Case vignette: premature surrender

Three commentaries are offered on the following case: George, age 57, is a previously healthy man who recently underwent surgery for removal of a low-grade malignant thymoma. At the time of admission to the hospital, George stressed to the staff that he had long ago signed a "living will," which he renewed immediately after he learned of his cancer diagnosis. At the time of surgery, the tumor was found to extend into his mediastinum; although it was removable, this required revision of part of the sternum and grafting of the vessels feeding the heart chambers. Because of the resultant tissue damage and neuronal hyperactivity, George experienced postoperative episodes of cardiac arrhythmia and bronchospasm. Unanimous medical opinion was that this situation was a temporary problem that would resolve itself as the tissues healed. Until that time, however, it will be difficult to wean him from ventilatory support. When his stay in the intensive care unit became prolonged, George and his family began to insist that his status be changed to "do not resuscitate" and reminded the staff about his longstanding living will. All of this is happening despite the fact that the patient and family seemingly comprehend that although the short-term interventions are invasive, there is a high probability of a successful outcome. George's cancer prognosis is excellent, and, although he may well have an episode of life-threatening arrhythmia, he is likely to respond to resuscitation interventions. Once the immediate postoperative period is over, his potential for a long and productive life with full capacities is excellent. Consider the following questions: (a) Should George's expressed wishes be respected, or should the staff take additional steps to help him survive the postoperative period, even if that means violating his stated wishes? and (b) What steps might the staff follow in sorting through this problem?     

Synaptic plasticity in the hypoglossal nucleus of female canaries: structural correlates of season, hemisphere, and testosterone treatment

The caudal portion of the hypoglossal nucleus (nXIIts) contains the motor neurons that control the syrinx in songbirds. In canaries, song occurs seasonally, is principally produced by males, and appears to be produced predominantly by muscles on the left side of the syrinx. The present study measures the effect of seasonal change and manipulation of testosterone levels on synapse number and morphology in nXIIts in adult female canaries. We find that synapse density is lower in testosterone-treated birds than in control birds and lower in fall than in spring. The number of vesicles per presynaptic profile increases in the spring as a result of a general increase in this measure in all synapses. The number of vesicles per presynaptic profile also increases with testosterone treatment, primarily due to an increase in the proportion of synapses associated with unusually high vesicle counts. Together, these changes suggest that large reserves of neurotransmitter may be necessary to sustain singing. Several ultrastructural differences between hemispheres are found. Postsynaptic thickenings are longer, and postsynaptic processes are larger on the left side than on the right side. In the spring, there are more vesicles per synapse on the left than on the right, but this lateralization is reversed in the fall. Thus, lateralization of song production is associated with lateral asymmetries in synapse morphology. These hemispheric differences are relatively small, like those seen at the light microscope level, encouraging further consideration of peripheral as well as CNS sources of functional lateralization. The seasonal and testosterone-induced changes in synapse number and morphology may be components of the periodic reorganization of canary vocalization.     

Physical fitness, body image, and locus of control in college freshman men and women

This study examined the relations among physical fitness, body image, and locus of control. The Hall-Physical Fitness Test Profile, the Winstead and Cash Body Self-relations Questionnaire (BSRQ) and the Nowicki-Strickland Locus of Control Scale were administered to 243 freshmen. Women were significantly more positive about their physical appearance than men. Men were more positive about their physical fitness than women. Men were more physically fit than women. Men and women scoring in the internal direction viewed the physical fitness domain of their body image positively. Unlike men, internally oriented women had more positive perceptions of the health aspect of their body image. Physically fit men and women had positive attitudes toward the physical fitness component of their body image. Physically fit men differed from physically fit women in that men were more internal and held more positive attitudes toward the physical health dimension of their body images.     

Relation of cognitive operational performance to comprehension and production of dimensional adjectives

This study compared normal developing children, aged 34 to 51 mo., on comprehension and production of relative dimensional adjectives using object manipulations in a close elicitation procedure and on Piagetian operational tests of conservation of continuous quantity, length, reversibility and seriation. Analysis indicated a significant difference on the expressive language performance of the transitional and the concrete operational children over the preoperational children, but no significant differences occurred between the first two groups. Children who performed better on seriation were significantly better on expressive language performance. Children classified as operational for length performed better on all language measures than those classified as nonoperational. Reversibility and conservation of a continuous quantity did not differentiate children.     

