Ethics at New York Medical College. Larry Rasmussen, Th.D., is Reinhold Niebuhr Professor of Social Ethics at Union Theological Seminary in New York. Dr. Harlan J. Wechsler is Rabbi of Congregation Or Zarua and Visiting Professor of Philosophy at Jewish Theological Seminary in New York.     

From denial to hope: A systemic response to clergy sexual abuse

This article offers a definition of sexual abuse in the ministerial relationship and describes a systemic approach for intervening that cares for the needs of victims and perpetrators, and provides an opportunity for congregations to move from denial to hope both spiritually and organizationally.He is the author of many articles on organizational structure and Christian social action.     

The imp of the reverse: A phenomenology of the unconscious

The debate regarding the unitary versus multiple nature of the human person is examined with special attention to the division between conscious and unconscious. The roots of the unconscious are traced to the experience of alienation or feeling divided within. An existential analysis is provided in order to shed light on the nature of the unconscious. The experience of feeling divided within is explained as a metaphor that is taken literally. An existential-phenomenological explanation of the unconscious is provided which preserves the essential unity of the human person.     

Transitional phenomena as evidenced in prayer

In this paper, we demonstrate that the study of prayer facilitates understanding of the deeply personal object related nature of religious experience. Within prayer, individuals enter the transitional sphere and meet their God representation. Both conscious and unconscious aspects of prayer can be made available through the use of a projective test developed by the authors, known as STARR: Spiritual Themes and Religious Responses test. The data obtained suggest the usefulness of Winnicottian concepts of transitional phenomena, playing, communicating, and capacity to be alone as a contemporary psychoanalytic framework for interpreting religious experience.     

The mormon health traditions: An evolving view of modern medicine

The Mormon church has long been seen as an unusual group in relation to its health practices. But its health traditions and practices go much further than the ban on tobacco, coffee, and alcohol for which it is so well known. Church teachings and influences pervade the entire Mormon existence. This paper briefly discusses these traditions, first by examining their roots in the teachings of its first two prophet/presidents, Joseph Smith and Brigham Young. Then, how these ideas have evolved into the church's current thought is examined; and finally, the church's responses to many modern-day health care issues are presented.The author wishes to thank Dr. John King at Eastern Virginia Medical School in Norfolk, for his assistance and encouragement.     

What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

Sado-masochism as a defense against merging: Six case studies

This paper reports on several patients who use sado-masochism as a defense against an unconscious wish for and fear of merging. The sado-masochism can be expressed as a sexual perversion or in a difficult ungratifying interpersonal relationship. These relationships have some of the quality of addictions in that the patients have a compulsive need to continue them and find it extremely difficult to leave them. Therapy must focus on helping the patient become more separate, rather than on other problems which may also be present. Initially, the therapist needs to take an educational stance in regard to the process the patient must complete, rather than the more traditional analytic stance.