Paranoia and narcissism in psychoanalytic theory. Contributions of self psychology to the theory and therapy of the paranoid disorders

Many factors go into a choice of a therapeutic focus: the patient's psychopathology; the therapist's training, countertransference reactions, and ideological beliefs; and, importantly, a decision about what seems most amenable to treatment and change. As a theory, self psychology describes one aspect of the paranoid process; as such, it is an incomplete theory that complements rather than invalidates more classical theories. As a technique, however, it suggests a style and focus conducive to working with paranoid patients, one that is markedly supportive, nonconfrontational, yet also interpretive. In this context, it must be remembered how difficult it is to treat paranoid patients psychotherapeutically, much less to keep them in treatment. The strategies discussed above do not wholly replace other dynamic approaches (e.g., counterprojective techniques), nor are they universally applicable. Some patients may be more amenable than others. However, the techniques provide a very supportive framework that may help the therapist to be more available to and in contact with the paranoid patient. More broadly, this paper's application of self psychology to the theory and therapy of the paranoid disorders further illustrates the practical utility of this approach. Attention to the narcissistic developmental line, interpersonal selfobject relationships, intrapsychic conflicts and deficits, and empathic immersion in the patients's world are important adjuncts to the psychotherapy of paranoid patients. Rather than an either/or dichotomy, the principle of overdetermination suggests a both/and relationship between self psychology and traditional theory, such that the self psychological approach complements rather than contradicts the classical psychoanalytic theory. The vicissitudes of the self simply add another perspective or vantage point from which to understand and respond to the patient, one which has perhaps more applicability for preoedipally disordered patients.     

Hair mineral analysis: biochemical imbalances and violent criminal behavior

Trace mineral analysis of human hair was utilized to determine whether violent and nonviolent criminals could be differentiated on the basis of concentrations of levels of major and trace minerals. 40 violent and 40 nonviolent inmates from a prison population were selected for study. 27 mineral levels were analyzed and a discriminant function analysis correctly classified 86% of the violent and 78% of the nonviolent inmates. The results lent support to the hypothesis that significantly different levels of trace minerals could be found between the two groups.     

Relationship between two nontraditional procedures for assessing speech-sound discrimination

Test of speech-sound discrimination are used by special educators, reading specialists and speech-language pathologists in assessing children's ability to differentiate between speech sounds occurring in standard English. Such tests are important in determining if speech-sound articulation errors are caused by difficulty in making such differentiations. However, during the past 10 years, these tests have been criticized on the basis of their reliability and validity. The purpose of this study was to examine the use of two alternative methods of assessing speech-sound discrimination with a school-aged population to determine if they elicited responses in a similar manner.     

Magnitude estimates for electrical pulses: evidence for two neural mechanisms

The hypothesis that there are two neural mechanisms for electrocutaneous stimulation--one that is sensitive to low current and is adaptive to repeated stimulation and another that is responsive to high current and is less adaptive--was tested in a control and four main experiments. In the main experiments, magnitude estimates obtained for single electrical pulses (of 2-msec duration) were described by a simple power function for each combination of high- and low-current levels and 10 trial blocks. The results were: (1) The slope of the power function for low current was steeper than was that for high current; (2) for low current, the intercept of the power function decreased with increasing block, whereas for high current, it remained constant over blocks; (3) this decrease of the intercept for low current disappeared when judgmental blocks were separated by a rest period of 8 min; (4) the modulus did not affect the slope; (5) for a large modulus combined with low current, the intercept decreased rapidly over trial blocks, whereas for a small modulus combined with high current, the intercept increased over trial blocks. The first four findings support the two-mechanism hypothesis, but the last one may also be interpretable in terms of the regression to absolute scale values.     

Effects of peripheral circular contours on dynamic spatial orientation

The rod-and-frame effect (RFE) was investigated with the use of a frame that oscillated about an axis at its center at five different frequencies, ranging from .013 to .213 Hz. The resultant RFE shifted continuously with the roll motion of the frame, and it was significantly larger at the lowest frequency (.013 Hz) than under comparable static conditions. The dynamic RFE was lowest at the higher oscillation frequencies. Oscillatory roll vection--apparent self-motion--was reported by 3 of the 9 subjects when the frame was oscillating at its highest frequency (.213 Hz). The subjects yielded large increases in the RFE during the sessions with reports of vection. Surrounding the kinetic frame with a circular contour eliminated all reports of vection and significantly interacted with frequency to reduce the RFE--but only at low frequencies. The reduction amounted to 21.2% averaged over all 9 subjects at the three lowest frequencies. A surrounding contour, therefore, suppressed low-frequency kinetic visual orientation information that might otherwise have produced larger changes in apparent self-orientation and perceived vertical. Vection-sensitive subjects differed from nonvection subjects by exhibiting (1) a high-frequency fall-off in real-motion gain, (2) a high-frequency enhancement in illusory-motion gain, and (3) only a small and nonsignificant increase in illusory-movement phase lag with increases in frequency.